The 2-microglobulin/cystatin C ratio -: a potential marker of post-transplant lymphoproliferative disease

Background: As a consequence of more intensified immunosuppression, post-transplant lymphoproliferative disease (PTLD) is increasingly observed in patients after solid-organ transplantation. (2) micro-globulin, a low-molecular weight protein (MW 11.8 kDa), is produced by all nucleated cells as part of the HLA complex. Its serum concentration is directly correlated with prognosis in patients with lymphatic neoplasms. Like other low-molecular weight proteins, (2)-microglobulin is eliminated by glomerular filtration. This complicates its use as a tumor marker in renal insufficiency. Cystatin C, a low-molecular weight protein of 13.3 kDa, is a new marker of kidney function largely unaffected by extrarenal disease. We, therefore, sought to assess the potential of the (2)-microglobulin/cystatin C ratio (M-2/Cys) as a marker of lymphoproliferation. Patients and methods: M-2/Cys was determined by particle-enhanced immunonephelometry in sera from 132 children with different degrees of renal insufficiency, 5 of whom had lymphoproliferative disease. Renal function was assessed using the Schwartz formula. Results: M-2/Cys was constant between 1.2 and 2.4 mg/mg for Schwartz GFR 40 ml/min x 1.73 m(2). With lower GFR, (M-2/Cys) rose progressively, maximum values being found in the hemodialysis patients (4.85-11.73). Healthy renal transplant recipients had (M-2/Cys) comparable to controls. With acute lymphoproliferative disease, all but one patient had significantly elevated (M-2/Cys) between 2.68 and 3.68 mg/mg, which returned to normal in remission (1.67-2.35 mg/mg). The sensitivity of a (M-2/Cys) ratio > 2.4 mg/mg for the detection of PTLD was 80%, the specificity 100%, positive predictive value 100%, negative predictive value 90%. Conclusion: The (2)-microglobulin/cystatin C ratio is a promising parameter of lymphoproliferation in patients with normal or mildly impaired renal function.