Serum C-reactive protein surge in renal transplant recipients: link with allograft survival.

The restoration of kidney function by transplantation improves the common finding of chronic inflammation in patients with end-stage renal disease (ESRD). The C-reactive protein (CRP) level is a reliable marker of inflammation in renal transplant recipients. We analyzed the predictive value of posttransplant CRP surges on renal allograft survival among 141 ESRD patients who underwent renal transplantation between May 1999 and September 2001 at our institution. Twenty-seven cadaveric and 114 living donors were also studied. The subjects' demographic, clinical, and laboratory data were recorded. The renal transplant recipients were divided into three groups defined by the type of serum CRP surge: a normal, intermittently high, or consistently high serum CRP concentration. Renal allograft survival rates were 90.0% among recipients with normal serum CRP concentrations, 72.6% among those with intermittently high concentrations, and 11.1% in those with consistently high concentrations. A Cox regression analysis of factors that affect allograft survival showed that acute rejection, advanced recipient age, and consistently high serum CRP concentrations were associated with a high risk of renal allograft loss. Intermittent elevations in the serum CRP level were not associated with an increased risk of allograft loss, according to the Cox regression model. We concluded that consistently high serum CRP concentrations in renal allograft recipients showed a high negative predictive value for renal allograft survival. In recipients who exhibited ongoing inflammatory process in the 5-year posttransplant period, additional efforts are necessary to manage inflammation and therefore prolong renal allograft survival.

Spectrum of liver damage and correlation with clinical and laboratory parameters in HCV infected hemodialysis patients.

There are conflicting results in studies concerning the best marker for liver histopathological features of HCV infection in HD patients. We planned a prospective study to follow HCV viremia and laboratory parameters of HD patients and correlate these with clinic features and histopathological findings. We included 68 HCV infected patients (45 male, 23 female, age: 39.8 +/- 11.9 years, HD duration: 58.2 +/- 36.4 months) in our study. The follow-up period after the biopsy was 33.2 +/- 20.3 months. Patients liver enzyme (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT)) levels were determined monthly and ferritin levels every three months, and the mean value was recorded. We also screened patients for HCV RNA. During the follow-up period, 22 (32.4%) of the patients had positive RNA, 26 (38.2%) negative RNA. 20 (29.4%) had intermittent RNA positivity. The patients with high grade of portal necroinflammatory activity had significantly higher AST and ALT levels. In addition patients with high grade lobular activity had significantly shorter HD and HCV infection duration and higher AST, ALT and ferritin levels. AST levels were negatively correlated with duration of HD and HCV infection, and positively correlated with GGT and ferritin levels. Additionally, we found that ALT levels were negatively correlated with HD duration and positively correlated with GGT levels. ALT levels higher than 30 U/L were reflected necroinflammatory activity more significantly than levels higher than 40 U/L. Cirrhosis was detected in 5.9% of the patients, and we could not find any laboratory parameter that was correlated with stage of fibrosis. Although there is a high degree of liver involvement, cirrhosis is a relatively less frequent finding in HD patients. Serum aminotransferases and ferritin levels but not the pattern of HCV viremia are predictors of necroinflammatory activity in liver biopsy specimens. Liver biopsy obligatory to assess the disease activity in HD patients.