Plasma and urine leukocyte elastase- 1protease inhibitor complex as a marker of early and long-term kidney graft function

Methods. Plasma and urine LE-alpha 1PI were estimated in 55 deceased-donor kidney graft recipients on postoperative days (POD) 1, 3 and 7, as well as in the late post-transplant period. Results. The plasma LE-alpha 1PI level peaked on POD 1 after kTx, and the urine LE-alpha 1PI peaked on POD 3. On POD 1 and POD 3, the urine LE-alpha 1PI levels were higher in delayed graft function (DGF) patients than in patients with immediate graft function (IGF: P < 0.001 and P < 0.003, respectively). Urine LE-alpha 1PI excretion on POD 1 was significantly higher in patients with longer cold ischaemia time (CIT) than in patients with shorter CIT, P < 0.002. Multivariate regression model revealed two factors influencing the occurrence of early acute rejection-urine LE-alpha 1PI complex on POD 3 and human leukocyte antigen (HLA) mismatches. There was a significant association between the plasma LE-alpha 1PI on POD 3 and serum creatinine level 6 and 12 months after kTx (r(2) 0.24; P < 0.005 and 0.19; P < 0.005, respectively). Conclusions. This study is the first presentation of a simple, non-invasive measurement of neutrophil activation after kTx. It also demonstrates a strong correlation between the early post-transplant LE-alpha 1PI complex level and kidney graft function.