Smedbråten J, Sagedal S, Åsberg A, Hartmann A, Rollag H, Mjøen G, Fagerland M W, Hansen S W K, Mollnes T E, Thiel S
Department of Nephrology, Ullevål Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Am J Transplant. 2017 Jan;17(1):265-271. doi: 10.1111/ajt.13933. Epub 2016 Jul 25.
Kidney transplanted patients still have significantly higher mortality compared with the general population. The innate immune system may play an important role during periods, with suppression of the adaptive immune system. In the present study, two soluble pattern recognition molecules of the innate immune system were investigated, collectin liver 1 (CL-L1) and collectin kidney 1 (CL-K1). Potential associations of their pretransplant levels and long-term graft and recipient survival were examined. The levels of CL-L1 and CL-K1 were measured at the time of transplantation in 382 patients (≥17 years) transplanted in 2000-2001. The cohort was subsequently followed until December 31, 2014. Data on patient and graft survival were obtained from the Norwegian Renal Registry. Both high CL-L1 (≥376 ng/mL) and high CL-K1 (≥304 ng/mL) levels were significantly associated with overall mortality in multivariate Cox analyses with hazard ration (HR) 1.50, 95% confidence interval (CI) 1.09-2.07, p = 0.013 and HR 1.43, 95% CI 1.02-1.99, p = 0.038, respectively. Moreover, high CL-K1 levels were significantly associated with cardiovascular mortality. No association between measured biomarkers and death-censored graft loss was found. Finally, there was a significant correlation between these two collectins, r = 0.83 (95% CI 0.80-0.86). In conclusion, CL-L1 and CL-K1 were significantly associated with mortality in kidney transplant recipients.
与普通人群相比,肾移植患者的死亡率仍然显著更高。在适应性免疫系统受到抑制的时期,先天性免疫系统可能发挥重要作用。在本研究中,对先天性免疫系统的两种可溶性模式识别分子进行了研究,即肝脏凝集素1(CL-L1)和肾脏凝集素1(CL-K1)。研究了它们移植前水平与长期移植物和受者存活之间的潜在关联。在2000 - 2001年接受移植的382例(≥17岁)患者移植时测量了CL-L1和CL-K1的水平。随后对该队列进行随访直至2014年12月31日。患者和移植物存活数据来自挪威肾脏登记处。在多变量Cox分析中,高CL-L1(≥376 ng/mL)和高CL-K1(≥304 ng/mL)水平均与总死亡率显著相关,风险比(HR)分别为1.50,95%置信区间(CI)1.09 - 2.07,p = 0.013和HR 1.43,95% CI 1.02 - 1.99,p = 0.038。此外,高CL-K1水平与心血管死亡率显著相关。未发现所测生物标志物与死亡审查的移植物丢失之间存在关联。最后,这两种凝集素之间存在显著相关性,r = 0.83(95% CI 0.80 - 0.86)。总之,CL-L1和CL-K1与肾移植受者的死亡率显著相关。