Nephrology Dialysis Transplantation, Vol 12, Issue 1 161-166, Copyright © 1997 by Oxford University Press
A Hartmann, T Eide, P Fauchald, O Bentdal, J Harbert, J Gallimore and M Pepys
Background. Early diagnosis of acute rejection after
renal transplantation is important. There is evidence that measurement of
the acute phase proteins, C-reactive protein (CRP) and serum amyloid A
protein (SAA) is helpful. Methods. In 64 consecutive
patients, CRP was measured in a routine clinical system (Technicon RA 1000,
Bayer) and SAA in a new sensitive automated immunoassay on the Abbott IMx
instrument, daily or on alternate days for 30 days after renal
transplantation. Results. Patients all received triple
immunosuppression with cyclosporin, azathioprine, and prednisolone and all
mounted a post-surgical acute phase response of SAA, but the CRP response
was reduced or absent. Serum creatinine rose significantly in 36 patients,
leading to treatment for first rejection. Thirty of these episodes were
confirmed rejection, three were definitely not and three were uncertain.
SAA, normally <10mg/l, rose to more than 100 mg/l in all episodes
except when rejection was definitely absent. In six cases SAA rose above
100 mg/l 1-3 days before the rise in creatinine leading to antirejection
therapy, and only twice did creatinine rise 1 day before SAA. In contrast,
CRP responses to rejection were modest or absent. In four patients there
were SAA and CRP responses unrelated to rejection, three associated with
intercurrent infection and one with administration of anti-lymphocyte
globulin. There were also two unexplained isolated spikes of SAA.
Conclusions. SAA is a sensitive marker of acute renal
allograft rejection. It is not specific, but the differential behaviour of
CRP in patients receiving cyclosporin helps to distinguish infection from
rejection. Availability of rapid assays for these analytes should
facilitate management of renal allograft recipients.
Keywords: acute phase protein; C-reactive protein;
diagnosis; rejection; renal transplantation; serum amyloid A protein
ORIGINAL ARTICLES
Serum amyloid A protein is a clinically useful indicator of acute renal allograft rejection
Section of Nephrology, Medical Department B and Surgical Department B, National Hospital, Oslo, Norway; Immunological Medicine Unit, Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK; Corresponding author
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