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Serum total homocysteine concentration does not predict outcome in renal transplant recipients
E Dimény1, B Hultberg, J Wahlberg
1Department of Medicine, Umeå University Hospital, Sweden.
Insights
High homocysteine levels (tHcy) are common in kidney transplant patients but do not appear to impact graft survival or function. This study found no correlation between pre- or post-transplant tHcy and long-term renal transplant outcomes.
Area of Science:
- Nephrology
- Cardiovascular Risk Factors
- Transplantation Immunology
Background:
- Cardiovascular risk factors like hypercholesterolemia can affect renal transplant outcomes.
- Hyperhomocysteinemia is an independent risk factor for atherosclerosis and is prevalent in dialysis and transplant patients.
Purpose of the Study:
- To investigate the impact of hyperhomocysteinemia on renal graft outcomes.
- To determine if pre- and post-transplant total homocysteine (tHcy) levels predict graft survival, function, or histopathology.
Main Methods:
- Measured serum total homocysteine (tHcy) in 81 patients pre-transplant and 57 patients post-transplant.
- Assessed graft function (serum creatinine, creatinine clearance) at 6 months and 5 years post-transplant.
- Evaluated allograft biopsy at 6 months post-transplant.
Main Results:
- Pre-transplant hyperhomocysteinemia prevalence was 94%; post-transplant prevalence was 88%.
- Neither pre- nor post-transplant tHcy levels correlated with patient survival, graft survival, graft function, or histopathology.
- Mean tHcy decreased from 33.2 +/- 19.2 mumol/L pre-transplant to 27.7 +/- 14.6 mumol/L at 6 months post-transplant.
Conclusions:
- Hyperhomocysteinemia is highly prevalent in renal transplant recipients.
- Elevated total homocysteine (tHcy) does not appear to be a predictor of short-term or long-term renal transplant outcomes.
Abstract:
Established cardiovascular risk factors such as hypercholesterolemia have been claimed to adversely influence the outcome of renal transplants. The aim of the present study was to assess the effect of another risk factor, hyperhomocysteinemia, on graft outcome. This was relevant for two reasons; hyperhomocysteinemia is by now recognized as an independent risk factor for the development of atherosclerosis and it is highly prevalent in both dialysis patients and renal transplant recipients. The serum concentration of total homocysteine (tHcy) was analyzed in samples collected before transplantation in 81 patients and at 6 months after transplantation in 57 of these patients. Before transplantation, mean tHcy was 33.2 +/- 19.2 mumol/L and the prevalence of hyperhomocysteinemia was 94%. Six months after transplantation, mean tHcy was 27.7 +/- 14.6 mumol/L and the prevalence of hyperhomocysteinemia was 88%. The patients were followed up for 5 yr. Six months and 5 yr after transplantation, serum creatinine concentration and endogenous creatinine clearance were determined. After 6 months, allograft biopsy was evaluated. Neither pre- nor post-transplant tHcy was found to influence patient or graft survival, graft function or histopathology. Thus, tHcy does not seem to predict either short-term or long-term outcome of renal transplantation.