SERUM AMYLOID A PROTEIN

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Abstract
Acute human renal allograft rejection induces a dramatic elevation of serum amyloid A protein (SAA). To evaluate the clinical significance of this finding 31 consecutive recipients of cadaveric renal allografts were monitored by daily SAA measurements. SAA increased significantly during 37/38 rejection episodes. Mean peak SAA level during the reversible rejections was 271 .+-. 31 mg/l (SE, median 220 mg/l, n = 35) and during the irreversible rejections 680 .+-. 29 mg/l (median 705 mg/l, n = 3). Excluding the predictable operation-induced SAA elevations that peaked on the 2nd postoperative day, there were 7 of 42 SAA elevations (.ltoreq. 100 mg/l) not due to rejection. They were all caused by severe infections, and in 1 instance by a surgical complication. In 17 of 35 SAA-positive rejections, the SAA elevation (.ltoreq. 100 mg/l) preceded the clinical diagnosis by 1-5 days; in 11, it occurred on the same day; and in 7, one day later. Rejection episodes in recipients with initially nonfunctioning grafts were all also characterized by significant SAA elevations. Daily monitoring of SAA concentrations offers a valuable aid in the early diagnosis of acute allograft rejection. The SAA test is not a renal function test, so it also be carried out in transplant patients who are anuric or oliguric in the postgrafting stage.