Pretransplant systemic inflammation and acute rejection after renal transplantation

Richard V Perez, David J. Brown, Steven A. Katznelson, Joel A. Dubin, Hans Georg Müller, Tammy Chang, Steven M. Rudich, John McVicar, George Kaysen

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background. There are presently no established pretransplant tests that consistently identify patients who may be at increased risk for acute rejection episodes after renal transplantation. We studied whether pretransplant serum levels of C-reactive protein (CRP), a marker for the presence of systemic inflammation, would predict the occurrence of acute rejection episodes after renal transplantation. Methods. Pretransplant serum was tested for CRP level in 97 consecutive renal transplant recipients. Time to acute rejection after transplantation was stratified by CRP level and compared using the Kaplan-Meier method. In addition, Cox regression multivariate analysis was performed to assess whether any pretransplant covariates could independently predict the subsequent occurrence of acute rejection episodes. Results. Pretransplant mean CRP levels were higher in patients who subsequently had a rejection episode versus those who had no rejection (22.2±2.9 vs. 11.7±1.8 μg/ml, respectively, P=0.003). Patients less than the median CRP value had a significantly longer time to rejection compared to those with higher CRP levels (P=0.002). Similarly, patients within the lowest CRP quartile had longer times to rejection when compared with the highest quartile (P=0.006). Cox proportional hazards regression multivariate analysis identified CRP level as the only independent pretransplant risk factor for rejection identified (P=0.044). Conclusions. Pretransplant systemic inflammation as manifested by elevated serum CRP level independently predicts the risk of acute rejection after renal transplantation and may be useful in stratifying patients at the time of transplantation according to immunological risk. Thus, assessment of pretransplant systemic inflammatory status may be helpful in prospective individualization of immunosuppression therapy after renal transplantation.

Original languageEnglish (US)
Pages (from-to)869-874
Number of pages6
JournalTransplantation
Volume69
Issue number5
StatePublished - Mar 15 2000

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C-Reactive Protein
Kidney Transplantation
Inflammation
Multivariate Analysis
Regression Analysis
Graft Rejection
Serum
Immunosuppression
Blood Proteins
Transplantation
Kidney

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Perez, R. V., Brown, D. J., Katznelson, S. A., Dubin, J. A., Müller, H. G., Chang, T., ... Kaysen, G. (2000). Pretransplant systemic inflammation and acute rejection after renal transplantation. Transplantation, 69(5), 869-874.

Pretransplant systemic inflammation and acute rejection after renal transplantation. / Perez, Richard V; Brown, David J.; Katznelson, Steven A.; Dubin, Joel A.; Müller, Hans Georg; Chang, Tammy; Rudich, Steven M.; McVicar, John; Kaysen, George.

In: Transplantation, Vol. 69, No. 5, 15.03.2000, p. 869-874.

Research output: Contribution to journalArticle

Perez, RV, Brown, DJ, Katznelson, SA, Dubin, JA, Müller, HG, Chang, T, Rudich, SM, McVicar, J & Kaysen, G 2000, 'Pretransplant systemic inflammation and acute rejection after renal transplantation', Transplantation, vol. 69, no. 5, pp. 869-874.
Perez RV, Brown DJ, Katznelson SA, Dubin JA, Müller HG, Chang T et al. Pretransplant systemic inflammation and acute rejection after renal transplantation. Transplantation. 2000 Mar 15;69(5):869-874.
Perez, Richard V ; Brown, David J. ; Katznelson, Steven A. ; Dubin, Joel A. ; Müller, Hans Georg ; Chang, Tammy ; Rudich, Steven M. ; McVicar, John ; Kaysen, George. / Pretransplant systemic inflammation and acute rejection after renal transplantation. In: Transplantation. 2000 ; Vol. 69, No. 5. pp. 869-874.
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abstract = "Background. There are presently no established pretransplant tests that consistently identify patients who may be at increased risk for acute rejection episodes after renal transplantation. We studied whether pretransplant serum levels of C-reactive protein (CRP), a marker for the presence of systemic inflammation, would predict the occurrence of acute rejection episodes after renal transplantation. Methods. Pretransplant serum was tested for CRP level in 97 consecutive renal transplant recipients. Time to acute rejection after transplantation was stratified by CRP level and compared using the Kaplan-Meier method. In addition, Cox regression multivariate analysis was performed to assess whether any pretransplant covariates could independently predict the subsequent occurrence of acute rejection episodes. Results. Pretransplant mean CRP levels were higher in patients who subsequently had a rejection episode versus those who had no rejection (22.2±2.9 vs. 11.7±1.8 μg/ml, respectively, P=0.003). Patients less than the median CRP value had a significantly longer time to rejection compared to those with higher CRP levels (P=0.002). Similarly, patients within the lowest CRP quartile had longer times to rejection when compared with the highest quartile (P=0.006). Cox proportional hazards regression multivariate analysis identified CRP level as the only independent pretransplant risk factor for rejection identified (P=0.044). Conclusions. Pretransplant systemic inflammation as manifested by elevated serum CRP level independently predicts the risk of acute rejection after renal transplantation and may be useful in stratifying patients at the time of transplantation according to immunological risk. Thus, assessment of pretransplant systemic inflammatory status may be helpful in prospective individualization of immunosuppression therapy after renal transplantation.",
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AU - Katznelson, Steven A.

AU - Dubin, Joel A.

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AU - Chang, Tammy

AU - Rudich, Steven M.

AU - McVicar, John

AU - Kaysen, George

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N2 - Background. There are presently no established pretransplant tests that consistently identify patients who may be at increased risk for acute rejection episodes after renal transplantation. We studied whether pretransplant serum levels of C-reactive protein (CRP), a marker for the presence of systemic inflammation, would predict the occurrence of acute rejection episodes after renal transplantation. Methods. Pretransplant serum was tested for CRP level in 97 consecutive renal transplant recipients. Time to acute rejection after transplantation was stratified by CRP level and compared using the Kaplan-Meier method. In addition, Cox regression multivariate analysis was performed to assess whether any pretransplant covariates could independently predict the subsequent occurrence of acute rejection episodes. Results. Pretransplant mean CRP levels were higher in patients who subsequently had a rejection episode versus those who had no rejection (22.2±2.9 vs. 11.7±1.8 μg/ml, respectively, P=0.003). Patients less than the median CRP value had a significantly longer time to rejection compared to those with higher CRP levels (P=0.002). Similarly, patients within the lowest CRP quartile had longer times to rejection when compared with the highest quartile (P=0.006). Cox proportional hazards regression multivariate analysis identified CRP level as the only independent pretransplant risk factor for rejection identified (P=0.044). Conclusions. Pretransplant systemic inflammation as manifested by elevated serum CRP level independently predicts the risk of acute rejection after renal transplantation and may be useful in stratifying patients at the time of transplantation according to immunological risk. Thus, assessment of pretransplant systemic inflammatory status may be helpful in prospective individualization of immunosuppression therapy after renal transplantation.

AB - Background. There are presently no established pretransplant tests that consistently identify patients who may be at increased risk for acute rejection episodes after renal transplantation. We studied whether pretransplant serum levels of C-reactive protein (CRP), a marker for the presence of systemic inflammation, would predict the occurrence of acute rejection episodes after renal transplantation. Methods. Pretransplant serum was tested for CRP level in 97 consecutive renal transplant recipients. Time to acute rejection after transplantation was stratified by CRP level and compared using the Kaplan-Meier method. In addition, Cox regression multivariate analysis was performed to assess whether any pretransplant covariates could independently predict the subsequent occurrence of acute rejection episodes. Results. Pretransplant mean CRP levels were higher in patients who subsequently had a rejection episode versus those who had no rejection (22.2±2.9 vs. 11.7±1.8 μg/ml, respectively, P=0.003). Patients less than the median CRP value had a significantly longer time to rejection compared to those with higher CRP levels (P=0.002). Similarly, patients within the lowest CRP quartile had longer times to rejection when compared with the highest quartile (P=0.006). Cox proportional hazards regression multivariate analysis identified CRP level as the only independent pretransplant risk factor for rejection identified (P=0.044). Conclusions. Pretransplant systemic inflammation as manifested by elevated serum CRP level independently predicts the risk of acute rejection after renal transplantation and may be useful in stratifying patients at the time of transplantation according to immunological risk. Thus, assessment of pretransplant systemic inflammatory status may be helpful in prospective individualization of immunosuppression therapy after renal transplantation.

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