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October 1, 2003

Pretransplantation Soluble Adhesion Molecule Expression Predicts Outcome After Living Donor Renal Transplantation

Author Affiliations

From the Division of Transplant Surgery (Drs Perez, McVicar, and Troppmann, and Messrs Huang and Johnson) and Transplant Medicine (Drs Gallay and Gandhi), University of California[[ndash]]Davis Medical Center, Sacramento.

Arch Surg. 2003;138(10):1113-1120. doi:10.1001/archsurg.138.10.1113

Hypothesis  Occult pretransplantation systemic inflammation will identify patients at risk for poor outcomes after renal transplantation.

Design  Retrospective cohort study. Adhesion molecule levels were measured in pretransplantation serum samples from 86 recipients. Univariate and multivariate analyses were conducted to assess a possible correlation between serum adhesion molecule level and outcome.

Setting  University referral center.

Main Outcome Measures  Allograft rejection and survival.

Results  Patients with low levels of vascular cell adhesion molecule 1 had less graft rejection (P = .007). Low levels of vascular cell adhesion molecule 1 independently predicted decreased rejection (relative risk, 0.17; P = .01), and high levels of vascular cell adhesion molecule 1 independently predicted graft loss (relative risk, 3.83; P = .02). Similar correlations were observed for intercellular adhesion molecule 1.

Conclusions  Decreased pretransplantation adhesion molecule expression correlates with less rejection, and increased levels correlate with graft loss. Assessment of pretransplantation inflammatory status may be useful in optimizing immunosuppression therapy.