SuPAR-based choice of the management strategy in kidney transplant recipients with infection

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Background: Infectious complications are a major problem in transplantology of today. Soluble urokinase-type plasminogen activator receptor (suPAR) could be one of the markers of infection in kidney transplant recipients. Aim: To determine the potential of suPAR implementation into clinical practice to choose the management strategy in kidney graft recipients with infectious complications.

Materials and methods: We conducted a single center, open-label pilot trial in 30 kidney graft recipients aged above 18 years, with clinical signs of infection (body temperature above 37.5 °С, dysuria or respiratory manifestations). Patients with diabetes mellitus, focal segmental glomerulosclerosis, chronic heart failure and cancer, as well as those with glomerular filtration rate below 15 mL/min/1.73 m2 were excluded. The patients were divided into 2 groups: those who were hospitalized to the nephrology department and those who were treated as outpatients.

Results: There was no difference in suPAR levels between the inand out-patients with kidney transplant and infectious complications (12.8 [10.4; 15] and 10.8 [7.6; 14.5] ng/mL, respectively, р = 0.194). The mean duration of hospitalization for infectious complications was 17.9 ± 10 days. SuPAR levels in the patients with a short in-hospital stay was 12.35 [9.6; 15] ng/mL, being not significantly different from that in the patients who required prolonged hospitalization (15 [10.4; 15] ng/mL, р = 0.347).

Conclusion: We have made the first attempt to use the permeability factor suPAR in kidney transplant patients with clinical signs of infections at an out-patient visit to decide if they should be hospitalized to the nephrology department for in-patient treatment. The results obtained indicate that the stratification of the risk of death and unfavorable disease course, as well as the recommendations for patient managements developed for the general population, are not applicable to kidney transplant recipients. The results of this pilot trial have shown that high suPAR levels are not always indicative of severe status in the patients with kidney transplant and infectious complications. The predictive value of the marker for unfavorable disease course and death in this patient category remains vague.

About the authors

N. V. Rapetskaya

Minsk Scientific and Practical Center for Surgery, Transplantation and Hematology

Author for correspondence.

Nadezhda V. Rapetskaya – Nephrologist, Department of Nephrology and Hemodialysis

23–248 prospekt gazety "Zvyazda", Minsk, 220116, Rebuplic of Belarus

Tel.: +375 (29) 787 82 56


K. S. Komissarov

Minsk Scientific and Practical Center for Surgery, Transplantation and Hematology


Kirill S. Komissarov – MD, PhD, Associate Professor, Head of Department of Nephrology, Renal Replacement Therapy and Kidney Transplantation

8 Semashko ul., Minsk, 220045, Republic of Belarus


O. V. Kalachik

Minsk Scientific and Practical Center for Surgery, Transplantation and Hematology

ORCID iD: 0000-0002-8993-0292

Oleg V. Kalachik – MD, PhD, Professor, Medical Deputy Director, Head of Republican Center of Nephrology, Renal Replacement Therapy and Kidney Transplantation

8 Semashko ul., Minsk, 220045, Republic of Belarus



  1. Chan S, Isbel NM, Hawley CM, Campbell SB, Campbell KL, Morrison M, Francis RS, Playford EG, Johnson DW. Infectious Complications Following Kidney Transplantation – A Focus on Hepatitis C Infection, Cytomegalovirus Infection and Novel Developments in the Gut Microbiota. Medicina (Kaunas). 2019;55(10): 672. doi: 10.3390/medicina55100672.
  2. Fishman JA. Infection in Organ Transplantation. Am J Transplant. 2017;17(4): 856–79. doi: 10.1111/ajt.14208.
  3. Galindo Sacristán P, Pérez Marfil A, Osorio Moratalla JM, de Gracia Guindo C, Ruiz Fuentes C, Castilla Barbosa YA, García Jiménez B, de Teresa Alguacil J, Barroso Martin FJ, Osuna Ortega A. Predictive factors of infection in the first year after kidney transplantation. Transplant Proc. 2013;45(10): 3620–3. doi: 10.1016/j.transproceed.2013.11.009.
  4. Shams SF, Eidgahi ES, Lotfi Z, Khaledi A, Shakeri S, Sheikhi M, Bahrami A. Urinary tract infections in kidney transplant recipients 1 st year after transplantation. J Res Med Sci. 2017;22:20. doi: 10.4103/1735-1995.200274.
  5. Thunø M, Macho B, Eugen-Olsen J. suPAR: the molecular crystal ball. Dis Markers. 2009;27(3): 157–72. doi: 10.3233/DMA-2009-0657.
  6. van den Berg VJ, Bouwens E, Umans VAWM, de Maat M, Manintveld OC, Caliskan K, Constantinescu AA, Mouthaan H, Cornel JH, Baart S, Akkerhuis KM, Boersma E, Kardys I. Longitudinally Measured Fibrinolysis Factors are Strong Predictors of Clinical Outcome in Patients with Chronic Heart Failure: The Bio-SHiFT Study. Thromb Haemost. 2019;119(12): 1947–55. doi: 10.1055/s-0039-1696973.
  7. Hayek SS, Divers J, Raad M, Xu J, Bowden DW, Tracy M, Reiser J, Freedman BI. Predicting Mortality in African Americans With Type 2 Diabetes Mellitus: Soluble Urokinase Plasminogen Activator Receptor, Coronary Artery Calcium, and High-Sensitivity C-Reactive Protein. J Am Heart Assoc. 2018;7(9):e008194. doi: 10.1161/JAHA.117.008194.
  8. Grabe M, Bjerklund-Johansen TE, Botto H, Wullt B, Çek M, Naber KG, Pickard RS, Tenke P, Wagenlehner F. Guidelines on urological infections. Arnhem; 2012. 110 p.
  9. Ватазин АВ, Готье СВ, Мойсюк ЯГ, Прокопенко ЕИ, Сюткин ВЕ, Томилина НА. Инфекционные осложнения после трансплантации почки. В: Шилов ЕМ, Смирнов АВ, Козловская НЛ, ред. Нефрология. Клинические рекомендации. М.: ГЭОТАР-Медиа; 2016. с. 761–804.
  10. Kinnunen S, Karhapää P, Juutilainen A, Finne P, Helanterä I. Secular Trends in Infection-Related Mortality after Kidney Transplantation. Clin J Am Soc Nephrol. 2018;13(5): 755–62. doi: 10.2215/CJN.11511017.
  11. Backes Y, van der Sluijs KF, Mackie DP, Tacke F, Koch A, Tenhunen JJ, Schultz MJ. Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review. Intensive Care Med. 2012;38(9): 1418–28. doi: 10.1007/s00134-012-2613-1.
  12. Donadello K, Scolletta S, Taccone FS, Covajes C, Santonocito C, Cortes DO, Grazulyte D, Gottin L, Vincent JL. Soluble urokinase-type plasminogen activator receptor as a prognostic biomarker in critically ill patients. J Crit Care. 2014;29(1): 144–9. doi: 10.1016/j.jcrc.2013.08.005.
  13. Koch A, Voigt S, Kruschinski C, Sanson E, Dückers H, Horn A, Yagmur E, Zimmermann H, Trautwein C, Tacke F. Circulating soluble urokinase plasminogen activator receptor is stably elevated during the first week of treatment in the intensive care unit and predicts mortality in critically ill patients. Crit Care. 2011;15(1):R63. doi: 10.1186/cc10037.
  14. Kumar P, Kakar A, Gogia A, Waziri N. Evaluation of soluble urokinase-type plasminogen activator receptor (suPAR) quick test for triage in the emergency department. J Family Med Prim Care. 2019;8(12): 3871–5. doi: 10.4103/jfmpc.jfmpc_116_19.
  15. Huttunen R, Syrjänen J, Vuento R, Hurme M, Huhtala H, Laine J, Pessi T, Aittoniemi J. Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study. J Intern Med. 2011;270(1): 32–40. doi: 10.1111/j.1365-2796.2011.02363.x.
  16. Virogates. suPAR (monograph) [Internet]. 2019. Available from:
  17. Kofoed K, Eugen-Olsen J, Petersen J, Larsen K, Andersen O. Predicting mortality in patients with systemic inflammatory response syndrome: an evaluation of two prognostic models, two soluble receptors, and a macrophage migration inhibitory factor. Eur J Clin Microbiol Infect Dis. 2008;27(5): 375–83. doi: 10.1007/s10096-007-0447-5.
  18. Cho SY, Choi JH. Biomarkers of sepsis. Infect Chemother. 2014;46(1): 1–12. doi: 10.3947/ic.2014.46.1.1.

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Copyright (c) 2020 Rapetskaya N.V., Komissarov K.S., Kalachik O.V.

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