Serdar ÇELİK, Arda YEŞİLOVA, Türker ACAR, Cenk ŞİMŞEK, Erhan TATAR, İBRAHİM HALİL BOZKURT, Yusuf Kadir TOPÇU, Ertuğrul ŞEFİK, İsmail BASMACI, İsmail Can TERCAN, Serkan YARIMOĞLU, BÜLENT GÜNLÜSOY, TANSU DEĞİRMENCİ, ADAM USLU

BÖBREK NAKİLLİ HASTALARDA AKUT REJEKSİYON İLE AKUT DÖNEM SONRASI ÜRETERAL JET DİNAMİĞİ ARASINDAKİ İLİŞKİ: PROSPEKTİF KOHORT ÇALIŞMA

Giriş: Bu çalışmadaki amacımız, böbrek nakli (BN) hastalarında akut rejeksiyonun (AR) pelvi-üreterik sistem fizyolojisi üzerine etkisini değerlendirmek, AR ile rejeksiyonun akut dönemi sonrası ölçülen üreteral jet akım dinamiklerinin ilişkisini araştırmaktır. Gereç ve Yöntem: Kasım 2017 ile Haziran 2018 arasında BN uygulanan hastalar prospektif olarak değerlendirildi. BN'nden sonra 3. ay tüm hastalara doppler ultrasonografi (D-US) yapıldı. D-US ile Renal arter rezitif indeksi (RA-Ri), renal pelvis ön-arka çapı (RP-APÇ), pelvikalisiyel sistem dilatasyonu (PCSD) ve üreteral jet akım dinamikleri (maksimum ve ortalama jet akım hız; JETmax ve JETave) ölçüldü. Ayrıca hastaların demografik özellikleri, tahmini glomerüler filtrasyon hızı (eGFR) seviyeleri, AR durumu ve hemodiyaliz (HD) süresi incelendi. Hastalar AR durumlarına göre üç gruba ayrıldı. Grup 1’de AR gelişen, Grup 2’de sınır değişiklikleri saptanan ve Grup 3’te AR gelişmeyen hastalar değerlendirildi. Sonra Grup 1, antikor aracılı AR ve hücresel AR gelişen hastalar diye iki alt grupta incelendi. Tüm veriler bu gruplar arasında karşılaştırıldı. Bulgular: Çalışmada ortalama yaşı 41,5 yıl olan 25 hasta değerlendirildi. Bu hastaların 5’i Grup 1’de, 4’ü Grup 2’de ve 16’sı Grup 3’te idi. Yapılan çok değişkenli analizde tüm veriler gruplar arasında benzer saptandı. AR gelişen hastaların böbrek biyopsilerini incelediğimizde, 2 antikor aracılı AR ve 3 hastada T hücre aracılı AR izlenmiştir. Grup 1 hastalar subgruplara ayrıldığında da üreteral jet dinamikleri açısından anlamlı farklılık saptanmamıştır. Sonuç: BN sonrası AR gelişen hastaların 3. ay üreteral jet akım dinamiklerinin ve dolayısı ile pelvi-üreterik fizyolojinin AR gelişmeyen hastalar ile benzer olduğu gözlenmiştir.

THE ASSOCIATION BETWEEN ACUTE REJECTION AND URETERAL JET DYNAMICS AFTER THE ACUTE PERIOD IN PATIENTS WITH RENAL TRANSPLANTATION: A PROSPECTIVE COHORT STUDY

Introduction: The aim of this study was to investigate the relationship between acute rejection (AR) and ureteral jet flow dynamics after the acute period of AR to assess the effect on the physiology of the pelvi-ureteric system in renal transplantation (RTx) patients. Material and Method: Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, doppler ultrasonography (D-US) was performed on all patients at 3rd month. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD) and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients’ demographics, estimated glomerular filtration rate (eGFR) levels, AR and haemodialysis (HD) time were investigated in the study. Patients were divided into three groups according to AR status. Patients with AR receipted in Group 1, patients with borderline alterations receipted in Group 2 and patients without AR receipted in Group 3. Then Group1 was divided into two subgroups as antibody-mediated AR and T-cell mediated AR groups. Data was compared between the groups. Results: A total of 25 patients who are 41.5 years old were evaluated in the study. Among, 5 patients were in Group 1, 4 patients were in Group 2 and 16 were in Group 3. In multivariate analysis, all data were similar between the groups. When we examined renal biopsies of patients with AR, 2 patients had antibody-mediated rejection and 3 patients had T-cell-mediated rejection. When group 1 patients were examined, there was no significant difference for ureteral jet dynamics between the subgroups of Group 1. Conclusion: It was observed that the ureteral jet flow dynamics that give us information about pelvi-ureteric physiology in patients with AR at the 3rd month after RTx were similar compared to patients without AR.

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