Böbrek nakilli hastalarda rejeksiyon gelişimi için risk faktörler

Yıl 2020, Cilt: 45 Sayı: 1, 215 - 222, 31.03.2020

Mustafa Ergin Ebru Gok Oguz Ozlem Yayar Kadir Gokhan Atilgan Sanem Oztekin Mehmet Deniz Ayli

Öz

Amaç: Bu çalışmada, kendi hasta populasyonumuzda böbrek nakil rejeksiyonu gelişimi için risk faktörü olabilecek parametrelerin değerlendirilmesini amaçladık.
Gereç ve Yöntem: Organ nakli ünitemizde yapılan nakil böbrek biyopsilerin sonuçları retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, primer böbrek hastalıkları, eşlik eden hastalıkları ve perkütan iğne biyopsisi anındaki laboratuar verileri kaydedildi. 45 hastaya yapılan 49 adet biyopsi verileri karşılaştırıldı.
Bulgular: Böbrek nakilli 45 hastaya yapılan toplam 49 biyopsi incelendiğinde biyopsi yapılma endikasyon sıklığı en sık olarak 34 biyopsi (%69.4) ile akut böbrek hasarı idi. Histopatolojik inceleme ile 23 (% 46.7) biyopside rejeksiyon saptandı. BK nefropati saptanan biyopsi sayısı 4 iken (%8.1), ilaç toksisitesi olarak kalsinörin inhibitörü toksisitesi 10 biyopside (%20.5) ve kronik allograft nefropatisi de 11 biyopside (%22.6) görüldü. 1 biyopside (%2.1) tekrarlayan glomerulonefrit saptandı. Rejeksiyon saptanan grup rejeksiyon saptanmayan grupla karşılaştırıldığında biyopsi anında serum glukoz, ürik asit ve total kolesterol düzeylerinin yüksek, hemoglobin değerlerinin daha düşük olduğu belirlenmiştir (hepsi için. Lojistik regresyon analizi ile, ürik asit ve glukoz yüksekliği rejeksiyon gelişimi için bağımsız risk belirleyicileri olarak tanımlanmıştır.
Sonuç: Hiperürisemi ve hipergliseminin böbrek nakli sonrası rejeksiyon gelişimini öngörebileceği düşünülmüştür. 

Anahtar Kelimeler

kidney transplantation, rejection, uric acid

Risk factors for development of rejection in kidney transplant patients

Öz

Purpose: The aim of this study was to evaluate the parameters that may be a risk factor for the development of rejection in our patient population.
Materials and Methods: The results of the biopsies performed in our organ transplantation unit were evaluated retrospectively. Demographic data of the patients about primary renal disease, concomitant disease and laboratory data in the time of biopsy were recorded. Forty-nine biopsies made for 45 patients and the results were compared.
Results: The most common cause of kidney biopsy was acute renal injury (34 biopsies, 69.4%). Histopathological examination revealed rejection in 23 (46.7%) biopsies. BK nephropathy was detected in 4 patients (8,1%), while the calcineurin inhibitor toxicity was found in 10 patients (20.5%). Chronic allograft nephropathy was observed in 11 biopsies (22.6%) and recurrent glomerulonephritis was detected in 1 biopsy (2.1%). Serum glucose, uric acid and total cholesterol levels were higher and hemoglobin levels were lower in the rejection group. By logistic regression analysis, uric acid and glucose elevation were defined as independent risk determinants for the development of rejection.
Conclusion: Hyperuricemia and hyperglycemia may predict the development of rejection after renal transplantation.

Anahtar Kelimeler

kidney transplantation, rejection, uric acid

Kaynakça

• 1. Meier-Kriesche HU, Ojo AO, Hanson JA, Cibrik DM, Punch JD, Leichtman AB, Kaplan B: Increased impact of acute rejection on chronic allograft failure in recent era. Transplantation. 2000;70(7):1098-1100.
• 2. Sellarés J, de Freitas DG, Mengel M, Reeve J, Einecke G, Sis B, Hidalgo LG, Famulski K, Matas A, Halloran PF: Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant. 2012;12(2):388-399.
• 3. Roberts DM, Jiang SH, Chadban SJ: The treatment of acute antibody-mediated rejection in kidney transplant recipients a systematic review. Transplantation. 2012; 94(8): 775-783.
• 4. Nankivell, BJ, Alexander SI. Rejection of the kidney allograft. N Engl J Med. 2010; 7;363(15):1451-1462.
• 5. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009; 9(3):1-155.
• 6. Rush D, Arlen D, Boucher A, Busque S, Cockfield SM, Girardin C, Knoll G, Lachance JG, Landsberg D, Shapiro J, Shoker A, Yilmaz S: Lack of benefit of early protocol biopsies in renal transplant patients receiving TAC and MMF: a randomized study. Am J Transplant. 2007;7(11):2538-2545.
• 7. Mehta R, Cherikh W, Sood P, Hariharan S: Kidney allograft surveillance biopsy practices across US transplant centers: A UNOS survey. Clin Transplant. 2017;31(5).
• 8. Leal R, Pinto H, Galvao A, Santos L, Romaozinho C, Macario F, et al: Nephrotic range proteinuria in renal transplantation: Clinical and histologic correlates in a 10 year retrospective study. Elsevier Inc. 2017;7929.
• 9. Sellarés J, de Freitas DG, Mengel M, Reeve J, Einecke G, Sis B, Hidalgo LG, Famulski K, Matas A, Halloran PF: Understanding the causes of kidney transplant failure: The dominant role of antibody‐mediated rejection and nonadherence. Am J Transplant. 2012;12(2):388-399.
• 10. Seyahi N, Ateş K, Süleymanlar G: Current Status of Renal Replacement Therapies in Turkey: Turkish Society of Nephrology Registry 2015 Summary Report. Turk Neph Dial Transpl 2017;26 (2):154-160.
• 11. First M.R: Renal function as a predictor of long‐term graft survival in renal transplant patients. Nephrology Dialysis Transplantation, 2003,18(1): 3-6.
• 12. Almond PS, Matas A, Gillingham K, Dunn DL, Payne WD, Gores P, Gruessner R, Najarian JS: Rısk factors for chronic rejectıon ın renal allograft recipients. Transplantation. 1993;55(4):752-756.
• 13. Maury CP, Teppo AM: Comparative study of serum amyloid-related protein SAA, C- reactive protein, and beta 2-microglobulin as markers of renal allograft rejection. Clin Nephrol. 1984;22(6):284-292.
• 14. Fink JC, Onuigbo MA, Blahut SA, Christenson RH, Mann D, Bartlett ST, Weir MR: Pretransplant serum C-reactive protein and the risk of chronic allograft nephropathy in renal transplant recipients: a pilot case-control study. Am J Kidney Dis. 2002 ;39(5):1096-1101.
• 15. Feig DI , Kang DH, Johnson RJ: Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811-1821.
• 16. Corry DB, Eslami P, Yamamoto K, Nyby MD, Makino H, Tuck ML: Uric acid stimulates vascular smooth muscle cell proliferation and oxidative stress via the vascular renin–angiotensin system. J Hypertens. 2008; 26(2):269-275.
• 17. Akgul A, Bilgic A, Ibis A, Ozdemir FN, Arat Z, Haberal M: Is uric acid a predictive factor for graft dysfunction in renal transplant recipients Transplant Proc. 2007;39(4):1023-1026.
• 18. Meier-Kriesche HU, Schold JD, Vanrenterghem Y, Halloran PF, Ekberg H: Uric acid levels have no significant effect on renal function in adult renal transplant recipients: evidence from the symphony study. Clin J Am Soc Nephrol. 2009;4(10):1655-1660.
• 19. Kim ED, Famure O, Li Y, Kim SJ: Uric acid and the risk of graft failure in kidney transplant recipients: a re-assessment. Am J Transplant. 2015;15(2):482-8.
• 20. Gerhardt U, Grosse Hüttmann M, Hohage H: Influence of hyperglycemia and hyperuricemia on long‐term transplant survival in kidney transplant recipients. Clin Transplant. 1999;13(5):375-379.
• 21. Akalin E, Ganeshan SV, Winston J, Muntner P: Hyperuricemia isassociated with the development of the composite outcomes ofnew cardiovascular events and chronic allograft nephropathy. Transplantation. 2008;86(5):652-658.
• 22. Haririan A , Nogueira JM, Zandi-Nejad K, Aiyer R, Hurley H, Cooper M, Klassen DK, Weir MR: The independent associationbetween serum uric acid and graft outcomes after kidney transplantation. Transplantation. 2010;89(5):573-579.
• 23. Zhang K, Gao B, Wang Y, Wang G, Wang W, Zhu Y, Yao L, Gu Y, Chen M, Zhou H, Fu Y: Serum Uric Acid and Renal Transplantation Outcomes: At Least 3-Year Post-transplant Retrospective Multivariate Analysis. PLoS One. 2015;10(7):e0133834.
• 24. Kim DG, Kim BS, Choi HY, Lim BJ, Huh KH, Kim MS, Jeong HJ, Kim YS: Association between post-transplant uric acid level and renal allograft fibrosis: Analysis using Banff pathologic scores from renal biopsies. Sci Rep. 2018;8(1):11601.
• 25. Ganji MR, Charkhchian M, Hakemi M, Nederi GH, Solymanian T, Saddadi F, Amini M, Najafi I: Association of hyperglycemia on allograft function in the early period after renal transplantation. Transplant Proc. 2007;39(4):852-854.
• 26. Sheu A, Depczynski B, O'Sullivan AJ, Luxton G, Mangos G: The Effect of Different Glycaemic States on Renal Transplant Outcomes. J Diabetes Res.2016;2016:8735782.
• 27. Nampoory MR, Johny KV, Costandi JN, Gupta RK, Nair MP, Samhan M, al-Muzairai IA, al-Mousawi M: Inferior long-term outcome of renal transplantation in patients with diabetes mellitus. Med Princ Pract. 2002;11(1):29-34.
• 28. Hermayer KL, Egidi MF, Finch NJ, Baliga P, Lin A, Kettinger L, Biggins S, Carter RE: A randomized controlled trial to evaluate the effect of glycemic control on renal transplantation outcomes, J Clin Endocrinol Metab. 2012;97(12):4399-43406.
• 29. Tufton N, Ahmad S, Rolfe C, Rajkariar R, Byrne C, Chowdhury TA: New-onset diabetes after renal transplantation, Diabet Med. 2014;31(11):1284-1292.