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Macrophage activation is associated with poorer long‐term outcomes in renal transplant patients
Author(s) -
Grebe Scott O.,
Kuhlmann Uwe,
Fogl Dominik,
Luyckx Valerie A.,
Mueller Thomas F.
Publication year - 2010
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2010.01345.x
Subject(s) - medicine , neopterin , dialysis , transplantation , gastroenterology , kidney transplantation , inflammation , c reactive protein , kidney disease , hemodialysis , immunology , surgery
Grebe SO, Kuhlmann U, Fogl D, Luyckx VA, Mueller TF. Macrophage activation is associated with poorer long‐term outcomes in renal transplant patients.
Clin Transplant 2011: 25: 744–754. © 2010 John Wiley & Sons A/S. Abstract: Long‐term graft and patient survival after renal transplantation are largely determined by progression of chronic allograft dysfunction and cardiovascular disease. Inflammation plays a crucial role in both disease processes. We prospectively analyzed the association of early peri‐transplant inflammatory burden on long‐term outcomes in 144 consecutive deceased donor renal allograft recipients. Single time point and cumulative levels of markers of acute phase response (serum amyloid A [SAA] and C‐reactive protein [SCRP]) and macrophage activation (serum and urine neopterin) were measured daily during the immediate post‐operative period. Mean patient follow‐up was 16 yr. Graft and patient survival rates at one‐, five‐, and 10‐yr were 90%, 70%, and 51%, and 97%, 77%, and 59%, respectively. Graft loss occurred in 90 patients, of whom 71 died with a functioning graft and 19 returned to dialysis. CRP, SAA and neopterin (NEOP) levels were all elevated post‐operatively. High levels of NEOP, in contrast to SAA or SCRP, were associated with poorer graft and patient survival (p < 0.05), specifically with death from cardiovascular events and cytomegalovirus IgG positivity. These findings strongly suggest that early post‐transplant macrophage activation, as reflected by NEOP levels, is associated with poorer long‐term graft and patient survival.