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Previous Volume 360:874-880 February 26, 2009 Number 9 Next

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ABSTRACT

Background Complement activation plays a role in the development of chronic allograft nephropathy, a common cause of late allograft loss. The role of two complement component 3 (C3) allotypes, called C3F (fast) and C3S (slow) on the basis of their electrophoretic motility, in the long-term outcome of renal allografts remains controversial.

Methods We selected a random sample of 1147 donor and recipient pairs from the Collaborative Transplant Study DNA bank, and their DNA specimens were genotyped for the C3F and C3S alleles. The genotyping results were analyzed according to allograft outcome. Transplants were divided into four groups, according to the recipient and donor genotypes: SS recipient and FS or FF donor (the standard for comparison, since this combination has been reported to have the best outcome), SS recipient and donor, FS or FF recipient and SS donor, and FS or FF recipient and donor.

Results Baseline characteristics of the four transplant groups were similar. The hazard ratios for allograft survival in the SS recipient and FS or FF donor group as compared with the other three groups (SS recipient and donor, FS or FF recipient and SS donor, and FS or FF recipient and donor) were not significant: 0.90 (95% confidence interval [CI], 0.7 to 1.14; P=0.33), 0.87 (95% CI, 0.65 to 1.16; P=0.33), and 0.89 (95% CI, 0.65 to 1.23; P=0.48), respectively. The four groups had similar patient-survival rates and similar cumulative rates of acute rejection and allograft dysfunction, as assessed by means of serum creatinine levels.

Conclusions Our results suggest that transplantation of FS or FF kidneys to SS recipients is not advantageous, possibly because chronic allograft nephropathy is a multifaceted disease involving the interplay of many biologic pathways.

Source Information

From the Barts and the London School of Medicine and Dentistry and the National Health Service Trust, London (M.V., M.M.Y.); and the Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany (B.D., G.O.).

Drs. Varagunam and Yaqoob contributed equally to this article.

Address reprint requests to Dr. Yaqoob at the Department of Renal Medicine and Transplantation, Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom, or at m.m.yaqoob{at}qmul.ac.uk.

Full Text of this Article

Related Letters:

C3 Polymorphisms and Outcomes of Renal Allografts
Mrug M., Zhou J., Mannon R. B., Naesens M., Butte A. J., Sarwal M. M., Varagunum M., Opelz G., Yaqoob M. M.
Extract | Full Text | PDF  
N Engl J Med 2009; 360:2477-2479, Jun 4, 2009. Correspondence

This article has been cited by other articles:

• Mrug, M., Zhou, J., Mannon, R. B., Naesens, M., Butte, A. J., Sarwal, M. M., Varagunum, M., Opelz, G., Yaqoob, M. M. (2009). C3 Polymorphisms and Outcomes of Renal Allografts. NEJM 360: 2477-2479 [Full Text]