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Impact of apolipoprotein(a) phenotypes on long-term renal transplant survival

Friederike Wahn1, Volker Daniel2, Florian Kronenberg3

  • 1University Children's Hospital, Charité, Berlin, Germany.

Journal of the American Society of Nephrology : JASN
|April 24, 2001
PubMed

Insights

Low molecular weight apolipoprotein(a) phenotypes in young kidney transplant recipients are linked to chronic rejection and reduced graft survival. High molecular weight phenotypes show better long-term outcomes.

Area of Science:

  • Nephrology
  • Cardiovascular Science
  • Transplantation Immunology

Background:

  • Chronic rejection (CR) limits long-term renal transplant success, sharing similarities with atherosclerosis.
  • Lipoprotein(a) [Lp(a)], an atherosclerosis risk factor, has an uninvestigated role in CR.
  • Plasma Lp(a) levels are primarily determined by inherited apolipoprotein(a) [apo(a)] isoforms, inversely correlating with apo(a) molecular weight.

Purpose of the Study:

  • To investigate the association between apolipoprotein(a) [apo(a)] phenotypes and long-term graft survival in renal transplant recipients.
  • To determine if apo(a) phenotype influences the risk of chronic rejection (CR) in kidney transplant patients.

Main Methods:

  • Retrospective analysis of 327 renal transplant recipients (1982-1992).
  • Identification of apolipoprotein(a) [apo(a)] isoforms (high molecular weight [HMW] vs. low molecular weight [LMW]) in patient sera.
  • Comparison of long-term graft survival between HMW and LMW apo(a) phenotype groups using Kaplan-Meier and Cox regression analysis.

Main Results:

  • No significant difference in overall mean graft survival between HMW and LMW apo(a) phenotypes (12.8 vs. 11.9 years, P=0.2065).
  • Younger recipients (≤35 years) with LMW apo(a) phenotypes had significantly shorter mean graft survival (9.9 years) compared to HMW phenotypes (13.2 years, P=0.0156).
  • In young patients, LMW apo(a) phenotypes were independently associated with an increased risk of CR (P=0.0434), irrespective of HLA mismatches, gender, or immunosuppression.

Conclusions:

  • Young renal transplant recipients with low molecular weight (LMW) apolipoprotein(a) [apo(a)] phenotypes exhibit significantly reduced long-term graft survival.
  • LMW apo(a) phenotypes represent an independent risk factor for chronic rejection in younger kidney transplant recipients.
  • Apo(a) phenotype may be a valuable biomarker for predicting CR risk and guiding management in specific kidney transplant populations.

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