Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: CXCL10 is a member of the CXCR3 chemokine family that mediates inflammation by inducing chemotaxis of effector cells. Urinary CXCL10 can provide a non-invasive and early monitoring marker for graft function. The aim of this study was to investigate the association of urinary CXCL10 levels with acute rejection (AR) and to evaluate its prognostic value as well as its utility as follow-up marker after antirejection treatment. Methods: Data were obtained and analyzed for ninety-seven transplanted children. Urine samples for CXCL 10 testing by ELISA technique were obtained from all patients.A CXCL10 level follow-up evaluation for rejection group one month later was performed. Results: Urine CXCL 10 level was significantly elevated in the rejection group (n=41; 42.3%) than in the control group (n=56; 57.7%) (Median (IQR) =350 (151-2104) versus 55 (38-82) pg/ml, p<0.001). The ROC curve analysis demonstrated that at a cut-off value of 87.5 pg/ml of CXCL10 level, AR could be predicted with 100% sensitivity, 78.6% specificity, 95% CI of (0.899-0.983) and AUC of 0.94. CXCL 10 levels declined significantly in the rejection group after receiving antirejection therapy (p<0.001). Elevated CXCL 10 levels are significantly associated with chronic graft dysfunction (CGD) 6 months after the initial assessment (p=0.03). Conclusion: Urine CXCL 10 is a reliable marker of acute allograft rejection after kidney transplantation in pediatrics. Levels of urine CXCL 10 in rejection patients significantly decline after receiving antirejection therapy. Elevated urine CXCL 10 levels significantly associated with poor short-term graft outcome

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