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Low Pretransplantation Mannose-Binding Lectin Levels Predict Superior Patient and Graft Survival after Simultaneous Pancreas-Kidney Transplantation
- Source :
- Journal of the American Society of Nephrology. 18:2416-2422
- Publication Year :
- 2007
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2007.
-
Abstract
- Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for patients with type 1 diabetes and renal failure. However, this procedure is characterized by a high rate of postoperative infections, acute rejection episodes, and cardiovascular mortality. The lectin pathway of complement activation contributes to cardiovascular disease in diabetes and may play an important role in inflammatory damage after organ transplantation. This study therefore sought to determine how mannose-binding lectin (MBL), a major recognition molecule of the lectin pathway of complement activation, influences outcome after SPKT. MBL serum levels were determined in 99 and MBL genotypes in 97 consecutive patients who received an SPKT from 1990 through 2000 and related to patient and graft survival. At 12 yr, cumulative death-censored kidney graft survival was 87.5% in patients with an MBL level400 ng/ml and 74.8% in the group with MBL levels400 ng/ml (P = 0.021). Pancreas graft survival was significantly better in patients with low MBL levels (P = 0.016). MBL levels400 ng/ml were associated with a hazard ratio of 6.28 for patient death (95% confidence interval 1.8 to 20.3; P = 0.003). Accordingly, survival was significantly better in recipients with MBL gene polymorphisms associated with low MBL levels. These findings identify MBL as a potential risk factor for graft and patient survival in SPKT. It is hypothesized that MBL contributes to the pathogenesis of inflammation-induced vascular damage both in the transplanted organs and in the recipient's native blood vessels.
- Subjects :
- Adult
Male
Nephrology
medicine.medical_specialty
medicine.medical_treatment
chemical and pharmacologic phenomena
Kaplan-Meier Estimate
Pancreas transplantation
Mannose-Binding Lectin
Organ transplantation
Predictive Value of Tests
Risk Factors
Internal medicine
Diabetes mellitus
Preoperative Care
medicine
Humans
Diabetic Nephropathies
Complement Activation
Kidney transplantation
Mannan-binding lectin
business.industry
Graft Survival
General Medicine
Middle Aged
bacterial infections and mycoses
medicine.disease
Kidney Transplantation
Transplantation
Lectin pathway
Immunology
Kidney Failure, Chronic
Female
Pancreas Transplantation
business
Subjects
Details
- ISSN :
- 10466673
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Journal of the American Society of Nephrology
- Accession number :
- edsair.doi.dedup.....d73a82b322be8cc70a8ec1a5a6d630fd