Turk J Immunol. 2015; 3(3): 105-110 | DOI: 10.5606/tji.2015.449

The Effect of Panel Reactive Antibody Results on Graft Functions of Patients with Chronic Kidney Failure

Ýbrahim Pirim¹, Tülay Kýlýçaslan Ayna¹, Derya Güleç², Mustafa Soyoz¹, Aslý Özkýzýlcýk Koçyiðit¹, Toprak Hamdi Güngör¹, Ceren Yüksel¹, Burcu Çerçi Gürbüz¹, Ýsmail Totur¹, Burcu Akman¹, Erhan Tatar³, Cem Tüðmen⁴, Ýsmail Sert⁴, Zeki Soyaçacý⁵, Adam Uslu^6
1Department of Biology and Genetics, Medical Faculty of Ýzmir Katip Çelebi University, Ýzmir, Turkey
²Department of Tissue Typing Laboratory, Ýzmir Tepecik Teaching and Research Hospital, Ýzmir, Turkey
³Department of Internal Medicine, Nephrology, Ýzmir Teaching and Research Hospital, Ýzmir, Turkey
⁴epartment of General Surgery, Ýzmir Teaching and Research Hospital, Ýzmir, Turkey
⁵Department of Internal Medicine, Nephrology, Ýzmir Atatürk Teaching and Research Hospital, Ýzmir, Turkey
⁶Department of Surgery, Ýzmir Teaching and Research Hospital, Ýzmir, Turkey

Objectives: This study aims to evaluate panel reactive antibody (PRA) results of patients with chronic kidney failure (CKF) and to obtain information about pre-transplantation PRA results and graft function of transplanted patients. Patients and methods: We evaluated PRA results of 2,517 patients (1,428 males, 1,089 females; mean age 49.9±14.7; range 2 to 82 years) with CKF on the waiting list and 304 transplanted patients (178 males, 126 females; mean age 41.1±11.4; range 9 to 71 years). Of the PRA tests, 85% and 15% were performed by Luminex and flow cytometric methods, respectively. The final post-transplantation serum creatinine levels and transplantation ages of the patients were recorded. We also assessed glomerular filtration ratio (GFR) for graft functions of transplanted patients. Results: Of the PRA positive patients (40.52%) on the waiting list, 12.55% were class I PRA positive (group 1), 8.78% were class II PRA positive (group 2), and 19.19% were both class I and II PRA positive (group 3). Of the patients, 59.48% were PRA negative (group 4). Pre-transplantation negative PRA results (group 4) were significantly higher among patients who were transplanted from related donor (78.09%) than patients with cadaveric transplantation (48.88%) and patients on the waiting list (59.48%) (p<0.05). Glomerular filtration ratios (GFRs) were higher among patients who were transplanted from related donor for all PRA groups. Of transplanted patients, although GFR values of the patients who had acute rejection episode (ARE) were higher than those without ARE, there was no statistically significant difference in between. Conclusion: Regularized pre-transplantation PRA tests and cautious evaluation of their results constitute great importance to prevent ARE and increase graft survival in Turkey, which is a country with already low organ donation ratios.

Keywords: Chronic kidney failure; graft function; panel reactive antibody.

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Panel Reaktif Antikor Sonuçlarýnýn Kronik Böbrek Yetmezliði Olan Hastalarýn Greft Fonksiyonu Üzerindeki Etkisi

Ýbrahim Pirim¹, Tülay Kýlýçaslan Ayna¹, Derya Güleç², Mustafa Soyoz¹, Aslý Özkýzýlcýk Koçyiðit¹, Toprak Hamdi Güngör¹, Ceren Yüksel¹, Burcu Çerçi Gürbüz¹, Ýsmail Totur¹, Burcu Akman¹, Erhan Tatar³, Cem Tüðmen⁴, Ýsmail Sert⁴, Zeki Soyaçacý⁵, Adam Uslu^6
1Department of Biology and Genetics, Medical Faculty of Ýzmir Katip Çelebi University, Ýzmir, Turkey
²Department of Tissue Typing Laboratory, Ýzmir Tepecik Teaching and Research Hospital, Ýzmir, Turkey
³Department of Internal Medicine, Nephrology, Ýzmir Teaching and Research Hospital, Ýzmir, Turkey
⁴epartment of General Surgery, Ýzmir Teaching and Research Hospital, Ýzmir, Turkey
⁵Department of Internal Medicine, Nephrology, Ýzmir Atatürk Teaching and Research Hospital, Ýzmir, Turkey
⁶Department of Surgery, Ýzmir Teaching and Research Hospital, Ýzmir, Turkey

Amaç: Bu çalýþmanýn amacý kronik böbrek yetmezliði (KBY) olan hastalarýn panel reaktif antikor (PRA) sonuçlarýnýn deðerlendirilmesi ve nakil öncesi PRA sonuçlarý ile nakil yapýlan hastalarýn greft fonksiyonu hakkýnda bilgi edinildi. Hastalar ve yöntemler: Bekleme listesindeki KBY olan 2.517 hastanýn (1.428 erkek, 1.089 kadýn; ort. yaþ 49.9±14.7 yýl; daðýlým 2-82 yýl) ve nakil yapýlan 304 hastanýn (178 erkek, 126 kadýn; ort. yaþ 41.1±11.4 yýl; daðýlým 9-71 yýl) PRA sonuçlarý deðerlendirildi. Panel reaktif antikor testlerinin %85 ve %15’i sýrasýyla Luminex ve akým sitometri yöntemleriyle yapýldý. Hastalarýn nakil sonrasý son serum kreatinin düzeyleri ve nakil yaþlarý kaydedildi. Ayrýca, nakil olan hastalarýn greft fonksiyonlarý için glomerüler filtrasyon hýzý (GFH) incelendi. Bulgular: Bekleme listesindeki PRA pozitif hastalarýn (%40.52) %12.55’i sýnýf I PRA pozitif (grup 1), %8.78’i sýnýf II PRA pozitif (grup 2) ve %19.19’u hem sýnýf I hem sýnýf II PRA pozitif (grup 3) idi. Hastalarýn %59.48’i PRA negatif (grup 4) idi. Nakil öncesi negatif PRA sonuçlarý (grup 4) canlý vericiden nakil yapýlan hastalarda (%78.09) kadavradan nakil yapýlan (%48.88) ve bekleme listesinde olan hastalardan (%59.48) anlamlý þekilde daha yüksekti (p<0.05). Glomerüler filtrasyon hýzlarý tüm PRA gruplarý için canlý vericiden nakil olan hastalarda daha yüksekti. Nakil yapýlan hastalarda akut rejeksiyon ataðý (ARA) olanlarýn GFR deðerleri ARA’sý olmayanlardan daha yüksek olsa da aralarýnda istatistiksel olarak anlamlý farklýlýk yoktu. Sonuç: Halihazýrda organ baðýþý oranlarýnýn düþük olduðu bir ülke olan Türkiye’de ARE’yi önlemek ve greft saðkalýmýný artýrmak için düzenli uygulanan nakil öncesi PRA testleri ve bunlarýn sonuçlarýnýn dikkatle deðerlendirilmesi büyük önem taþýmaktadýr.

Anahtar Kelimeler: Kronik böbrek yetmezliði; greft fonksiyonu; panel reaktif antikor.

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