Estimating the Contribution of Renal Function to Endothelial Dysfunction and Subclinical Inflammation with a Two-Cohort Study: Living Kidney Donors and Their Transplant Recipients

TL;DR

This study examines how kidney function affects blood vessel health and inflammation in kidney donors and transplant recipients.

Contribution

The study uniquely compares endothelial dysfunction and inflammation biomarkers in matched donor-recipient pairs before and after kidney transplantation.

Findings

Endothelial dysfunction biomarker sVCAM-1 increased in donors but decreased in recipients after transplantation.

Inflammation biomarkers sTNFR1 and sTNFR2 increased in donors and decreased in recipients post-transplantation.

Parallel changes in endothelial dysfunction and inflammation biomarkers were observed in the two cohorts.

Abstract

Living kidney transplantation offers the best results for end-stage renal disease patients, but concerns about cardiovascular risk after nephrectomy for kidney donors have been raised. We aimed to estimate the contribution of renal function to endothelial dysfunction (ED) and subclinical inflammation in a non-interventional, prospective, multicenter, longitudinal study with two cohorts: living kidney donors and their transplant recipients (registered clinical trial NCT02515643). The measured glomerular filtration rate (mGFR) by iohexol clearance, estimated GFR according to the CKD-EPI and MDRD-4 formulas, and levels of endothelial dysfunction (sVCAM-1, sICAM-1, E-selectin, von Willebrand Factor, pentraxin, and urinary albumin-to-creatinine ratio) and subclinical inflammation biomarkers (sIL-6, sTNF-R1, sTNF-R2, sTWEAK, and high-sensitivity C-reactive protein) were determined at baseline and 1-year follow-up. Fifty pairs of donors and recipients were recruited between 2015 and 2018. Among the endothelial dysfunction biomarkers, sVCAM-1 increased in donors and decreased in recipients (p < 0.01) while, among the inflammation biomarkers, sTNFR1 and sTNFR2 significantly increased in donors and decreased in recipients (p < 0.001). After transplantation, parallel increases and decreases in ED and subclinical inflammation biomarkers were observed in the donor and recipient cohorts, respectively. Long-term follow-up is needed to characterize the cardiovascular risk associated with these changes.

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