Aslı Özkızılcık Koçyiğit, İbrahim Pirim, Tülay Kılıçaslan Ayna, Mustafa Soyöz

Böbrek Nakli Olan Hastalarda Nakil Sonrasında Oluşan Anti-HLA Antikorlarının Saptanması ve Çeşitli Parametrelerle İlişkisinin Değerlendirilmesi

Amaç: Bu çalışmada İzmir Tepecik Eğitim ve Araştırma Hastanesi’nde kadavra veya canlı donörden böbrek nakli olmuş hastaların nakil sonrasında periyodik olarak toplanan serum örneklerinde grefte karşı gelişen immünolojik cevabın ve ilgili faktörlerle arasındaki ilişkisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: 31 hasta serumunun anti-HLA antikor tarama ve tanımlama testleri flow sitometrik yöntemle yapılmıştır. Bu serum örnekleri, hastanemizde nakilden sonra periyodik olarak (1. gün, 1. hafta, 2. hafta, 4. hafta, 12. hafta, 24. hafta ve 52. hafta) toplanmıştır. Bütün örneklere tarama testi yapılırken, sadece PRA pozitif olan serum örneklerine anti-HLA antikor tipini belirlemek amacıyla tanımlama testi uygulanmıştır. Bütün prosedürler üretici firmanın talimatlarına göre yapılmıştır. Diğer parametreler Pearson korelasyon testiyle istatistiksel oalrak değerlendirilmiştir. Bulgular: Nakilden sonra 52. haftadan sonra hastaların sırasıyla %12,9 ile %6,45’i anti-HLA sınıf I ve II antikorları bakımından pozitif bulunmuştur. Hastalarda 1. gün, 1., 2., 4. ve 12. haftalarda mismatch antijenlere karşı antikor oluşumu gözlenmemiştir. Bir hastada antikorlar 24. haftadan itibaren oluşmuştur. Yapılan korelasyon analizlerinde hastaların nakil sonrası son kreatinin değerleriyle donör yaşları ve GFR değerleriyle hasta yaşları arasında istatistiksel olarak anlamlı sonuçlar elde edilmiştir (sırasıyla p<0.001, p<0.01). Nakil sonrasında de novo antikor üreten hastaların kreatinin değerleriyle antikor üretimi arasında ilişki bulunmamıştır (p>0.05). Sonuç: Nakil öncesinde kan transfüzyonu olan bir hastada 12. haftada anti-HLA antikoru oluştuğu görülmüştür. 5 hastada 24. haftadan sonra antikor oluşmuştur. Dolayısıyla nakil sonrası 12. haftadan itibaren rutinde yapılacak anti-HLA antikoru tarama testleri tedavi protokolü için önemli olabilir.

Anahtar Kelimeler:

böbrek nakli, doku uyumu, HLA

Detection of Anti-HLA Antibodies Produced After Transplantation in Renal Transplants and Evaluation of Its Association with the Other Parameters

Aim: In this study, it was aimed to evaluate the immunological response to graft and its association with related factors in the sera samples collected periodically from patients transplanted from deceased or alive donors in Izmir Tepecik Education and Research Hospital.Material and Method: Anti-HLA antibody screening and identification tests of 31 patient sera samples were performed by flow cytometric method. The sera samples were collected periodically (1st day, 1st week, 2nd week, 4th week, 12th week, 24th week and 52nd week) after transplantations in our hospital. After the screening of all samples, anti-HLA antibodies of PRA positive samples were identified. All of procedures were performed according to the manufacturer’s instructions. The other parameters were statistically evaluated by Pearson correlation test.Results: Of the patients, 12.9% and 6.45% were only class I and II positive in the post-transplant 52nd week, respectively. None of the patients was class I and II positive. It was found that antibodies were not produced against mismatched antigens on the 1st day, 1st, 2nd, 4th, and 12th weeks after transplantation. The antibodies were produced 24 weeks after transplantation in some cases. However, the results could not be evaluated statistically because of the small patient group. There were statistically significant correlations between last creatinine levels-donor ages and GFR values-patient ages (p<0.001, p<0.01, respectively), whereas there was no significant association between antibody production and creatinine levels. Conclusion: It was observed that anti-HLA antibodies were produced before transplantation in a patient with pre-transplant blood transfusion. The antibodies were produced in 24th week in five patients. Therefore, anti-HLA antibody screening tests to be performed on the 12th week after transplantation may be important for the treatment protocol.

Keywords:

kidney transplantation, histocompatibility, HLA,

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