Publication: Pretransplant Gelişmiş Hla Sınıf I ve II Panel Reaktif Antikorların Böbrek Allogrefti Üzerine Klinik ve Patolojik Düzeyde Etkileri
Abstract
AMAÇ: Böbrek nakli öncesi gelişmiş ve tepe-PRA düzeyleri kullanılarak değerlendirilen anti-HLA Sınıf-I ve II antikorlarının, klinik sonlanımlar ve histopatolojik düzeyde allogreft üzerine olan etkileri araştırıldı.GEREÇ ve YÖNTEMLER: Merkezimizde böbrek nakli olan 111 hastanın verileri geriye dönük olarak değerlendirildi. Tepe-PRA düzeyinin >%15 olması, HLA Sınıf-I ve/veya Sınıf-II antikorlar için pozitif kabul edildi. Lenfosit çapraz karşılaştırma (LÇK) ve PRA düzeyi ölçümlerinde akım sitometri yöntemi kullanıldı. Preoperatif bütün hastalarda LÇK negatifti. Histopatolojik olarak allogreft biyopsileri Banff 2011 kriterlerine göre HLA antikorların etkileri açısından değerlendirildi.BULGULAR: PRA Sınıf-I %21,5, PRA Sınıf-II ise %22,5 hastada pozitifti. PRA Sınıf-II pozitif hastalar, negatif olanlarla kıyaslandığında anlamlı olarak greft kaybı (p=0,028), ölüm-dışı greft kaybı (p=0,008), akut rejeksiyon (p=0,016) ve kronik rejeksiyon gelişimi (p=0,029) daha fazla bulundu. Histopatolojik olarak, PRA Sınıf-II pozitif olan hastalarda, negatif olanlara göre peritubular kapillerit skorunun daha yüksek (0,44±0,78'e karşı 1,55±1,12, p=0,008) ve glomerülit+peritubular kapillerit skorunun >=2 olan hastaların daha fazla olduğu bulundu (%64'e karşı %36, p=0,026). PRA Sınıf-I ve PRA Sınıf I+II pozitif olanlarda ise klinik veya histopatolojik düzeyde negatif olanlara göre anlamlı bir farklılık yoktu.SONUÇ: Böbrek nakli öncesi PRA yöntemi ile saptanmış HLA Sınıf-II antikoru olan hastalar, LÇK negatif olsa bile allogreft rejeksiyonu ve azalmış greft sağ kalımı riski taşırlar
OBJECTIVE: The aim of the study was to investigate the influence of preformed anti-HLA antibodies that are represented by peak PRA levels on clinical and histopathologic outcomes of kidney allograft. MATERIAL and METHODS: The study was a retrospective cohort that consisted of 111 kidney transplant recipients. A peak PRA level greater than 15% was accepted positive for HLA class I and II antibodies. Flow cytometric assay was used for PRA and lymphocyte cross-match (LCM). All recipients were LCM negative. Allograft biopsies were indication biopsy and evaluated according to Banff 2011 criteria to investigate the influence of HLA antibodies.RESULTS: PRA was positive in 21.5% of patients for Class-I and 22.5% for Class-II antibodies. PRA Class-II positive patients had significantly more graft failure (p=0.028), death censored graft failure (p=0.008), acute rejection (p=0.016) and chronic rejection (p=0.029). Regarding the pathological evaluation, peritubular capillaritis score was significantly higher in PRA Class-II positive patients (0.44±0.78 vs. 1.55±1.12, p=0.008) and more patients had a glomerulitis+peritubular capillaritis score >=2 (64% vs. 36%, p=0.026). These significant clinical and pathological outcomes were not observed for PRA Class-I and PRA Class I+II positive patients.CONCLUSION: Preformed anti-HLA Class-II antibodies are responsible for increased allograft rejection and reduced graft survival despite the negative flow cytometric lymphocyte crossmatch in kidney transplantation
OBJECTIVE: The aim of the study was to investigate the influence of preformed anti-HLA antibodies that are represented by peak PRA levels on clinical and histopathologic outcomes of kidney allograft. MATERIAL and METHODS: The study was a retrospective cohort that consisted of 111 kidney transplant recipients. A peak PRA level greater than 15% was accepted positive for HLA class I and II antibodies. Flow cytometric assay was used for PRA and lymphocyte cross-match (LCM). All recipients were LCM negative. Allograft biopsies were indication biopsy and evaluated according to Banff 2011 criteria to investigate the influence of HLA antibodies.RESULTS: PRA was positive in 21.5% of patients for Class-I and 22.5% for Class-II antibodies. PRA Class-II positive patients had significantly more graft failure (p=0.028), death censored graft failure (p=0.008), acute rejection (p=0.016) and chronic rejection (p=0.029). Regarding the pathological evaluation, peritubular capillaritis score was significantly higher in PRA Class-II positive patients (0.44±0.78 vs. 1.55±1.12, p=0.008) and more patients had a glomerulitis+peritubular capillaritis score >=2 (64% vs. 36%, p=0.026). These significant clinical and pathological outcomes were not observed for PRA Class-I and PRA Class I+II positive patients.CONCLUSION: Preformed anti-HLA Class-II antibodies are responsible for increased allograft rejection and reduced graft survival despite the negative flow cytometric lymphocyte crossmatch in kidney transplantation