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Donor Urinary C5a Levels Independently Correlate With Posttransplant Delayed Graft Function

Bernd Schröppel1,2, Peter S Heeger2, Heather Thiessen-Philbrook3

  • 1Section of Nephrology, University Hospital, Ulm, Germany.

Transplantation
|November 20, 2018
PubMed
Abstract

Insights

Donor urinary C5a levels predict kidney transplant recipients

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation Immunology

Background:

  • The complement cascade contributes to ischemia-reperfusion injury and delayed graft function (DGF) in kidney transplant recipients.
  • Kidney injury may begin in the donor before organ procurement.
  • Anaphylatoxins C3a and C5a are key complement components implicated in injury.

Purpose of the Study:

  • To investigate the association between donor urinary C5a and C3a levels and posttransplant outcomes.
  • To determine if donor urine anaphylatoxins predict acute kidney injury (AKI) and DGF in recipients.

Main Methods:

  • Evaluated C5a and C3a in donor urine from 469 deceased donors and 902 kidney recipients.
  • Correlated urinary C5a/C3a with donor AKI and recipient DGF (dialysis within the first week).
  • Performed adjusted analyses to assess independent associations with DGF and graft function.

Main Results:

  • Urinary C5a was threefold higher in donors with stage 2-3 AKI.
  • Higher donor urinary C5a associated with recipient DGF (P=0.002).
  • Donor urinary C5a independently predicted DGF in recipients from donors without AKI (RR 1.31).
  • Urinary C3a showed no association with donor AKI or recipient DGF.
  • A trend suggested better 12-month allograft function with lower donor C5a tertiles (P=0.09).

Conclusions:

  • Urinary C5a concentration correlates with donor kidney injury severity.
  • Donor urinary C5a predicts recipient DGF, especially in the absence of clinical donor AKI.
  • Donor urinary C5a may identify high-risk transplant scenarios for targeted interventions.

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