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Association between baseline serum hepcidin levels and infection in kidney transplant recipients: Potential role for iron overload
Author(s) -
FernándezRuiz Mario,
Parra Patricia,
RuizMerlo Tamara,
LópezMedrano Francisco,
San Juan Rafael,
Polanco Natalia,
González Esther,
Andrés Amado,
Aguado José María
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12807
Subject(s) - hepcidin , medicine , hazard ratio , gastroenterology , confidence interval , incidence (geometry) , ferritin , biomarker , kidney transplantation , transplantation , immunology , anemia , biology , biochemistry , physics , optics
Background The liver‐synthesized peptide hepcidin is a key regulator of iron metabolism and correlates with total iron stores. We analyzed the association between pre‐transplant hepcidin‐25 levels and infection after kidney transplantation ( KT ). Methods Serum hepcidin‐25 levels were measured at baseline by high‐sensitivity ELISA in 91 patients undergoing KT at our institution between December 2011 and March 2013. The impact of this biomarker on the incidence of post‐transplant infection (excluding lower urinary tract infection) during the first year was assessed by Cox regression. Results Mean hepcidin‐25 level was 82.3 ± 67.4 ng/mL and strongly correlated with serum ferritin (Spearman's rho = 0.703; P < .001). There were no significant differences in hepcidin‐25 levels between patients with or without overall infection (96.4 ± 67.5 vs 72.6 ± 66.7 ng/mL; P = .101). Such difference was evident for opportunistic (128.9 ± 75.0 vs 73.0 ± 62.3 ng/mL; P = .003) and, to a lesser extent, surgical‐site infection (107.5 ± 73.3 vs 76.5 ± 65.2 ng/mL; P = .087). Patients with hepcidin‐25 levels ≥72.5 ng/mL had higher 12‐month cumulative incidence of overall infection (51.2% vs 29.2%; P = .032). After multivariate adjustment, hepcidin‐25 ≥72.5 ng/mL acted as an independent risk factor for overall (adjusted hazard ratio [ aHR ] 3.86; 95% confidence interval [ CI ] 1.49‐9.96; P = .005) and opportunistic infection ( aHR 4.32; 95% CI 1.18‐15.75; P = .027). Conclusion Elevated baseline serum hepcidin‐25 levels were associated with increased risk of infection after KT , suggesting a role for iron overload in the individual susceptibility to post‐transplant infection.