Galectin-3 and Risk of Late Graft Failure in Kidney Transplant Recipients: A 10-year Prospective Cohort Study
Camilo G Sotomayor, Charlotte A Te Velde-Keyzer, Arjan Diepstra, Marco van Londen, Robert A Pol, Adrian Post, Rijk O B Gans, Ilja M Nolte, Riemer H J A Slart, Martin H de Borst, Stefan P Berger, Ramón Rodrigo, Gerjan J Navis, Rudolf A de Boer, Stephan J L Bakker, Camilo G Sotomayor, Charlotte A Te Velde-Keyzer, Arjan Diepstra, Marco van Londen, Robert A Pol, Adrian Post, Rijk O B Gans, Ilja M Nolte, Riemer H J A Slart, Martin H de Borst, Stefan P Berger, Ramón Rodrigo, Gerjan J Navis, Rudolf A de Boer, Stephan J L Bakker
Abstract
Background: Galectin-3 may play a causal role in kidney inflammation and fibrosis, which may also be involved in the development of kidney graft failure. With novel galectin-3-targeted pharmacological therapies increasingly coming available, we aimed to investigate whether galectin-3 is associated with risk of late graft failure in kidney transplant recipients (KTR).
Methods: We studied adult KTR who participated in TransplantLines Insulin Resistance and Inflammation Biobank and Cohort Study, recruited in a university setting (2001-2003). Follow-up was performed for a median of 9.5 (interquartile range, 6.2-10.2) years. Overall and stratified (Pinteraction < 0.05) multivariable-adjusted Cox proportional-hazards regression analyses were performed to study the association of galectin-3 with risk of graft failure (restart of dialysis or retransplantation).
Results: Among 561 KTR (age 52 ± 12 y; 54% males), baseline median galectin-3 was 21.1 (interquartile range, 17.0-27.2) ng/mL. During follow-up, 72 KTR developed graft failure (13, 18, and 44 events over increasing tertiles of galectin-3). Independent of adjustment for donor, recipient, and transplant characteristics, galectin-3-associated with increased risk of graft failure (hazard ratios [HR] per 1 SD change, 2.12; 95% confidence interval [CI], 1.63-2.75; P < 0.001), particularly among KTR with systolic blood pressure ≥140 mmHg (HR, 2.29; 95% CI, 1.80-2.92; P < 0.001; Pinteraction = 0.01) or smoking history (HR, 2.56; 95% CI, 1.95-3.37; P < 0.001; Pinteraction = 0.03). Similarly, patients in the highest tertile of galectin-3 were consistently at increased risk of graft failure.
Conclusions: Serum galectin-3 levels are elevated in KTR, and independently associated with increased risk of late graft failure. Whether galectin-3-targeted therapies may represent novel opportunities to decrease the long-standing high burden of late graft failure in stable KTR warrants further studies.
Trial registration: ClinicalTrials.gov NCT03272854 NCT03272785.
Conflict of interest statement
The authors declare no conflicts of interest.
Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.
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