PRE-TRANSPLANT SYSTEMIC INFLAMMATION PREDICTS ACUTE REJECTION AFTER RENAL TRANSPLANTATION

Abstract

564 Background: There are no pre-transplant tests which consistently identify patients who are at increased risk for acute rejection episodes. Thus, immunosuppression is often dosed by uniform protocol resulting in some patients suffering the complications of either insufficient or excessive immunosuppression. Hypothesis: Elevated pre-transplant serum C-reactive protein(CRP), a marker of systemic inflammation may predict those patients at increased risk for the occurrence of an acute rejection episode after renal transplantation. Methods: Pre-transplant serum CRP levels were measured in 97 consecutive renal transplant patients. The post-transplant clinical course was retrospectively reviewed and multivariate analysis performed to assess whether a relationship existed between pre-transplant CRP and the subsequent incidence of and time to biopsy proven acute rejection episodes. Results: Pre-transplant CRP ranged from 0 to 60μg/ml (median 9, mean 14.5±1.6) and was non-normally distributed, skewed toward the lower values. Mean pre-transplant CRP was higher in patients who had a rejection episode within 6 months post-transplant versus those with no rejection (22.2±2.9 vs 11.7±1.8, respectively,P<.003, Wilcoxon/Kruskal-Wallis Test). Patients in the quartile with the highest CRP levels had an increased incidence of rejection compared to all other quartiles (Fisher's Exact Test). TableCox regression analysis showed that among 12 covariates tested, CRP was the only pre-transplant risk factor that predicted rejection, even when donor source, panel reactive antibody and HLA match are considered.TableConclusions: Pre-transplant CRP independently predicts the risk of acute rejection after renal transplantation and may be useful in stratifying patients by immunologic risk. Thus, pre-transplant CRP may be helpful in prospective individualization of immunosuppression therapy in renal transplantation.