Long-Term Effects of Antibodies Against Human Leukocyte Antigens Detected by Flow Cytometry in the First Year After Renal Transplantation

Abstract

Objective: In this study, we aimed to investigate the incidence, dynamics and profiles of human leukocyte antigen (HLA)-directed antibodies developed after transplantation and their impact on graft rejection and outcome in kidney recipients. Study Design: Prospective follow-up study. Material and Methods: A total of 56 kidney recipients were monitored at 1st, 6th and 12th months for the development of anti-HLA antibodies using bead based flow-cytometry assays (Flow PRA tests). Results: In 21 (37.5%) patients, panel reactive antibodies (PRA) was positive after transplantation, however, in 35 (62.5%) patients PRA was found negative. Twelve (57.1%) patients with post-transplantation HLA-reactive antibodies [PRA (+)] and 8 (22.9%) patients with no detectable alloantibodies [PRA (-)] were developed allograft rejection (p=0.010). In the PRA positive patient group the rates of early period infection and delayed graft function (DGF) were higher than the PRA negative patient group. Serum creatinine levels of PRA positive group at 6. and 12. months after transplantation were significantly higher than the PRA negative group (p=0.015 and p=0.048, respectively). The rejection rates of patients who had class I and II HLA antibodies were significantly higher than the patients who had either class I or II HLA antibodies (p=0.011). Acute rejection rates were significantly higher in patients who had class I and II HLA antibodies at the first month (p=0.007). Conclusion: Higher occurrence of rejection episodes in PRA positive group may show the importance of anti-HLA antibody monitoring using Flow-PRA after renal transplantation as a prognostic marker in terms of graft survival. Turkish Başlık: Böbrek Nakli Sonrası Birinci Yılda Akım Sitometri ile Saptanan İnsan Lökosit Antijenlerine Özgü Antikorların Uzun Dönem Etkileri Anahtar Kelimeler: Anti-HLA antikorları, akım sitometri, böbrek nakli Amaç: Bu çalışmada transplantasyon sonrası gelişen İnsan Lökosit Antijenlerine Özgü Antikorların (anti- Human Leukocytes Antigen-(HLA) antibody) etkilerini, dinamik ve profillerini araştırmayı amaçladık. Gereç ve Yöntemler: Toplam 56 böbrek alıcısı akım sitometri temelli boncuk testleri ile 1., 6. ve 12. aylarda anti-HLA antikorları izlendi. Bulgular: Nakil sonrası hastaların 21'inde (% 37,5), panel reaktif antikorlar (PRA)pozitif iken, 35'inde (% 62,5) negatif olduğu bulundu. Nakil sonrası Panel reaktif antikora sahip [PRA(+)] hastaların 12'sinde (%57,1) ve panel reaktif antikor saptanmayan hastaların 8'inde (% 22,9) allograft rejeksiyonu gelişti (p=0.010). PRA pozitif hasta grubunda erken dönem infeksiyon oranı ve gecikmiş graft fonksiyonu (delayed graft function-DGF) oranı, PRA negatif hasta grubundan daha yüksekti. PRA pozitif grupta nakil sonrası 6. ve 12. aylardaki serum kreatinin düzeyleri, PRA negatif gruptan anlamlı derecede yüksekti (p= 0,015, ve p0 0.048 sırasıyla). Sınıf I ve sınıf II HLA antikorları olan hastaların rejeksiyon oranı, ya sınıf I yada sınıf II HLA antikorları olan hastalardan önemli derecede yüksekti (p= 0.011). Akut rejeksiyon oranları birinci ayda sınıf I ve sınıf II HLA antikorları olan hastalarda anlamlı derecede yüksekti ( p=0.007) Sonuç: Böbrek transplantasyonu sonrasında PRA pozitif grupta rejeksiyon ataklarının daha yüksek olması, graft sağkalımında prognostik belirteç olarak Flow-PRA ile anti-HLA antikorlarının takip edilmesinin önemini gösterebilir.

Keywords

• Anti-HLA antibodies, flow cytometry, renal transplantation

Long-Term Effects of Antibodies Against Human Leukocyte Antigens Detected by Flow Cytometry in the First Year After Renal Transplantation

Öz

Kaynakça

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