TOLERANCE WITHOUT MICROCHIMERISM: IS THAT POSSIBLE IN LIVER TRANSPLANTATION?

Year 2021, , 403 - 410, 13.09.2021

Murat Çağ , Sevda Yeşim Özdemir

https://doi.org/10.17343/sdutfd.811187

Cited By: 1

Abstract

Objective
It is uncovered the relationship between microchimerism
and liver graft tolerance. Many studies inspired the
concept of microchimerism and tolerance in solid
organ transplantation (SOT). Our aim is to explore this
aspect in a strictly selected patients’ cohort on CD3+
cells to show the microhimerism disappearance prove
the tolerance instead of presence of it.
Materials and Methods
We strictly selected liver transplantation patients
treated with calcineurins inhibitors (cnis), with
very low dose of drugs who has never developed
documented rejection. The DNA extraction and
microchimerism research method used was based
on the discrimination of donor and recipient alleles
by PCR amplification of microsatellite markers and
capillary electrophoresis with fluorescence detection.
Results
Twelve patients with alcohol-induced cirrhosis
without rejection or rejection-related complications
during the post-operative course were selected. The
immunosuppressive regimen included tacrolimus and
mycophenolate mofetil. The blood residual tacrolimus
concentration was under or equal 5 ng/L below normal.
We described the count of white blood cells and
selected CD3+ after the MACS separation procedure.
In our study, we did not observe any microchimerism
in none of the patients.
Discussion
We achieved that in case of absence of microchimerism
with maintained biochemical stability we could choose
to switch off the immunosuppressive therapy even
the microchimerism accepted like a condition to the
tolerance till our study. Consequently, it will be reduce
the side effects of immunosuppressive treatment
such as renal failure, metabolic disorders, diabetes
mellitus and cancers and the patient's quality of life
will be improved be decreased financial aspect of
immunesuppressive treathment

Keywords

Microchimerism, Liver Transplantation, Tolerence

KARACİĞER TRANSPLANTASYONUNDA MİKROKİMERİZM OLMADAN TOLERANS MÜMKÜN MÜDÜR?

Abstract

Amaç
Karaciğer transplantasyonu sonrası tolerans kavramı
son yıllarda giderek popülarite kazanmaktadır. Bu çalışmada
amacımız çok özenli parametrelerle seçilmiş
yaklaşık on yıllık bir seride düşük doz immünosupressif
kullanan bir grupta toleransın varlığını CD3+
hücrelerde mikrokimerizmin yokluğu ile kanıtlamaya
çalışmaktır.
Gereç ve Yöntem
Mikrokimerizm yokluğunu araştırma yöntemi; retrospektif
olarak donör kanlarından cross match yapılarak
DNA izolasyonunun ardından, mikrosatellit markerlarının
PCR ile amplifikasyonu ve dönör ve alıcı allellerinin
karşılaştırılması ilkesine dayanıyordu.
Bulgular
Postoperatif takiplerinde organ reddi ya da buna bağlı
komplikasyonları olmayan alkole bağlı sirozu olan
12 hastadan bir izogrup oluşturuldu. Bu hastalar immunsüpresif
olarak takrolimus ve mikofenolat mofetil
kullanıyordu ve ilaç kan düzeyleri 5 ng/l yani kabul
edilebilir sınırın altında idi. Çalışmamızda hiçbir hastamızda
kimerizm gözlemlemedik.
Sonuç
Biyokimyasal stabiliteyi koruyan mikrokimerizmin
yokluğu yani transplantasyona tolerans olması durumunda
immunsupressif tedavilerin kesilebilir olmasının
düşünülebilirliği gündeme gelmektedir.Böylelikle
immünsüpressif tedavilerin yan etkileri azalacak ve
hastalar böbrek yetmezliği, metabolik bozukluklar,
diyabet ve kanserlerin artmış riskinden korunacak,
dolayısı ile yaşam kalitesi artmış ve transplantasyon
sonrası kullanılan ilaçların ülke ekonomisine yükü
azalmış olacaktır.

Keywords

mikrokimerizm, karaciğer nakli, tolerans

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