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

Year 2020, Volume: 15 Issue: 2, 121 - 126, 12.06.2020

Mustafa Gürkan Yenice Serdar Karadağ Ubeyd Sungur , Fatih Gökhan Akbay , Kamil Gökhan Şeker , Ahmet Faysal Güler Alev Kural Süheyla Apaydın Ali İhsan Taşçı

https://doi.org/10.33719/yud.643442

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

References

• 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.