Predictive value of serum complement (C3) in renal allograft rejection

Kumar, Prem; Kodlin, Dankward; Marks, Charles; Leech, Stephen H.

doi:10.1002/bjs.1800670716

Cited by 7 publications

(3 citation statements)

References 4 publications

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“…We observed specific kinetics of C3 in the participating centers, and this may have affected the relationship between hypocomplementemia and infection analyzed in our study. C3 levels tended to increase in the post‐transplant period in some centers; this increase has been attributed to the prevalence of infections and rejection in previous studies 31‐34 …”

Section: Discussionmentioning

confidence: 87%

Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study

Sarmiento

Jiménez

Natale

et al. 2020

Transplant Infectious Dis

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Background We performed a multicenter study to assess the association between secondary antibody deficiency (immunoglobulin G [IgG] hypogammaglobulinemia combined with low levels of specific antibodies) and development of infection in kidney transplantation. Methods We prospectively analyzed 250 adult kidney recipients at four centers. The assessment points were before transplantation and 7 and 30 days after transplantation. The immune parameters were as follows: IgG, IgA, and IgM and complement factors C3 and C4 tested by nephelometry; specific IgG antibodies to cytomegalovirus (CMV) and IgG and IgG2 antibodies to pneumococcal polysaccharide (anti‐PPS) determined using enzyme‐linked immunosorbent assay. The clinical follow‐up period lasted 6 months. The clinical outcomes were CMV disease and recurrent bacterial infections requiring antimicrobial therapy. Statistics: Multivariate logistic regression. Results At day 7, IgG hypogammaglobulinemia (IgG levels < 700 mg/dL) combined with low IgG anti‐CMV antibody titers (defined as levels < 10 000 units) was present in 12% of kidney recipients. IgG hypogammaglobulinemia combined with low IgG anti‐PPS antibody titers (defined as levels < 10 mg/dL) at 1 month after kidney transplantation were recorded in 16% of patients. At day 7 the combination of IgG hypogammaglobulinemia and low anti‐CMV titers was independently associated with the development of CMV disease (odds ratio [OR], 6.95; 95% confidence interval [CI], 1.17‐41.31; P = .033). At day 30 after transplantation, the combination of IgG < 700 mg/dL and IgG anti‐PPS < 10 mg/dL, was independently associated with recurrent bacterial infection (OR, 5.942; 95% CI, 1.943‐18.172; P = .002). Conclusion In a prospective multicenter study, early immunologic monitoring of secondary antibody deficiency proved useful for the identification of kidney recipients who developed severe infection.

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Section: Discussionmentioning

confidence: 87%

Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study

Sarmiento

Jiménez

Natale

et al. 2020

Transplant Infectious Dis

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“…There is scarce information regarding the kinetics of complement levels after KT . Barnes et al did not find significant differences between pre‐ and posttransplant values of C3 .…”

Section: Discussionmentioning

confidence: 98%

Hypocomplementemia in Kidney Transplant Recipients: Impact on the Risk of Infectious Complications

Fernández‐Ruiz

López‐Medrano

Varela-Peña

et al. 2013

American Journal of Transplantation

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The usefulness of monitoring of complement levels in predicting the occurrence of infection in kidney transplant (KT) recipients remains largely unknown. We prospectively assessed serum complement levels (C3 and C4) at baseline and at months 1 and 6 in 270 patients undergoing KT. Adjusted hazard ratios (aHRs) for infection in each posttransplant period were estimated by Cox regression. The prevalence of C3 hypocomplementemia progressively decreased from 21.5% at baseline to 11.6% at month 6 (p = 0.017), whereas the prevalence of C4 hypocomplementemia rose from 3.7% at baseline to 9.2% at month 1 (p = 0.004). Patients with C3 hypocomplementemia at month 1 had higher incidences of overall (p = 0.002), bacterial (p = 0.004) and fungal infection (p = 0.019) in the intermediate period (months 1-6). On multivariate analysis C3 hypocomplementemia at month 1 emerged as a risk factor for overall (aHR 1.911; p = 0.009) and bacterial infection (aHR 2.130; p = 0.014) during the intermediate period, whereas C3 hypocomplementemia at month 6 predicted the occurrence of bacterial infection (aHR 3.347; p = 0.039) in the late period (>6 month). A simple monitoring strategy of serum C3 levels predicts the risk of posttransplant infectious complications in KT recipients.

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“…1 . Complement levels can fall to very low levels within a few hours due to the development of immune complexes so that the fall in complement here may be a reflection of activation; consumption of complement in response to the physiological stress response and reduction of complement levels have been reported in acute pancreatitis with the levels of C3 and C4 being sensitive and accurate to the severity of the pancreatitis [ 45 ], whilst a fall in C3 and its reversibility was predictive in renal allograft rejection and recovery [ 46 ].…”

Section: Discussionmentioning

confidence: 99%