Lasin Ozbek, Berk Mizrak, Zeynep Y Yilmaz, Mustafa Guldan, Derya G Fidan, Sama Mahmoud Abdel-Rahman, Mehmet Kanbay
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Elevated IL-6 was associated with a higher risk of graft dysfunction (HR 1.53, 95 % CI 1.28-1.83; I<sup>2</sup> = 0 %) and all-cause mortality (HR 1.66, 95 % CI 1.05-2.61; I<sup>2</sup> = 97.2 %), but not cardiovascular events. CRP was associated with all-cause mortality (HR 2.07, 95 % CI 1.59-2.70; I<sup>2</sup> = 0 %) and cardiovascular events (HR 6.89, 95 % CI 2.52-18.85; I<sup>2</sup> = 0 %), but not cardiovascular mortality or graft dysfunction. Elevated hsCRP was associated with all-cause mortality (HR 1.29, 95 % CI 1.15-1.44; I<sup>2</sup> = 61 %), but not with cardiovascular events or graft dysfunction.</p><p><strong>Conclusions: </strong>Among kidney transplant recipients, elevated levels of IL-6, CRP, and hsCRP were significantly associated with increased all-cause mortality, though the association of IL-6 with all-cause mortality showed substantial heterogeneity and should be interpreted with caution. 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引用次数: 0
摘要
背景：肾移植受者会经历更高的全身性炎症，生物标志物如白细胞介素-6 （IL-6）、c反应蛋白（CRP）和高敏CRP （hsCRP）已被提出作为预后指标。目的：本荟萃分析评估IL-6、CRP和hsCRP水平与肾移植受者全因死亡率、心血管事件和移植物功能障碍之间的关系。方法：全面检索PubMed、Web of Science、Scopus、Ovid MEDLINE和Cochrane图书馆，直到2024年10月11日，确定了IL-6、CRP或hsCRP与成人肾移植受者临床结果相关的符合条件的研究。结果：系统评价纳入40项研究，其中18项符合meta分析标准。IL-6升高与移植物功能障碍的高风险（HR 1.53, 95 % CI 1.28-1.83; I2 = 0 %）和全因死亡率（HR 1.66, 95 % CI 1.05-2.61; I2 = 97.2 %）相关，但与心血管事件无关。CRP与全因死亡率（HR 2.07, 95 % CI 1.59-2.70; I2 = 0 %）和心血管事件（HR 6.89, 95 % CI 2.52-18.85; I2 = 0 %）相关，但与心血管死亡率或移植物功能障碍无关。hsCRP升高与全因死亡率相关（HR 1.29, 95 % CI 1.15-1.44; I2 = 61 %），但与心血管事件或移植物功能障碍无关。结论：在肾移植受者中，IL-6、CRP和hsCRP水平的升高与全因死亡率的增加显著相关，尽管IL-6与全因死亡率的关系显示出很大的异质性，应谨慎解释。IL-6也可作为移植物功能障碍的预测因子，而CRP则与心血管事件密切相关。这些发现强调了炎症生物标志物，特别是IL-6和CRP在移植后风险分层中的潜在作用；然而，需要进一步的研究来确定因果关系并阐明其临床应用。
Association between interleukin 6, C-reactive protein, and kidney transplantation outcomes: A systematic review and meta-analysis.
Background: Kidney transplant recipients experience heightened systemic inflammation, and biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), and high-sensitivity CRP (hsCRP) have been proposed as prognostic indicators.
Objective: This meta-analysis evaluates the associations between IL-6, CRP, and hsCRP levels and all-cause mortality, cardiovascular events, and graft dysfunction in kidney transplant recipients.
Methods: A comprehensive search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and the Cochrane Library until October 11, 2024, identified eligible studies reporting associations between IL-6, CRP, or hsCRP and clinical outcomes in adult kidney transplant recipients.
Results: The systematic review included 40 studies, with 18 meeting criteria for meta-analysis. Elevated IL-6 was associated with a higher risk of graft dysfunction (HR 1.53, 95 % CI 1.28-1.83; I2 = 0 %) and all-cause mortality (HR 1.66, 95 % CI 1.05-2.61; I2 = 97.2 %), but not cardiovascular events. CRP was associated with all-cause mortality (HR 2.07, 95 % CI 1.59-2.70; I2 = 0 %) and cardiovascular events (HR 6.89, 95 % CI 2.52-18.85; I2 = 0 %), but not cardiovascular mortality or graft dysfunction. Elevated hsCRP was associated with all-cause mortality (HR 1.29, 95 % CI 1.15-1.44; I2 = 61 %), but not with cardiovascular events or graft dysfunction.
Conclusions: Among kidney transplant recipients, elevated levels of IL-6, CRP, and hsCRP were significantly associated with increased all-cause mortality, though the association of IL-6 with all-cause mortality showed substantial heterogeneity and should be interpreted with caution. IL-6 also emerged as a predictor of graft dysfunction, while CRP demonstrated a strong association with cardiovascular events. These findings highlight the potential role of inflammatory biomarkers, particularly IL-6 and CRP, in post-transplant risk stratification; however, further studies are needed to establish causality and clarify their clinical utility.
期刊介绍：
Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.
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