Pretransplant inflammation: a risk factor for delayed graft function?

J Nephrol. Mar-Apr 2008;21(2):221-8.


Background: Inflammation plays an important role in the pathogenesis of ischemic acute kidney injury (IAKI). In this study, we hypothesize that transplant recipients with pretransplant inflammation may have a greater chance of developing delayed graft function (DGF), an example of IAKI.

Patients and methods: We analyzed 178 patients who had undergone their first transplant using cadaveric donors. Blood samples were extracted from transplant recipients prior to transplantation. C-reactive protein (CRP) (nephelometry); interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) (automatized enzyme chemiluminescence immunometric assay); and pregnancy-associated plasma protein A (PAPP-A) (enzyme-linked immunosorbent assay) were determined using the pretransplant blood samples. The risk factors analyzed included cold ischemia, type and time of dialysis, donor and recipient age and HLA compatibility.

Results: Sixty-one patients (34.3%) developed DGF. Pretransplant TNF-alpha (9.31 +/- 2.57 vs. 10.56 +/- 3.82 pg/mL; p=0.039) and PAPP-A (1.25 +/- 0.74 vs. 1.90 +/- 1.56 mU/L; p=0.002) were significantly elevated in the group of patients with DGF. Univariate analysis showed that PAPP-A, TNF-alpha, cold ischemia, type of dialysis (hemodialysis) and donor age were associated with DGF. Multivariate analysis showed that PAPP-A (p=0.006), cold ischemia (p=0.009) and type of dialysis (p=0.046) were independent risk factors for DGF.

Conclusions: Pretransplant inflammation (TNF-alpha, PAPP-A) in transplant recipients could be a risk factor for the development of DGF.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • C-Reactive Protein / analysis
  • Cadaver
  • Delayed Graft Function / etiology*
  • Female
  • Humans
  • Inflammation
  • Inflammation Mediators / blood
  • Interleukin-6 / blood
  • Kidney / pathology*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Pregnancy-Associated Plasma Protein-A / analysis
  • Reperfusion Injury / etiology
  • Risk Factors
  • Tumor Necrosis Factor-alpha / blood


  • Inflammation Mediators
  • Interleukin-6
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein
  • Pregnancy-Associated Plasma Protein-A