Is inflammation prior to renal transplantation predictive for cardiovascular and renal outcomes?

Krüger, Bernd; Walberer, Andreas; Debler, Jens; Böger, Carsten A.; Farkas, S.; Reinhold, Stephan W.; Obed, Aiman; Fischereder, Michael; Banas, Bernhard; Krämer, Bernhard K.

doi:10.1016/j.atherosclerosis.2010.01.004

Cited by 12 publications

(13 citation statements)

References 29 publications

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“…In this study, pretransplant CRP level did not show independent association with post-transplant ACS, although several former studies reported an association between high CRP levels and CV outcomes [ 18 , 24 , 29 ]. The occurrence of ACS in the patients with sustained high CRP levels after transplantation cannot be verified, because post-transplant one-year CRP value was not measured routinely in all patients.…”

Section: Discussioncontrasting

confidence: 79%

“…Most of these reports focused on different outcomes such as mortality (including cardiovascular mortality and all-cause mortality), delayed graft function, chronic allograft nephropathy, or graft outcomes [ 17 , 20 – 23 ]. Some were either small in sample size [ 18 ] or focused on association only with one MIA factor (albumin or CRP level) [ 24 ]. To our knowledge, this is the first multicenter study on the occurrence of ACS in kidney transplant recipients with combined factor for considering pretransplant MIA score.…”

Section: Discussionmentioning

confidence: 99%

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Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation

Hwang

Ryu

et al. 2015

BMC Nephrol

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BackgroundMalnutrition, inflammation, and atherosclerosis (MIA) syndrome is associated with a high mortality rate in patients with end-stage renal disease. However, the clinical relevance of MIA syndrome in kidney transplantation (KT) recipients remains unknown.MethodsWe enrolled 1348 adult KT recipients. Recipients were assessed based on serum albumin, cholesterol, or body mass index for the malnutrition factor and C-reactive protein level for the inflammation factor. Any history of cardiovascular (CV), cerebrovascular, or peripheral vascular disease satisfied the atherosclerosis factor. Each MIA factors were assessed by univariate analysis and we calculated an overall risk score by summing up scores for each independent variable. The enrolled patients were divided into 4 groups depending on the MIA score (0, 2–4, 6, 8–10).ResultsThe patients with higher MIA score showed worse outcome of fatal/non-fatal acute coronary syndrome (ACS) (p < 0.001) and composite outcomes of ACS and all-cause mortality (p < 0.001) than with the lower MIA score. In multivariate analysis, ACS showed significantly higher incidence in the MIA score 8-10 group than in the MIA score 0 group (Hazard ratio 6.12 95 % Confidence interval 1.84–20.32 p = 0.003).ConclusionsThe presence of MIA factors before KT is an independent predictor of post-transplant CV outcomes.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation

Hwang

Ryu

et al. 2015

BMC Nephrol

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“…This leads to the frequently observed chronic inflammatory status post-transplantation with potentially deleterious effects, e.g. indicated by slightly elevated CRP (C-reactive protein) levels, itself a stimulator of the innate immune system [3,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…polyoma virus nephropathy. In particular, MACE and, subsequently, fatal cardiovascular events cause up to 50 % of all late allograft losses, revealing the important impact on late transplant outcome [25,26,34].…”

Section: Discussionmentioning

confidence: 99%

A comprehensive genotype–phenotype interaction of different Toll-like receptor variations in a renal transplant cohort

et al. 2010

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To date, the impact of the TLR (Toll-like receptor) system on early and late kidney transplantation outcome, such as ARE (acute rejection episodes) or cardiovascular morbidity and mortality, has still not been elucidated conclusively. Genetically determined alterations in TLR expression exhibit a possibility to evaluate their role in transplantation. In the present study, we sought to determine a comprehensive genotype-phenotype association with early and late allograft outcomes. We studied 11 SNPs (single nucleotide polymorphisms) in TLR2, TLR3, TLR4, TLR5, TLR9 and within a co-molecule CD14 in 265 patients receiving their first kidney transplant and the association of these with the occurrence of DGF (delayed graft function), ARE or MACE (major adverse cardiovascular events). ARE were significantly more frequent in patients carrying the TLR3 TT/CT allele (43.8 compared with 25.8%; P=0.001) as were rates of DGF (21.4 compared with 12.0%; P=0.030). Furthermore, TLR9 was significantly involved in the occurrence of MACE (TLR9 -1237; P=0.030). Interestingly, there was no significant effect of any TLR polymorphism on graft survival or renal function and the incidence of any infection, including CMV (cytomegalovirus) infection. In conclusion, our present study in renal transplant recipients suggests that the TLR system may be involved in both acute rejection and MACE. Modulation of the TLR system may be a promising target in future therapeutic strategies.

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“…Eisenberg et al, in their groundbreaking study on cardiac transplant recipients, established that CRP levels are a 'modifiable marker of risk', effective for predicting risk of cardiac graft failure in the transplant population and for determining successful forms of therapy [9]. CRP levels can serve as a predictor for mortality, chronic allograft nephropathy or the development of major cardiovascular events in renal transplant recipients, or graft failure in pancreas-kidney transplant populations [7,8,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of using C-reactive protein for point-of-care testing

Joshi

Perin

Gehle

et al. 2013

THC

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BACKGROUND: C-reactive protein (CRP) point-of-care testing (POCT) can be a valuable tool for decision making in primary care. Very few studies have illustrated the utilization of CRP POCT. OBJECTIVE: To conduct a systematic review on the use of CRP POCT in primary care settings and to examine its feasibility and acceptability in an outpatient primary care setting. METHODS: The search was conducted via PubMed. Final articles in the systematic review met inclusion and exclusion criteria. For the feasibility and acceptability analysis, a convenience sample of 20 adult subjects was enrolled and CRP POCT was conducted. RESULTS: Antibiotic prescription was the most predominant outcome assessed, and antibiotic prescription reduction was the most common finding of CRP POCT effectiveness testing. CONCLUSION: CRP POCT can be used to detect inflammation and can reduce antibiotic prescription in primary care. It is a satisfactory procedure that should be available in the primary care setting.

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Is inflammation prior to renal transplantation predictive for cardiovascular and renal outcomes?

Cited by 12 publications

References 29 publications

Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation

Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation

A comprehensive genotype–phenotype interaction of different Toll-like receptor variations in a renal transplant cohort

Feasibility of using C-reactive protein for point-of-care testing

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