Prediction of chronic allograft damage index of renal allografts using serum level of plasminogen activator inhibitor-1

Background: lasminogen activator inhibitor-1 (PAI-1) plays an important role in renal fibrosis. We conducted this study to examine whether serum PAI-1 has a role in predicting chronic allograft nephropathy (CAN). Methods: Fifty kidney transplant recipients receiving graft biopsies were enrolled. The pathologic diagnoses were acute tubular necrosis (ATN; n = 12), borderline rejection (BR; n = 7), acute rejection (ACR; n = 12), CAN (n = 11), polyomavirus nephropathy (PVN; n = 3) and others (n=5; glomerulopathy, n = 4; calcineurin inhibitor nephropathy, n = 1). The serum level of PAI-1 and chronic allograft damage index (CADI) score of each patient were determined. Results: The CADI score of all patients was 4 (0-10) (median and range) and in each group was ATN 0.5 (0-4), BR 2.0 (1-4), ACR 4.0 (2-8), CAN 5.0 (4-10), PVN 7 (4-8) and others 2 (0-8). The serum PAI-1 level of each group was ATN 9.38 (2.35-14.52) ng/mL, BR 10.09 (0.61-18.06) ng/mL, ACR 11.08 (2.32-20.68) ng/mL, CAN 14.51 (3.66-21.12), PVN 14.79 (13.94-21.94) and others 16.35 (4.05-21.01) ng/mL. CADI score is associated with serum PAI-1 activity (r = 0.405, p = 0.003) and is inversely associated with serum creatinine (r = -0.348, p = 0.011), but not with estimated glomerular filtration rate (p = 0.124). Conclusion: Serum PAI-1 level has the potential to be a marker to predict CADI score, the quantitative score of CAN.