Yalçın SEYHUN, Çiğdem KEKİK, Savran Fatma OĞUZ, YAŞAR KEREM ÇALIŞKAN, Aydın TÜRKMEN, Mahmut ÇARİN

Canlı donörden böbrek transplantasyonu yapılan hastalarda minör HA-1 dağılımı

Amaç: Son dönem böbrek yetersizliği (SDBY) olan hastalar için hayat standartlarını arttıran bir tedavi yöntemi olan böbrek naklinde HLA uyumunun önemi bilinen bir gerçektir. Alıcı ve verici arasındaki İnsan Lökosit Antijenleri (Human Leukocyte Antigens, HLA) uyumunun, allojenik böbrek transplantasyonu sonrası graft sağkalımı üzerine önemli bir etkisi vardır. Ancak HLA identik kardeşler arası yapılan transplantlar da graft kaybı ile sonlanabilmektedir. Minör histokompatibilite antijenleri (mHag) HA-1, 19. kromozom üzerindeki diallelik genlerce kodlanan, 9 aminoasitlik düşük polimorfizm gösteren immünojenik bir peptiddir. Minör histokompatibilite antijenleri, HLA uyumlu solid organ transplantasyonlarının graft rejeksiyonu için potansiyel bir risk faktörüdür. Yaptığımız bu çalışmada böbrek transplantasyonunda mHA-1 uyumu veya uyumsuzluğunun, transplant sonrası graft sağkalımı ile ilişkisini araştırmayı amaçladık. Hastalar ve Yöntemler: Son dönem böbrek yetersizliği tanısı konmuş 59 hasta ile onların akraba vericileri çalışmaya alındı. Minör HA-1 genotipleri ise PCR-SSP yöntemiyle ticari kitler kullanılarak yapıldı. Bulgular: 59 hastada HH, RR, HR genotiplerinin sıklıkları sırası ile %17, %25 ve %58 idi. Rejeksiyon/rejeksiyon atağı saptanması ile mHA-1 uyumu açısından anlamlı bir fark saptanmadı (p=0.73, Or=1.44, güven aralığı=0.36-5.74; Fischer's Exact Test). Kronik Allograft Nefropatisi (KAN) gelişimi ile mHA-1 uyumu açısından anlamlı bir fark saptanmadı (p=0.61, Or=2.89, güven aralığı=0.28-29.57; Fischer's Exact Test). Sonuç: Yaptığımız çalışmada canlı donörden böbrek nakillerinde rejeksiyon ile HA-1 uyumsuzluğu arasında anlamlı bir fark saptayamadık.

Characterization of minor HA-1 in patients who underwent living donor kidney transplantation

Objectives: The importance of the Human Leukocyte Antigens (HLA) matching is well known in renal transplantation that is one of the best treatment options for end-stage solid organ deficiency. Human Leukocyte Antigens matching between recipient and donor has an influence on graft survey after the renal transplantation. However allogeneic renal transplants between HLA identical siblings might be ended with rejection. Minor histocompatibility antigen (mHag) HA-1 is a nine-amino acid peptide encoded by a diallelic gene on human chromosome 19. mHags have low polymorphisms. Minor histocompatibility antigens are likely to function as potantial risks for graft rejection of HLAmatched solid organ transplantation. In our study, we aimed to investigate the effect of minor HA-1 mismatch on kidney transplant survey. Patients and Methods: We examined the HA-1 locus in living donor renal transplant patients (n=59) and their donors. We used PCR-SSP for HA-1 typing. Results: The frequencies of the three possible genotypes HH, RR, HR were 17%, 25% and 58%, respectively, in recipients. No significant correlation was established between the occurrence of rejection/rejection episodes and HA-1 matching (p=0.73, Or=1.44, Confidence intervals= 0.36-5.74; Fischer's Exact Test). In addition, no significant carrelation was established between CAN (chronic allograft nephropathy) and mHA-1 matching (p=0.61, Or=2.89, Confidence intervals=0.28-29.57; Fischer's Exact Test). Conclusion: We could not find relation between graft survey and HA-1 match/mismatch in living donor kidney transplantation.

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