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

Year 2018, Volume: 25 Issue: 4, 385 - 392, 01.12.2018

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

https://doi.org/10.17343/sdutfd.363352

Abstract

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 (1^st day, 1^st week, 2^nd week, 4^th
week, 12^th week, 24^th week and 52^nd 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 52^nd 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, 2^nd, 4^th, and 12^th
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
24^th 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

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

Abstract

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.

Keywords

böbrek nakli, doku uyumu, HLA

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