AUTHOR=Morath Christian , Hayek Salim S. , Döhler Bernd , Nusshag Christian , Sommerer Claudia , Zeier Martin , Reiser Jochen , Süsal Caner 

TITLE=Soluble Urokinase Receptor and Mortality in Kidney Transplant Recipients

JOURNAL=Transplant International

VOLUME=Volume 35 - 2021

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2021.10071

DOI=10.3389/ti.2021.10071

ISSN=1432-2277

ABSTRACT=Main problem: Soluble urokinase plasminogen activator receptor (suPAR) is an immunological risk factor for kidney disease and a prognostic marker for cardiovascular events.
Methods: We measured serum suPAR levels in a total of 1,023 kidney transplant recipients either before (cohort 1, n=474) or at year 1 after transplantation (cohort 2, n=549). The association of suPAR levels and all-cause and cardiovascular mortality was evaluated by multivariable Cox regression analysis.
Results: The highest suPAR tertile compared to the two lower tertiles had a significantly higher risk of all-cause mortality in both cohorts separately (cohort 1: hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.20–3.08, P=0.007; cohort 2: HR=2.78, 95% CI 1.51–5.13, P=0.001) and combined (n=1,023, combined HR=2.14, 95% CI 1.48–3.08, P<0.001). The association remained significant in the subgroup of patients with normal kidney function (cohort 2: HR=5.40, 95% CI 1.42–20.5, P=0.013). The increased mortality risk in patients with high suPAR levels was attributable mainly to an increased rate of cardiovascular death (n=1,023, HR=4.24, 95% CI 1.81–9.96, P<0.001).
Conclusions: A high suPAR level prior to and at 1 year after kidney transplantation was associated with an increased risk of patient death independent of kidney function, predominantly from cardiovascular cause.