Introduction We hypothesize that innate inflammatory response either preexistent in the recipient or released by injured allografts during transplantation may influence graft outcome. In a retrospective study we evaluated the influence of kynurenine, HMGB-1, C5b-9 and IL-33 on the development of delayed graft function (DGF), acute rejection (AR) and the long term outcome (GS). IL–33 is an IL-1 family cytokine, constitutively expressed by epithelial and endothelial cells and induced in myeloid cells. IL-33 is considered an alarmin, or an endogenous molecule that signals tissue and cell damage. Numerous studies have also reported a regulatory or protective function for IL-33 following cardiac injury and transplantation, and in ischemia / reperfusion injury.

Patients and Methods A consecutive group of patients after renal transplantation (in total n=122, mean age 42±11 years, immunosuppressive protocol CsA (70) / TAC (52), EC-MPS/MMF, MP; induction therapy (ATG-F) n=14), was evaluated. Demographic data were comparable between different CNI´s. Probes were taken prior tx 0, wk1, wk2, wk3, wk4 and month3.

Results Concerning DGF, HMGB-1 was an excellent parameter already preoperative (donor) and correlated with the duration of pop dialysis need. C5b-9, kynurenin and HMGB-1 (p<.001) were significant elevated during DGF, but not IL-33. IL-33 was significant higher after 3 months in the DGF group.

AR was allover 16%. Predictive values were only given by kynurenine, whereas, C5b-9 was not significant elevated during AR. IL-33 was significant increased during AR and elevation in the long-term run(>3^rd month) is correlated with a higher creatinine after 1 to 3 years (r²=0.685).

GS was correlated with lower kynurenine values in the early postoperative period and lower IL-33. ATG induction therapy was correlated with a lower inflammatory response.

Conclusion Kynurenine showed an excellent correlation to acute rejection as well as to long term graft function. HMGB-1 showed significant the injury of the graft and C5b-9 was not useful as a predictive parameter for DGF but elevated in AR. IL-33 showed a correlation to the graft function in the later follow up <3 months. Pre-op testing of inflammatory markers could be a step towards individualized immunosuppressive therapy and might decrease the risk of rejection.

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