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

Citation
F. Wahn et al., Impact of apolipoprotein(a) phenotypes on long-term renal transplant survival, J AM S NEPH, 12(5), 2001, pp. 1052-1058
Citations number
58
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
ISSN journal
10466673 → ACNP
Volume
12
Issue
5
Year of publication
2001
Pages
1052 - 1058
Database
ISI
SICI code
1046-6673(200105)12:5<1052:IOAPOL>2.0.ZU;2-J
Abstract
The long-term success of renal transplantation is limited because of chroni c rejection (CR), which shows histologic parallels to atherosclerosis. Lipo protein(a) [Lp(a)] is an independent risk factor for atherosclerosis, but i ts role in CR has not been investigated. Plasma levels of Lp(a) are determi ned mainly by the inherited isoform (phenotype) of apolipoprotein(a) [apo(a )] and show an inverse correlation with the molecular weight of apo(a). Apo (a) isoforms were identified in frozen sera of 327 patients who received a renal transplant during 1982 to 1992. Long-term graft survival in recipient s with high molecular weight (HMW) or low molecular weight (LMW) apo(a) phe notypes were compared retrospectively. Mean (95% confidence interval) trans plant survival was 12.8 yr(range, 11.9 to 13.6 yr) in patients with HMW and 11.9 yr (range, 10.8 to 13.1 yr) in patients with LMW apo(a) phenotypes (P = 0.2065). In patients who were 35 yr or younger at the time of transplant ation, mean transplant survival was more than 3 yr longer in recipients wit h HMW apo(a) phenotypes compared with those with LMW apo(a) phenotypes (13. 2 yr [range, 12.1 to 14.4 yr] versus 9.9 yr (range, 8.5 to 11.5 yr); P = 0. 0156). In a Cox's proportional hazards regression model, the presence of LM W phenotypes-but not gender, immunosuppression, or HLA mismatches-in young patients was associated with a statistically significant risk of CR (P = 0. 0434). These retrospective data indicate that young renal transplant recipi ents with LMW apo(a) phenotypes have a significantly shorter long-term graf t survival, regardless of the number of HLA mismatches, gender, or immunosu ppressive treatment.