Morphological and functional differences in haemostatic axis between kidney transplanted and end-stage renal disease patients

Paolo Fiorina, Franco Folli, Elisabetta Ferrero, Elena Orsenigo, Giovanna Finzi, Gabriella Mazzolari, Claudia Placidi, Lucia Perego, Stefano La Rosa, Marco Melandri, Lucilla Monti, Carlo Capella, Armando D'Angelo, Carlo Staudacher, Antonio Secchi

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Abstract

End-stage renal disease (ESRD) is characterized by several atherothrombotic abnormalities, and kidney transplant seems to improve most of them. However, because it is not clear which mechanism is responsible for such improvement, our purpose was to clarify that point. We conducted a cross sectional study involving 30 ESRD patients, 30 ESRD kidney-transplanted patients (Ktx) and 30 healthy controls (C) to evaluate platelet morphology and function, atherothrombotic profile, endothelial abnormalities and cytokine levels involved in the insulin resistance/endothelial dysfunction. (i) Platelet morphology: The ESRD group showed platelet size similar to the other two groups (ESRD = 3518 × 103 ± 549 × 103 nm2, C = 3075 × 103 ± 197 × 103 nm2, Ktx = 2862 × 103 ± 205 × 103 nm 2) with similar platelet granules and number. (ii) Platelet surface glycoprotein: The CD41 and P-Selectin were similar between groups. (iii) Platelet intracellular calcium: Resting intracellular calcium was statistically higher in ESRD compared to the C group (ESRD = 182.1 ± 34.5, Ktx = 126.7 ± 14.1, C = 72.0 ± 11.0 nM, P < 0.01). (iv) Hypercoagulability markers and natural anticoagulants: The Ktx and ESRD groups showed higher levels of hypercoagulability markers compared to the C group. A reduction in antithrombin activity was evident in ESRD compared to the Ktx group (P = 0.03). (v) Endothelial morphology: The ESRD group showed a thickened vessel basal membrane compared to the Ktx and C groups with more endothelial sufference. (vi) Insulin resistance and pro-inflammatory cytokine profile: The ESRD showed a higher homeostasis model assessment provided equations for estimating insulin resistance (HOMA-IR) compared to the Ktx and C groups (ESRD = 2.6 ± 0.3, Ktx = 1.8 ± 0.2, C = 1.1 ± 0.1, P = 0.005) and increased soluble tumor neurosis factor α (sTNFα) (P < 0.05) and soluble vascular cell adhesion molecule (sVCAM) levels (P < 0.01). Positive correlations were evident among HOMA-IR and sTNFα (P < 0.001) and sVCAM (P = 0.01), respectively. In a small subgroup of ESRD who underwent Ktx (five pts), our findings were confirmed at 1 year of follow-up, suggesting an improvement of almost haemostatic abnormalities. Kidney transplant is associated with a better atherothrombotic profile in ESRD, platelet intracellular calcium and cytokines seem to be most influenced by the transplant, while most morphological abnormalities are retained.

Original languageEnglish (US)
Pages (from-to)1036-1047
Number of pages12
JournalTransplant International
Volume18
Issue number9
DOIs
StatePublished - Sep 1 2005

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Keywords

  • End-stage renal disease
  • Haemostasis
  • Kidney transplant
  • Platelets

ASJC Scopus subject areas

  • Transplantation

Cite this

Fiorina, P., Folli, F., Ferrero, E., Orsenigo, E., Finzi, G., Mazzolari, G., Placidi, C., Perego, L., La Rosa, S., Melandri, M., Monti, L., Capella, C., D'Angelo, A., Staudacher, C., & Secchi, A. (2005). Morphological and functional differences in haemostatic axis between kidney transplanted and end-stage renal disease patients. Transplant International, 18(9), 1036-1047. https://doi.org/10.1111/j.1432-2277.2005.00173.x