| IntroductionRenal transplantation has now been the choice of treatment for the patients with end-stage renal disease. Although the development of operation skills and induction of novel immunosuppressant greatly improved the recipient/graft long-term survival, acute rejection is still a major complication after renal transplantation. The overall incidence of acute rejection varied from 10% to 50% within the first 6 months. Chronic rejection is the most prevalent cause of late renal transplant failure, with acute rejection one of its most important risk factors. So identifying the individuals at high risk of graft loss before transplantation is very important to both clinician and recipients. In current clinical practice, PRA is the only established immunological parameter that provides clinically useful information concerning the responder status of the cadaver kidney recipients. The high PRA was correlated with rejection and graft failure. Though some recipients' PRAwere negative before transplantation, they still developed acute rejections. So how can we identify such recipients into high or low immunologic risk? Susal et al tested pre-transplant serum sCD30 concentrations of 3899 cadaver kidney recipients and found high sCD30 was associated with graft loss and more rejection treatments. Interestingly when compared PRA with sCD30, it seemed sCD30 was more relevant to the long-term survival of grafts. Unfortunately they did not discuss patients with high sCD30 were more prone to which rejection, vascular or cellular-type rejection, and what factors would affect the pre-transplant sCD30 value. The purpose of this study was to investigate the relationship between sCD30 and recipient/graft long-term survival, rejection type as well as other prognostic factors in chinenese kidney transplant recipients.Materials and methods1. Clinical dataA retrospective cohort of 707 patients who underwent cadaver renal transplants between Dec. 1998 and Aug 2003 was studied. Information on graft, function and patient survival was documented every month. Patients were followed to death, return to dialysis or Mar.2004. The average follow-up was 29.18 17.87 months (1-63 months) .2. Blood samples and testingBlood samples were centrifuged and plasma was separated from cells, collected and stored at - 80 until tested. Plasmalevels of sCD30 were determined by ELISA assay.3. Detection of C4d and C3dThe deposition in the PTC of the complement degradation products C4d and C3d were detected in 60 patients with histologic changes of acute rejection by using immunohistochemical technique.4. Statistical analysisFor statistical analysis, SPSS for windows vision 10.0 was used.A P value <0.05 was considered statistically significant.Results1. Kidney graft recipients had a significant higher serum sCD30 content before transplantation than adult healthy controls(145. 18 66. 59 U/ml vs. 35. 62 12. 84 U/ml, p<0. 001).2. The incidences of different type of rejection episodes increased along the value of sCD30. The sCD30 values of vascular rejection cellular rejection board-line and clinical rejection groups were 198. 95 76. 09, 165. 89 44. 56, 172. 94 74. 22 and 161.23 64.87 U/ml, which were all significant higher than that of the non-rejection groups(p alL <0. 001). There were no statistical differences of sCD30 values between the C4d or C3d positive and negative groups (P=0. 193 and 0.117 respectively). The complete inversion of rejection rates in 3 groups were 100%, 90.6%and 78.6%.The high group was significantly lower than the low and intermediate groups(p all<0.05).3. sCD30 PRA and CMV Ag are the risk factors for acute rejection, with the odd ratio of 2.683, 2.384, 2.065 respectively.4. The 5-year graft survival/functional rates of the high sCD30 group were 77.73 3.48%/84.99 3.20%,which were significantly lower than the low and the intermediate groups, which are 84. 68 2. 13%/98. 86 1. 14% and 88.10 2.86%/95.09 ?1.64% respectively. The 5-year recip...
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