INCREASED LEVELS OF ALPHA-2,6-SIALYLTRANSFERASE PRE-TRANSPLANT PREDICT DELAYED GRAFT FUNCTION IN KIDNEY TRANSPLANTS.

Abstract

594 Sialyltransferase is an acute phase reactant whose release from cells can be induced by pro-inflammatory cytokines. The importance of changes in the level of sialyltransferase activity may lie in its regulatory effects on cellular adhesion molecules, in particular in ischemia reperfusion injury through neutrophil adherence to endothelium. Patients with chronic renal failure have high circulating levels of pro-inflammatory cytokines. We hypothesized therefore that patients on the renal transplant waiting list would have high levels of sialyltransferase. High levels of sialyltransferase might adversely affect post-transplant (Tx) events, particularly the development of delayed graft function (DGF). Levels of sialyltransferase were measured in serum samples taken immediately pre-Tx in 70 patients. The mean serum level of sialyltransferase(3162±97 units/ml) was significantly higher than in 19 controls(2569±125 units/ml; p<0.003). We found that patients who required dialysis post-Tx for treatment of DGF (n=20) had significantly higher levels of sialyltransferase pre-Tx (3735±228 units/ml) than patients (n=50) who did not require dialysis (2933±83 units/ml; p< 0.0001). Sialyltransferase activity was also correlated (r= 0.48; p<0.02) with the total prednisone requirement of patients in the first month post-Tx. Using stepwise logistic regression we found that sialyltransferase levels correlated with the length of time on dialysis (r=0.28; p<0.03), were significantly higher in patients with previously failed transplants(3877±345 vs 3095±98; p< 0.02), and in patients whose original cause of renal failure was glomerulonephritis (3294±140 units/ml vs 2966±197; p<0.005). Conclusions: These data suggest that high sialytransferase activity pre-transplant may be a risk factor for the development of DGF. As DGF is a major predictor of long-term graft outcome, an understanding of the cause of DGF and possible contribution of sialyltransferase to this event is important. The assessment and perhaps modulation of a potential transplant recipient's systemic sialyltransferase level may be beneficial.