POST‐TRANSPLANT C‐REACTIVE PROTEIN MONITORING PREDICTS CHRONIC REJECTION AND RENAL ALLOGRAFT SURVIVAL

Abstract

Chronic allograft nephropathy (CAN) is a major problem after renal transplantation, and chronic inflammation is an important element of this condition. C‐reactive protein (CRP) is an important marker of inflammation and atherosclerosis. This retrospective study analyzed the value of post‐transplantation CRP monitoring in the prediction of CAN and graft failure in kidney transplantation.The study included 125 renal transplant patients whose CRP levels were in the normal range (<10 mg/l) at the time of transplantation. Serum CRP levels before transplantation, at 1 month and at 1 year post‐transplantation, at the time of CAN diagnosis, and the mean level throughout follow up in patients without CAN were recorded. The CRP findings were compared in patients grouped according to whether or not they developed CAN. Chronic rejection was diagnosed in 40.8% of the patients, and 82.4% of this group progressed to graft failure at a mean of 45.8±30.4 months after the diagnosis of CAN. When the group CRP results were compared, the levels before transplantation were similar, but at 1 month post‐transplantation the levels in the group with CAN were significantly higher (P<0.04). The mean CRP level at 1 year was also higher in the CAN group, but this difference was not significant. The mean level at the time of the CAN diagnosis was significantly higher than the mean level during follow up in the group without CAN (P<0.01). Thus, the CRP levels were significantly higher in CAN group than in the group without CAN at two of the timepoints tested: immediately after transplantation and at the time of CAN diagnosis. Regression analysis showed that the high CRP level at 1 month post‐transplantation and at the time of the CAN diagnosis significantly influenced the allograft failure (P<0.005 and P<0.01, respectively).In conclusion, post‐transplantation CRP monitoring provides important information concerning the risks of CAN and graft failure. Testing of CRP levels should be part of the follow‐up assessment after renal transplantation.