Investigation of levels of TNF-α, sTNFR I, sTNFR II, IL-18, IL-6, SVCAM-1, sICAM-1, CRP, cystatin C and creatine in serum as a graft function marker in renal transplant recipients

In kidney transplant, routine use of an ideal marker has crucial importance for the risk assesment during pre-transplantation (PreT) and post-transplantation (PostT) period and following up the graft function during PostT period and planning of early and proper treatment but such an ideal marker has not been explored yet. Searches for new and effective markers have been going on for the diagnosis of graft inability and rejection in the earliest period after kidney transplantation because of limited value of serum creatinine and cystatin C. The aim of this study was to discover the availability of these rum levels of TNF-?, sTNFR I, sTNFR II, IL-18, IL-6, sVCAM-1, sICAM-1, CRP, cystatin C, and creatinine for evaluating of PostT graft function and acute rejection in renal recipients. Fifty patients who were transplanted from alive donors were subjects of this study. The serum levels of TNF-?, sTNFR I, sTNFR II, IL-18, IL-6, sVCAM-1, sICAM-1, CRP, cystatin C, and creatinine were measuredin PreT period and during PostT period on 7th day, in first and 3rd monthes. Serum creatinine, cystatin C, CRP, TNF-?, sTNFR I, sTNFR II, IL-18, IL-6, sVCAM-1, sICAM-1 were measured by kinetic colorimetric assay, PENIA, immunoturbidimetric assay, and ELISA methods. The difference between PreT and PostT measurements was compared. Patients? glomerular filtration rate (GFH) were calculated using modification of diet in renal disease (MDRD), Cockgrouft-Gault (C&G), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C based formules. Renal recipients were divided into two groups: PostT acute rejection (AR group, n=6) and without PostT acute rejection (NAR group, n=44). Serum levels of cystatin C, creatinine, TNF-?, sTNFR I, sTNFR II, sVCAM, sICAM measured after transplantation, on 7th day, in first month, and 3rd monthes were found to be significantly lower than corresponding pre-transplantation levels (p=0,001). There was no statistically significant difference between pre-transplantation and post-transplantation levels of creatinine, 117 cystatin C, sTNFR II, sICAM-1 in renal recipients with AR on 7th day, but serum levels determined in first month and 3rd monthes were found to be lower than those measured in pre-transplantation period (p<0,05, p<0,032, respectively). In AR group, serum levels of creatinine and cystatin C measured on 7th day (p=0,006 p=0,009, respectively), levels of CRP and IL-6,measured in first month (p=0,049 p=0,032, respectively), serum levels of TNF-?, sTNFR I, sTNFR II measured on 7th day and in first month (p=0,012 p=0,049 for TNF-?, p=0,001 p=0,002 for sTNFR I, p=0,001 p=0,002 for sTNFR II) were found to be significantly higher than those measured in NAR group. ROC analysis for GFH confirmation, in PostT 3rd month for creatinine (sensitivity 77%, specifity 92%), cystatin C (sensitivity 66%, specifity 85%) and sTNFR II (sensitivity 86%, specifity 71%) exhibited significant differences. ROC analysis for acute rejection diagnosis, on 7th day for creatinine (sensitivity 95%, specifity 83%), cystatin C (sensitivity 84%, specifity 83%), TNF-? (sensitivity 80%, specifity 75%), sTNFR I (sensitivity 84%, specifity 91%), sTNFR II (sensitivity 1, specifity 80%), sVCAM (sensitivity 50%, specifity 1) and in first month for TNF-? (sensitivity 88%, spesifite 66%), sTNFR I (sensitivity 75%, spesifite 1), sTNFR II (sensitivity 81%, spesifite 1), IL-6 (sensitivity 61%, spesifite 1) also pointed out significant differences. In conclusion, our results showed that the determination of serum sTNFR I and sTNFRII levels may be a good alternative markers to common markers such as serum creatinine and cystatin C to follow up graft function and for acute rejection diagnosis levels. Further studies are needed to establish there alistic role of serum sTNFR I and sTNFR II levels in future.