Mustafa Gürkan YENİCE, Serdar KARADAĞ, Ubeyd SUNGUR, Fatih Gökhan AKBAY, Kamil Gökhan ŞEKER, Ahmet Faysal GÜLER, Alev KURAL, Süheyla APAYDIN, Ali İhsan TAŞÇI

Renal Transplantasyon Sonrası Erken Dönemde İnflamatuar Marker Olarak B-2 Mikroglobulin ve Pentraksinin Kullanımı

Amaç: Kronik böbrek hastalığında böbrek nakil alıcılarında inflamasyon belirteci olarak en sık kullanılan biyomarker CRP olmuş, renal fonksiyonlar ise kreatinin düzeyleri ile takip edilmiştir. Bu çalışmada inflamatuar belirteç olarak B-2 mikroglobulin ve pentraksin seviyelerinin renal transplant yapılan hastalarda erken dönemdeki seyrini kaydettik ve inflamasyon belirteci olarak kullanılabilirliğini belirlemeyi amaçladık Materyal ve Metod: Çalışma Ocak-Haziran 2017 tarihleri arasında canlı donörlerden böbrek nakli yapılan 23 yetişkin hasta ile yapılan prospektif bir gözlem çalışmasıdır. Hastaların demografik özellikleri, transplantasyon sonrası ilk gün, 3.gün , 7.gün ve 30.gün kan örnekleri alınarak biyokimya parametreleri ve inflamasyon belirteçleri çalışıldı. Bulgular: Çalışmamıza alınan 23 hastanın 18’i (%78) transplantasyon öncesi diyaliz programındaydı, 5 hasta (% 22) ise preemptif diyaliz aldı. Laboratuar çalışmalarda B2 Mikroglobulin seviyelerinde postoperatif ilk gün 3. Gün ve 7.gün anlamlı düşüşler (p<0,05) izlenmekle beraber 1.hafta ile 1.ay arasında anlamlı fark saptanmadı ( p>0.05) . Kreatinin seviyeleri ise 3.günde ilk güne göre anlamlı olarak düştüğü izlenirken 1.hafta ve 1.ayda ise anlamlı değişim göstermedi. B2 mikroglobulin ile kreatinin arasında postop 0.gün ile 3.gün, 7.gün ve 1.ayda anlamlı pozitif korelasyon saptandı (p< 0.05) . Pentraksin ve CRP seviyeleri ise 3.günde ilk güne göre anlamlı olarak yükseldi sonrasında 7.gün ve 1.ayda anlamlı olarak düştü. ( P< 0.05) Ancak Pentraksin değişimleri ile CRP değişimleri arasında anlamlı korelasyon saptanmadı. Sonuç: Böbrek transplant alıcılarında inflamasyonun erken dönemde belirlenmesi greft rejeksiyonu riski açısından önemlidir. Greft rejeksiyonu açısından ve renal fonksiyonların değerlendirilmesinde yeni belirteçler olarak B2 mikroglobulin ve Pentraksin seviyeleri kullanılabilir ancak bu konuda daha geniş hasta sayıları ile yapılacak randomize kontrollü çalışmalara ihtiyaç bulunmaktadır.

Anahtar Kelimeler:

B2-mikroglobulin, inflamasyon, pentraksin, transplantasyon

Use of B-2 Microglobulin and Pentraxin as an Inflammatory Marker in the Early Post-Renal Transplantation Period

Subject: CRP was the most commonly used marker of inflammation in renal transplant recipients in chronic renal disease, and renal functions were monitored with creatinine levels. In this study, we recorded the early course of B-2 microglobulin and pentraxin levels as inflammatory markers in renal transplant patients and aimed to determine its usefulness as markers of inflammation.Materials and Methods: This is a prospective observation study of 23 adult patients who underwent renal transplantation from living donors between January and June 2017. Demographic characteristics, blood samples ,biochemical parameters and inflammation markers were studied on the first day, 3rd day, 7th day and 30th day after transplantation.Results: Eighteen (78%) of the 23 patients included in our study were in the pre-transplant dialysis program and 5 (22%) received preemptive dialysis. There were significant decreases in B2 microglobulin levels on the first postoperative day on the 3rd day and 7th day (p <0.05), but no significant difference was found between the 1st week and the first month (p> 0.05). Creatinine levels decreased significantly on the third day compared to the first day. There was a significant positive correlation between B2 microglobulin and creatinine at postoperative day 0, day 3, day 7 and month 1 (p <0.05). Pentraxine and CRP levels increased significantly on the third day compared to the first day, then decreased significantly on the 7th day and the first month. (P <0.05) However, there was no significant correlation between pentraxin changes and CRP changes. Conclusion: Early detection of inflammation in renal transplant recipients is important for the risk of graft rejection. B2 microglobulin and pentraxin levels may be used as new markers for graft rejection and renal function evaluation, but randomized controlled trials with larger patient numbers are needed.

Keywords:

b2-microglobulin, inflammation, pentraxin, transplantation,

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1. Honda H, Qureshi AR, Heimbürger O, et al. Serum albumin, Creactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis. 2006;47(1):139-148.
2. Cicora F, Roberti J, Lausada N, et al. Immunosuppression in kidney donors with rapamycin and tacrolimus. Proinflammatory cytokine expression [in Spanish]. Medicina (B Aires). 2012;72(1):3-9.
3. Woitas RP, Stoffel-Wagner B, Poege U et al. Low-molecular weight proteins as markers for glomerular filtration rate. Clin Chem 2001; 47: 2179–2180.
4. Cheung AK, Rocco MV, Yan G et al. Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. J Am Soc Nephrol 2006; 17: 546–555
5. Bianchi C, Donadio C, Tramonti G et al. Reappraisal of serum beta2-microglobulin as marker of GFR. Ren Fail 2001; 23: 419–429.
6. Donadio C, Lucchesi A, Ardini M et al. Cystatin C, beta 2-microglobulin, and retinol-binding protein as indicators of glomerular filtration rate: comparison with plasma creatinine. J Pharm Biomed Anal 2001; 24: 835–842.
7. Bernier GM, Post RS. 2-Microglobulin. A marker of renal homograft survival. Transplantation 1973; 15: 176–179.
8. Poge U, Gerhardt T, Bokenkamp A et al. Time course of low molecular weight proteins in the early kidney transplantation period—influence of corticosteroids. Nephrol Dial Transplant 2004; 19: 2858–2863.
9.Matos AC, Durao MS Jr., Pacheco-Silva A. Serial beta-2 microglobulin measurement as an auxilliary method in the early diagnosis ofcytomegalovirus infection in renal transplant patients. Transplant Proc 2004; 36: 894–895.
10. Sasaki TM, Pirsch JD, D’Alessandro AM et al. Increased beta 2- microglobulin (B2M) is useful in the detection of post-transplant lymphoproliferative disease (PTLD). Clin Transplant 1997; 11: 29–33.
11. Mantovani A, Garlanda C, Bottazzi B, et al. The long pentraxin PTX3 in vascular pathology. Vascul Pharmacol. 2006;45(5):326- 330.
12. Boehme M, Kaehne F, Kuehne A, et al. Pentraxin 3 is elevated in haemodialysis patients and is associated with cardiovascular disease. Nephrol Dial Transplant. 2007;22(8):2224-2229.
13. Muller B, Peri G, Doni A, et al. Circulating levels of the long pentraxin PTX3 correlate with severity of infection in critically ill patients. Crit Care Med. 2001;29(7):1404-1407.
14. Kovacs A, Tornvall P, Nilsson R, Tegnér J, Hamsten A, Björkegren. Human C-reactive protein slows atherosclerosis development in a mouse model with human-like hypercholesterolemia. Proc Natl Acad Sci USA. 2007;104(34):13768-13773.
15. Tong M, Carrero JJ, Qureshi AR, et al. Plasma pentraxin 3 in patients with chronic kidney disease patients: associations with renal function, protein-energy wasting, cardiovascular disease, and mortality. Clin J Am Soc Nephrol. 2007;2(5):889-897.
16. Suliman ME, Qureshi AR, Carrero JJ, et al. The long pentraxin PTX- 3 in prevalent hemodialysis patients: associations with comorbidities and mortality. QJM. 2008;101(5):397-405.
17. Risch L, Blumberg A, Huber AR. Assessment of renal function in renal transplant patients using cystatin C. A comparison to other renal function markers and estimates. Ren Fail 2001; 23: 439–448.
18. Akbas SH, Yavuz A, Tuncer M et al. Serum cystatin C as an index of renal function in kidney transplant patients. Transplant Proc 2004; 36: 99–101.
19. Andriy V. Trailin, Marina V. Pleten, Tatiana I. Ostapenko, Nadiia F. Iefimenko, and Olexander S. Nikonenko, “High Serum Level of β2-Microglobulin in Late Posttransplant Period Predicts Subsequent Decline in Kidney Allograft Function: A Preliminary Study,” Disease Markers, vol. 2015, Article ID 562580, 10 pages, 2015
20. Mantovani A, Garlanda C, Doni A, Bottazzi B. Pentraxins in innate immunity: from C-reactive protein to the long pentraxin PTX3. J Clin Immunol. 2008;28(1):1-13.
21. Imai N, Nishi S, Yoshita K, et al. Pentraxin-3 expression in acute renal allograft rejection. Clin Transplant. 2012;26(Suppl 24):25-31.