Kovac J, Arnol M, Vidan-Jeras B, Bren A F, Kandus A
Department of Nephrology, University Medical Centre, Ljubljana, Slovenia.
Transplant Proc. 2008 Jun;40(5):1357-61. doi: 10.1016/j.transproceed.2008.03.092.
Elevated serum concentrations of soluble CD30 molecule (sCD30) have been related to acute cellular rejection and poor graft outcomes in kidney transplantation. This historical cohort study investigated the association of pretransplant sCD30 serum concentrations with kidney graft function expressed as estimated glomerular filtration rate (GFR) at 3 years after transplantation. Pretransplant sera from 176 adult deceased-donor kidney graft recipients were tested for sCD30 content using a commercially available automated enzyme-linked immunosorbent assay. The immunosuppression consisted of induction therapy with monoclonal anti-CD25 antibodies and a maintenance regimen of cyclosporine (CsA)-based therapy. GFR was estimated (eGFR) by the four-variable Modification of Diet in Renal Disease (MDRD) Study equation. According to the distribution of pretransplant sCD30 levels (median 66.7 U/mL; interquartile range, 46.6 to 98.6 U/mL), a concentration of 66 U/mL or higher was defined as high (n = 89) and below 66 U/mL as low (n = 87). Three years after transplantation, eGFR was not significantly different among recipients in high versus low sCD30 groups (69 +/- 23 mL/min/1.73m2 vs 66 +/- 21 mL/min/1.73m2; P = .327) and there was no correlation between eGFR and pretransplant sCD30 levels (r2 = 0.001; P = .73). Upon multivariate regression analysis, donor age, recipient body mass index at transplantation, and acute rejection episodes were independent variables affecting eGFR at 3 years after transplantation. This study showed that pretransplant sCD30 serum concentrations were not associated with deceased-donor kidney graft function at 3 years after transplantation. The immunosuppression with anti-CD25 antibodies and a triple CsA-based maintenance regimen could possibly be decisive for our findings.
血清可溶性CD30分子(sCD30)浓度升高与肾移植中的急性细胞排斥反应及不良移植结局相关。这项历史性队列研究调查了移植前sCD30血清浓度与移植后3年以估计肾小球滤过率(GFR)表示的肾移植功能之间的关联。使用市售的自动化酶联免疫吸附测定法检测了176例成年尸体供肾移植受者移植前血清中的sCD30含量。免疫抑制包括使用单克隆抗CD25抗体进行诱导治疗以及基于环孢素(CsA)的维持治疗方案。采用四变量肾脏疾病饮食改良(MDRD)研究方程估算肾小球滤过率(eGFR)。根据移植前sCD30水平的分布(中位数为66.7 U/mL;四分位间距为46.6至98.6 U/mL),将浓度66 U/mL及以上定义为高水平(n = 89),低于66 U/mL定义为低水平(n = 87)。移植后3年,sCD30高水平组与低水平组受者的eGFR无显著差异(69±23 mL/min/1.73m² 对 66±21 mL/min/1.73m²;P = 0.327),且eGFR与移植前sCD30水平之间无相关性(r² = 0.001;P = 0.73)。多因素回归分析显示,供体年龄、移植时受者体重指数和急性排斥反应发作是影响移植后3年eGFR的独立变量。该研究表明,移植前sCD30血清浓度与移植后3年尸体供肾移植功能无关。使用抗CD25抗体及基于CsA的三联维持治疗方案的免疫抑制可能是造成我们研究结果的决定性因素。