Recipient’s low-grade chronic inflammation has an impact on one-year survival after simultaneous pancreas and kidney transplantation
Michal Macech1, Tadeusz Grochowiecki1, Magdalena Durlik2, Leszek Paczek3, Slawomir Nazarewski1.
1Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland; 2Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland; 3Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
Introduction: Diabetes mellitus type 1 and end-stage renal disease can induce low-grade chronic inflammation (LGCI) which has an impact on simultaneous pancreas and kidney transplantation (SPKTx) results, even in carefully qualified recipient.
Objective: To evaluate impact of preoperative LGCI on one-year survival recipients after SPKTx.
Material and methods: Mean observation after SPKTx was 82,7 months (range: 0,1-220). Among 103 SPKTx recipients following parameters of LGCI were assessed directly before transplantation: white blood cells (WBC) [mean: 7,55*103/mm3 (SD±2,56)], neutrophiles (NEU) [mean: 5,12*103/mm3 (SD±2,13)]; platelets (PLT) [mean: 244,3*103/mm3 (SD±84,03)]; C-reactive Protein (CRP) [mean: 4,5 mg/L (SD±4,97)]; albumin (ALB) [mean 4,5(g/dL) (SD±0,75)]. The markers were categorized using Weight of Evidence test (WoE) supported by Information Value test (IV). Uni- and multivariate analysis was performed with ROC curve and area under curve (AUC) was assessed. Cumulative survivals were assessed using Kaplan-Meier curves.
Results: One-year cumulative survival rates was 87,2 % (SD±0,03). During first year deaths due to complications of infections had significantly higher rate than in second to tenth year after SPKTx (89% vs 11%, Fisher test). ALB, CRP, PLT, WBC and NEU were categorized with cut-off points for further analysis: 3,65g/dL, 2,25mg/L, 180*103/mm3, 8,2*103/mm3 and 5,8*103/mm3, respectively. In univariate analysis significant for 12-month survival were: NEU>5,8*103/mm3, PLT<180*103/mm3, CRP>2,25mg/L and ALB <3,65g/dL with odds ratios (OR): 2,97; 6,75; 5,51; 4,05, respectively. In multivariate analysis, there were two models with independent factors for 12-month survival: model 1 (ALB+PLT) with OR: 3,12 and 5,55; and model 2 (CRP+PLT) with OR: 5,51 and 4,3, respectively. AUC for model 1 and 2 were: 0,74 and 0,759, respectively.
Conclusions: Preoperative recipients LGCI status measured by PLT, ALB and CRP levels have significant impact on one-year survival of SPKTx reicpients.
