Elevated soluble cellular adhesion molecules are associated with increased mortality in a prospective cohort of renal transplant recipients

Grainne M Connolly,Ian S Young,Ronan Cunningham,Alexander P Maxwell,Peter T Mcnamee

doi:10.1186/1471-2369-12-23

Abstract

BackgroundIncreased plasma levels of cellular adhesion molecules (CAMs) have been shown to be predictors of all cause mortality in individuals with chronic renal failure [1,2] and patients with end-stage renal disease receiving haemodialysis [3]. In renal transplant recipients the predictive value of CAMs has not been well characterised. The aim of this study was to assess the relationship between CAMs and all-cause mortality during prospective follow-up of a renal transplant cohort.MethodsA total of 378 renal transplant recipients were recruited between June 2000 and December 2002. Soluble vascular CAM-1 (VCAM) and soluble intercellular CAM-1 (ICAM) were measured at baseline and prospective follow-up data was collected at a median of 2441 days after enrolment.ResultsIn univariate survival analysis the renal transplant recipients with a VCAM or ICAM concentration in the lowest third were significantly more likely to have survived at follow-up (p < 0.001 and p = 0.009 respectively). In multivariate survival analysis VCAM and ICAM remained significant independent predictors of mortality following adjustment for traditional cardiovascular risk factors, hsCRP and estimated GFR (p = 0.030 and p = 0.037 respectively).ConclusionsThe results of this prospective study are the first to show that the CAMs, ICAM and particularly VCAM, are significant independent predictors of mortality in patients with a renal transplant.

Highlights

Increased plasma levels of cellular adhesion molecules (CAMs) have been shown to be predictors of all cause mortality in individuals with chronic renal failure [1,2] and patients with end-stage renal disease receiving haemodialysis [3]
The predictive value of CAMs has not been well defined in renal transplant recipients
243 (64%) were male, 72 (19%) were smokers and 54 (14%) had diabetes. 12 (3%) participants had received a pre-emptive renal transplant and 366 (97%) participants had been on dialysis prior to renal transplantation

Summary

Introduction

Increased plasma levels of cellular adhesion molecules (CAMs) have been shown to be predictors of all cause mortality in individuals with chronic renal failure [1,2] and patients with end-stage renal disease receiving haemodialysis [3]. Soluble cellular adhesion molecules (CAMs) represent promising biomarkers that may reflect underlying endothelial activation and vascular inflammation [9]. Many factors have been shown to alter expression of cellular adhesion molecules. These include hypertension [10] immunosuppressive therapy [11], autoimmune disease [11,12,13] and cell mediated allograft rejection [14,15]

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