P1764EXPRESSION OF TOLL-LIKE RECEPTOR 4, BUT NOT THE TOLL-LIKE RECEPTOR 2, MAY BE USEFUL I ASSESING THE RISK OF RENAL TRANSPLANT DETERIORATION IN RECIPIENTS WHO HAVE RECOVERED FROM CYTOMEGALOVIRUS INFECTION

Abstract

Abstract Background and Aims Data binding the expression of Toll-like (TLR) 4 receptor (TLR4ex), or TLR2 receptor (TLR2ex) and transplanted kidney (KT) function and symptomatic infections with CMV (CMV+) and are scarcely available. Objective: To investigate the relationships between TLR4ex and TLR2ex, a relapse of CMV+ and transplant function. Method Materials and methods: TLR4ex and TLR2ex were measured in peripheral blood mononuclear cells of KT recipients. We compared TLR4ex and TLR2ex among 25 CMV+ patients; 81 patients without CMV infection (CMVn). At the beginning (Day-0) TLR4ex, as well as concentrations of cyclosporin A (CyA) and tacrolimus (TAC) were determined. Both CMV+ and CMVn patients were divided according to the respective median of TLR4ex into groups of low-TLR2/4 expression (L-TLR2/4ex) and high-TLR2/4 expression (H-TLR2/4ex). Glomerular filtration rate (EGFR) was assessed on Day-0 and after the follow-up (F-up). The magnitudes of EGFR change (ΔEGFR) were evaluated. Stable treatment along the F-up period (median 11.9 months) was applied. Results Results. In CMV+ TLR2ex of 64,3% and TLR4ex in 67% is below respective median. Past CMV strongly affected TLR2ex and moderately TLR4ex. On Day-0: in CMV+ we found no link of TLR2 ex and TLR4ex with EGFR; In CMV+ TLR2ex and TLR4ex were lower but Day-0 EGFR did not differ from H-TLR2 or H-TLR4ex. In CMVn: GFR-TLR4ex link was present with no similar in case of GFR-TLR2ex. In patients treated with tacrolimus CMV strongly affected TLR4ex, blurring CMV+/CMVn differences. Post F-up: in CMV+ with L-TLR4ex EGFR declined, there was no change of EGFR in H-TLR4ex; L/H-TLR2ex showed no differences in EGFR. In CMVn with H-TLR4ex EGFR rose, there was no change in L-TLR4ex. In case of TLR2ex we showed no similar differences. Regression analysis points out the impact of CMV+ and TLR4ex on eGFR and ΔEGFR. No similar impact of CMV+ and TLR2ex on eEGFR and ΔEGFR was found. Conclusion Conclusion: In the group who had a symptomatic CMV + infection, low TLR4 expression increases the risk of worsening EGFR. In CMVn, high TLR4 expression increases the chance of EGFR improvement. Historic CMV + strongly affects TLR2ex. However, TLR2ex cannot be used as a factor in assessing the risk of EGFR deterioration.