Inflammation after kidney transplantation correlates with increased mortality
In the early phase following a kidney transplantation, inflammation is associated with increased long-term all-cause mortality, according to data published in the American Journal of Transplantation.
Further, no general inflammatory pathway stood out as a main cause of mortality, which researchers noted suggests general inflammation is more important.
“Low-grade systemic inflammation is established as a risk factor for all-cause mortality in the general population and is associated with increased risk and severity of several diseases, including cardiovascular disease and cancer,” Torbjørn Fossum Heldal, MD, PhD student and member of the department of internal medicine at Telemark Hospital Trust in Norway, and colleagues wrote. “The main goal of the study was to examine the effect of general systemic inflammation measured 10 weeks after kidney transplantation on long-term mortality and for this purpose, we analyzed a wide spectrum of markers reflecting different but overlapping inflammatory pathways.”
Researchers evaluated 1,349 adult kidney transplant recipients at the Norwegian national transplant center at Oslo University Hospital between April 2007 and October 2012. Ten weeks after kidney transplants, patients provided blood samples and researchers examined inflammation among patients using different composite inflammation scores based on 21 biomarkers. Researchers determined an overall inflammation score and five pathway-specific inflammation scores (fibrogenesis, vascular inflammation, metabolic inflammation, growth/angiogenesis and leukocyte activation). Using Cox regression models adjusted for traditional risk factors, researchers measured independent correlations between all-cause mortality among patients and each inflammation score.
Overall, 312 patients died during the follow-up. Analyses revealed the hazard ratio for death among patients in the highest quartile of the overall inflammation score was 4.71, and the hazard ratios were 2.35 to 2.54 for those in the intermediate groups.
Researchers identified a strong and consistent correlation between low-grade systemic inflammation 10 weeks following kidney transplantation and long-term mortality.
“These findings are associative; however, they could have potential consequences for future follow-up strategies and studies. The inflammation scores’ predictive abilities on identification of patients at risk could be exploited with for example closer monitoring, more aggressive antihypertensive treatment, and/or lower cholesterol and HbA1c target levels,” Fossum Heldal and colleagues wrote. “The results also give insight into why kidney transplant recipients have high long-term mortality rates, and this could be targeted in future studies on for instance different immunosuppressive regimes for patients with various grades of inflammation.”