The Investigation of Endomyocardial Biopsy Results, Plasma pro-BNP Levels and Non-invasive Parameters for Diagnosing of Acute Rejection in Patients Who Undergo Cardiac Transplantation

Yıl 2021, Cilt: 5 Sayı: 1, 11 - 17, 23.04.2021

Özgür Akkaya

https://doi.org/10.30565/medalanya.831555

Öz

Aim: Heart failure is a disease with high mortality and morbidity, reducing the patient's quality of life. Each year 10% of heart failure patients progress to end-stage heart failure. Cardiac transplantation is the gold standard treatment method in these patients, however acute rejection is the most important factor affecting the success of this treatment. In this study, it was aimed to evaluate endomyocardial biopsy results, serum pro-BNP and non-invasive parameters in patients with acute rejection following cardiac transplantation.

Patients and Methods: Twenty patients who underwent cardiac transplantation in our center were included in the study. The patients were divided into two groups, namely acute rejection (n: 10) and without rejection (n: 10). Echocardiography, electrocardiography (ECG), endomyocardial biopsy results, serum reactive proteins (CRP), sedimentation rate and serum pro-BNP levels, were evaluated among the patients and compared between the groups.

Results: Endomyocardial biopsies obtained from patients with acute rejection revealed grade 1 rejection in 6 (60%) patients, grade 2 in 3 (30%) patients and grade 3 rejection in 1 (10%) patients. CRP and sedimentation rate were found to be similar between the groups (p> 0.05). High pro-BNP levels were found in patients with rejection (4843.20 ± 6690.10 pg / ml) when compared to the control group (496.30± 216.20 pg / ml) (p: 0.001). In addition, higher pro-BNP levels were detected with progressing of rejection grade (p: 0.03). The highest pro-BNP level was found in a patient with Grade-3 rejection (15211 pg / ml, p: 0.000).

Conclusion: Our results show that serum pro-BNP levels are associated with acute rejection. In addition, higher pro-BNP levels were found to be associated with advanced rejection levels.

Anahtar Kelimeler

Cardiac transplant, acute rejection, endomyocardial biopsy, pro-BNP

Teşekkür

This article has been produced from the medical specialty thesis, which titled " The comparision between endomyocardial biopsy results and blood pro-bnp levels to diagnose acute rejection in patients who undergo cardiac transplantation" prepared for Cardiovascular Surgery of Akdeniz University Faculty of Medicine. (Thesis number: 421999)

Kalp Transplantasyonu Yapılan Hastalarda Akut Rejeksiyon Tanısında Endomiyokardiyal Biyopsi Sonuçları, Plazma pro-BNP Seviyeleri ve Non-invazif Parametrelerin Araştırılması

Öz

Amaç: Kalp yetersizliği, mortalite ve morbiditesi yüksek olan hastanın yaşam kalitesini
düşüren bir hastalıktır. Kalp yetmezliği hastalarının her yıl %10'u son dönem
kalp yetmezliğine ilerlemektedir. Bu hastalarda kalp nakli altın standart tedavi yöntemidir.
Ancak nakil hastalarında akut rejeksiyon tedavinin başarısını etkileyen en
önemli faktördür. Bu çalışmada kalp nakli sonrası akut rejeksiyon olan hastalarda
endomiyokardial biyopsi sonuçları, serum pro-BNP ve non-invazif parametrelerin
değerlendirilmesi amaçlanmıştır.

Hastalar ve Yöntem: Merkezimizde kalp nakli yapılan 20 hasta çalışmaya dâhil
edil-erek, akut rejeksiyon gelişen (n:10) ve gelişmeyen (n:10) olarak iki gruba
ayrılmıştır. Hastalar arasında ekokardiyografi, elektrokardiyografi (EKG),
endomiyokardiyal bi-yopsi sonuçları, serum reaktif protein (CRP), sedim ve serum
pro-BNP seviyeleri değerlendirilmiş ve gruplar arasında karşılaştırılmıştır.

Bulgular: Akut rejeksiyon gelişen hastalardan alınan endomiyokardiyal biyopsilerde
6(%60) hastada grade 1, 3(%30) hastada grade 2, 1(%10) hastada grade 3 rejeksiyon
bulguları, CRP ve sedimantasyon oranı gruplar arasında benzer olarak saptanmıştır
(p>0.05). Rejeksiyon olan hastalarda (4843,20 ± 6690,10 pg / ml) kontrol
grubu ile karşılaştırıldığında (496,30 ± 216,20 pg / ml) yüksek pro-BNP seviyeleri
tespit edilmiştir (p:0,001). Bunun yanı sıra rejeksiyon grade ilerledikçe daha yüksek
pro-BNP seviyelerine ulaşılmıştır (p:0,03). Bu bağlamda grade-3 rejeksiyon olan
hastada en yüksek pro-BNP düzeyi bulgusu elde edilmiştir (15211 pg / ml, p:0,000).

Sonuç: Bulgularımız serum pro-BNP düzeylerinin akut rejeksiyon ile ilişkili
olduğunu göstermiştir. Ayrıca daha yüksek pro-BNP düzeyleri ile rejeksiyon
seviyeleri ilişkili olarak bulunmuştur

Anahtar Kelimeler

Kalp nakli, akut rejeksiyon, endomiyokardiyal biyopsi, pro-BNP

Kaynakça

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