Risk factors of acute rejection in sensitized kidney transplant recipients

Abstract

Abstract: Objective To identify the risk factors of acute rejection in sensitized recipients undergoing kidney transplantation.Methods The clinical data of 102 sensitized kidney transplant recipients were retrospectively analyzed to evaluate the incidence of acute rejection in relation to panel reactive antibodies (PRA),amino acid residual match,postoperative elevation of PRA level and cytokine genotypes. Results During the follow-up,acute rejection occurred in totally 33 patients,and the incidence was higher in the recipients with high tumor necrosis factor (TNF)-α or high interleukin (IL)-10 producer genotype than in those with low TNF-α or low/intermediate IL-10 producer genotype (53.1%,55.0%vs22.8%,20.9%,P<0.01 respectively). Acute rejection was even more frequent in the recipients with both high TNF-α and high/intermediate IL-10 producer genotypes than in those with low TNF-α and IL-10 producer genotype (66.7%vs10.2%,P<0.01). No relations were found between TGF-β1,IL-6,IFN-γ gene polymorphisms and the incidence of acute rejection. The incidence in the recipients with PRA level of more than 40% was also higher than those with lower PRA level (<20%,53.3%vs22.7%,P<0.05),and the amino acid residual mismatch with 3-4 MM was responsible for a higher incidence in comparison with a mismatch with 0-1 MM (75.0%vs24.1%,P<0.01). Postoperative elevation of PRA level also increased the risk of acute rejection (45.4%vs22.4%,P<0.01).Conclusion TNF-α,IL-10 gene polymorphism,PRA,amino acid residual mismatch,and increased postoperative PRA level may significantly influence acute rejection in sensitized kidney transplantation recipient,and preoperative evaluation of these factors may benefit the designing of immunosuppressive protocols for these patients.

CLC Number:

HUANG Xian-en¹, FAN Li-pei¹, LI Liu-yang¹, ZHAO Ming¹, XIA Sui-sheng². Risk factors of acute rejection in sensitized kidney transplant recipients[J]. Journal of Southern Medical University, 2004, 24(10): 1188-1191.

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