sdü tıp fak derg Medical Journal of Süleyman Demirel University 2602-2109 Süleyman Demirel Üniversitesi 10.17343/sdutfd.811187 Clinical Sciences Klinik Tıp Bilimleri TOLERANCE WITHOUT MICROCHIMERISM: IS THAT POSSIBLE IN LIVER TRANSPLANTATION? KARACİĞER TRANSPLANTASYONUNDA MİKROKİMERİZM OLMADAN TOLERANS MÜMKÜN MÜDÜR? https://orcid.org/0000-0003-4006-4079 Çağ Murat Université de Strasbourg https://orcid.org/0000-0002-4398-2767 Özdemir Sevda Yeşim ÜSKÜDAR ÜNİVERSİTESİ, TIP FAKÜLTESİ 09 13 2021 28 3 403 410 10 15 2020 03 24 2021 Copyright © 1994, Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi 1994 Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi

ObjectiveIt is uncovered the relationship between microchimerismand liver graft tolerance. Many studies inspired theconcept of microchimerism and tolerance in solidorgan transplantation (SOT). Our aim is to explore thisaspect in a strictly selected patients’ cohort on CD3+cells to show the microhimerism disappearance provethe tolerance instead of presence of it.Materials and MethodsWe strictly selected liver transplantation patientstreated with calcineurins inhibitors (cnis), withvery low dose of drugs who has never developeddocumented rejection. The DNA extraction andmicrochimerism research method used was basedon the discrimination of donor and recipient allelesby PCR amplification of microsatellite markers andcapillary electrophoresis with fluorescence detection.ResultsTwelve patients with alcohol-induced cirrhosiswithout rejection or rejection-related complicationsduring the post-operative course were selected. Theimmunosuppressive regimen included tacrolimus andmycophenolate mofetil. The blood residual tacrolimusconcentration was under or equal 5 ng/L below normal.We described the count of white blood cells andselected CD3+ after the MACS separation procedure.In our study, we did not observe any microchimerismin none of the patients.DiscussionWe achieved that in case of absence of microchimerismwith maintained biochemical stability we could chooseto switch off the immunosuppressive therapy eventhe microchimerism accepted like a condition to thetolerance till our study. Consequently, it will be reducethe side effects of immunosuppressive treatmentsuch as renal failure, metabolic disorders, diabetesmellitus and cancers and the patient's quality of lifewill be improved be decreased financial aspect ofimmunesuppressive treathment

AmaçKaraciğer transplantasyonu sonrası tolerans kavramıson yıllarda giderek popülarite kazanmaktadır. Bu çalışmadaamacımız çok özenli parametrelerle seçilmişyaklaşık on yıllık bir seride düşük doz immünosupressifkullanan bir grupta toleransın varlığını CD3+hücrelerde mikrokimerizmin yokluğu ile kanıtlamayaçalışmaktır.Gereç ve YöntemMikrokimerizm yokluğunu araştırma yöntemi; retrospektifolarak donör kanlarından cross match yapılarakDNA izolasyonunun ardından, mikrosatellit markerlarınınPCR ile amplifikasyonu ve dönör ve alıcı allellerininkarşılaştırılması ilkesine dayanıyordu.BulgularPostoperatif takiplerinde organ reddi ya da buna bağlıkomplikasyonları olmayan alkole bağlı sirozu olan12 hastadan bir izogrup oluşturuldu. Bu hastalar immunsüpresifolarak takrolimus ve mikofenolat mofetilkullanıyordu ve ilaç kan düzeyleri 5 ng/l yani kabuledilebilir sınırın altında idi. Çalışmamızda hiçbir hastamızdakimerizm gözlemlemedik.SonuçBiyokimyasal stabiliteyi koruyan mikrokimerizminyokluğu yani transplantasyona tolerans olması durumundaimmunsupressif tedavilerin kesilebilir olmasınındüşünülebilirliği gündeme gelmektedir.Böylelikleimmünsüpressif tedavilerin yan etkileri azalacak vehastalar böbrek yetmezliği, metabolik bozukluklar,diyabet ve kanserlerin artmış riskinden korunacak,dolayısı ile yaşam kalitesi artmış ve transplantasyonsonrası kullanılan ilaçların ülke ekonomisine yüküazalmış olacaktır.

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