Weimer R et al. (2006) Post-transplant sCD30 and neopterin as predictors of chronic allograft nephropathy: impact of different immunosuppressive regimens. Am J Transplant 6: 1865–1874

Immunosuppressive treatment tailored to individual renal transplant recipients might improve long-term graft and patient survival. Developing immunological tests to predict chronic allograft nephropathy (CAN), thereby identifying patients who could benefit from intensified immunosuppression, is of considerable interest.

Levels of serum soluble CD30 and neopterin—markers of T-cell activation, which has an important role in CAN—were prospectively assessed in 84 renal transplant recipients randomized to one of three immunosuppressive regimens involving ciclosporin and azathioprine, ciclosporin and mycophenolate mofetil, or tacrolimus and azathioprine. At 1 year, overall patient survival was 100% and overall graft survival was 95%.

Levels of serum CD30 and neopterin were significantly higher in patients whose glomerular filtration rate subsequently decreased during 2 years of follow-up (P = 0.02 and P <0.0005, respectively). High levels of serum CD30 and neopterin (≥60 U/ml and ≥200 nmol/mg, respectively) at 1 year were also associated with CAN in eight patients at 2 years (P <0.0005 and P = 0.001, respectively). Together, 1-year serum CD30 and neopterin concentrations had a positive predictive value for CAN at 2 years of 0.71, and a negative predictive value of 0.96.

As only tacrolimus was independently associated with downregulation of serum CD30 expression at 1 year, the authors suggest that this calcineurin inhibitor might be the immunosuppressant of choice for patients with high pretransplantation levels of this risk factor for CAN.