Open AccessIncreasing urinary IL‐6 levels announce kidney graft rejection *
Author(s) -
Kaden J.,
Priesterjahn R.
Publication year - 2000
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2000.tb02055.x
Subject(s) - medicine , methylprednisolone , immunosuppression , urinary system , urology , azathioprine , gastroenterology , transplantation , kidney transplantation , urine , kidney , clinical significance , bolus (digestion) , disease
Acute rejection (AR) is the recipient's inflammatory response to the grafted organ. Within the graft‐infiltrating cells, a high ratio of IL‐6 producing cells can be found, indicating local IL‐6 production. Therefore, in cases of kidney transplantation, urinary (u) IL‐6 should be detectable. In order to establish the dynamics and diagnostic relevance, uIL‐6 levels were determined daily by Quantikine IL‐6 immunoassay (R&D Systems, Minneapolis, Minn.) in 101 kidney graft recipients ( n = 1915 urine samples) during their post‐transplant hospital stay. Immunosuppression consisted of azathioprine, steroids, cyclosporine and an intraoperative high‐dose single antithymocyte globulin (ATG)‐Fresenius bolus (9 mg/kg). In all the uncomplicated courses ( n = 31) mean uIL‐6 level was determined, after a post‐transplant peak of 174 pg/ml, to be between 4 and 8 pg/ml. In contrast, delayed graft function ( n = 16) was always associated with very high uIL‐6 levels (> 200 pg/ml), dropping down only with commencement of graft function. Steroid‐sensitive AR ( n = 14) was consistently associated with significantly increasing uIL‐6 levels prior to antirejection therapy (from 23 to 82 pg/ml). In cases of steroid‐resistant AR, following anti‐rejection therapy with methylprednisolone (5 days 5 mg/kg), there was no obvious trend towards normalization, indicating the persistence of inflammation (mean uIL‐6 peak prior to OKT3 or ATG therapy: 99 pg/ml). In addition, AR‐associated uIL‐6 levels were found to be of much greater diagnostic relevance than AR‐associated serum IL‐6 levels. In bacterial urinary tract infections ( n = 20), increased uIL‐6 levels (peak 53 pg/ml) coincided with the commencement of antibiotic therapy. In mild cytomegalovirus diseases ( n = 8), the development of leukocytopenia was associated with a slight increase of uIL‐6 (peak 26 pg/ml), showing graft involvement. All increased uIL‐6 values returned towards baseline after successful treatment. Thus, uIL‐6 provides information about the intragraft inflammatory situation. Its determination is simple, expressive, non‐invasive and can be recommended.