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

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.