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

Abstract

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.

Keywords

• B2-mikroglobulin,inflamasyon,pentraksin,transplantasyon

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

Abstract

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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