Group IIA Secretory Phospholipase A₂ Predicts Graft Failure and Mortality in Renal Transplant Recipients by Mediating Decreased Kidney Function

• Main Authors: Wijtske Annema, Jan Freark de Boer, Arne Dikkers, Lidiya G. Dimova, Markus van der Giet, Stephan J.L. Bakker, Uwe J.F. Tietge
• Format: Article
• Language: English
• Published: MDPI AG 2020-04-01
• Series: Journal of Clinical Medicine
• Subjects: transplantation; phospholipase; prospective; kidney function; mortality; cohort study
• Online Access: https://www.mdpi.com/2077-0383/9/5/1282

The acute phase protein group IIA secretory phospholipase A₂ (sPLA₂-IIA) has intrinsic proatherosclerotic properties. The present prospective cohort study investigated whether plasma sPLA₂-IIA associates with graft failure, cardiovascular, and all-cause mortality in renal transplant recipients (RTRs), patients with accelerated atherosclerosis formation both systemically and within the graft. In 511 RTRs from a single academic center with stable graft function >1 year, baseline plasma sPLA₂-IIA was determined by ELISA. Primary end points were death-censored graft failure and mortality (median follow-up, 7.0 years). Baseline sPLA₂-IIA was higher in RTRs than in healthy controls (median 384 ng/dL (range 86–6951) vs. 185 ng/dL (range 104–271), <i>p</i> < 0.001). Kaplan–Meier analysis demonstrated increased risk for graft failure (<i>p</i> = 0.002), as well as cardiovascular (<i>p</i> < 0.001) and all-cause mortality (<i>p</i> < 0.001), with increasing sPLA₂-IIA quartiles. Cox regression showed strong associations of sPLA₂-IIA with increased risks of graft failure (hazard ratio (HR) = 1.42 (1.11–1.83), <i>p</i> = 0.006), as well as cardiovascular (HR = 1.48 (1.18−1.85), <i>p</i> = 0.001) and all-cause mortality (HR = 1.39 (1.17−1.64), <i>p</i> < 0.001), dependent on parameters of kidney function. Renal function during follow-up declined faster in RTRs with higher baseline sPLA₂-IIA levels. In RTRs, sPLA₂-IIA is a significant predictive biomarker for chronic graft failure, as well as overall and cardiovascular disease mortality dependent on kidney function. This dependency is conceivably explained by sPLA₂-IIA impacting negatively on kidney function.