Low pretransplantation mannose-binding lectin levels predict superior patient and graft survival after simultaneous pancreas-kidney transplantation

Stefan P Berger, Anja Roos, Marko J K Mallat, Alexander F M Schaapherder, Ilias I Doxiadis, Cees van Kooten, Friedo W Dekker, Mohamed R Daha, Johan W de Fijter

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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 level <400 ng/ml and 74.8% in the group with MBL levels >400 ng/ml (P = 0.021). Pancreas graft survival was significantly better in patients with low MBL levels (P = 0.016). MBL levels >400 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.

Original languageEnglish
Pages (from-to)2416-22
Number of pages7
JournalJournal of the American Society of Nephrology
Volume18
Issue number8
DOIs
Publication statusPublished - Aug-2007
Externally publishedYes

Keywords

  • Adult
  • Complement Activation
  • Diabetic Nephropathies
  • Female
  • Graft Survival
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic
  • Kidney Transplantation
  • Male
  • Mannose-Binding Lectin
  • Middle Aged
  • Pancreas Transplantation
  • Predictive Value of Tests
  • Preoperative Care
  • Risk Factors
  • Journal Article
  • Research Support, Non-U.S. Gov't

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