Adiponectin/leptin ratio as a predictor of acute rejection in early post-transplant period in patients after kidney transplantation

Karol Graňák; Matej Vnučák; Monika Beliančinová; Patrícia Kleinová; Margaréta Pytliaková; Marián Mokáň; Ivana Dedinská

doi:10.3389/fmed.2023.1117819

Adiponectin/leptin ratio as a predictor of acute rejection in early post-transplant period in patients after kidney transplantation

Front Med (Lausanne). 2023 Feb 17:10:1117819. doi: 10.3389/fmed.2023.1117819. eCollection 2023.

Authors

Karol Graňák^{1

2}, Matej Vnučák^{1

2}, Monika Beliančinová^{1

2}, Patrícia Kleinová^{1

2}, Margaréta Pytliaková³, Marián Mokáň², Ivana Dedinská^{1

2}

Affiliations

¹ Transplant Centre, University Hospital Martin, Martin, Slovakia.
² Department of Internal Medicine, University Hospital in Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.
³ Department of Gastrointestinal Internal Medicine, University Hospital Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.

Abstract

Introduction: Adipokines are largely involved in the regulation of immune system activity. While leptin is the main pro-inflammatory marker of adipose tissue, adiponectin is characterized by anti-inflammatory effects. The aim of our study was to determine the risk of acute graft rejection in protocol biopsy depending on the adiponectin/leptin (A/L) ratio in patients after kidney transplantation (KT).

Materials and methods: A total of 104 patients were included in the prospective analysis, in whom the levels of adipokines were examined pre-transplant, in the 3rd month after KT and the A/L ratio was calculated. In the 3rd month after KT, all patients underwent protocol biopsy of the graft and examination of donor-specific antibodies (DSA) using the Luminex method.

Results: After adjusting for differences in the basic characteristics of the donor and recipient, we identified a subgroup with A/L ratio < 0.5 pre-transplant [HR 1.6126, (P = 0.0133)] and 3 months after KT [HR 1.3150, (P = 0.0172)] as independent risk factor for acute graft rejection. In the subsequent specification of the rejection episode, we identified the risk ratio A/L < 0.5 before KT [HR 2.2353, (P = 0.0357)] and 3 months after KT [HR 3.0954, (P = 0.0237)] as independent risk factor for the development of acute humoral rejection with DSA positivity.

Conclusion: This is the first study to investigate the relationship between A/L ratio and immunological risk in terms of the development of rejection changes in patients after KT. In our study, we found that A/L ratio < 0.5 is an independent risk factor for the development of acute humoral rejection and de novo DSA production in the third month after KT.

Keywords: acute rejection; adiponectin/leptin ratio; adipose tissue hormones; antibody-mediated rejection; kidney transplantation.

Grants and funding

This study was supported by the Project of Research Agency of Slovak Ministry of Education, Science and Sports (VEGA) 1/0238/21 and by Research and Development Project ITMS2014 +: 313011V344.