Böbrek Transplantasyonu Yapılacak PRA (Panel Reaktif Antikor) Pozitif Hastalarda Hla Haplotipleri İle İmmünofenotip İlişkisinin Araştırılması

Abstract

The Human Leukocyte Antigen (HLA- Human Leucocyte Antigen) has an extremely complex morphology. This complex structure is an important factor that causes incompatibility between the patient and the donor, especially when it comes to some organ transplants, such as kidneys. The more compliance there is at the HLA loci, the less the risk of rejection and the amount of immunosuppressants to be used. The Panel Reactive Antibody (PRA) test is a test that allows the identification of anti-HLA antibodies found in the patient's serum. In patients on the renal waiting list, the presence of anti-HLA antibodies formed in the patient's serum causes hyperacute and acute rejection in the patient. The success of transplantation of PRA positive patients is lower than that of PRA negative patients. In this study, 24 patients who came to the Tissue Typing Laboratory of Deckapı Yıldırım Beyazıt Training and Research Hospital between 2012 and 2022 and were diagnosed with chronic renal failure (CRF) and were eligible for the study were selected. T lymphocytes are involved in kidney transplantation as immune regulators. T lymphocytes, which interact with antigen-presenting cells, stimulate T cells through signals. The most important signal is obtained from the contact of the T-cell receptor CD3 with a major histocompatibility complex (MHC). However, other signaling molecules expressed on T cells also affect the differentiation and activation of T cells into regulatory or effector cells. These activated T cells are involved in initiating and maintaining the rejection of the transplanted organ. However, the clinical significance of T lymphocyte subgroups and HLA-DR positive cells found in the blood of kidney transplant patients still remains unclear. In this study, antibodies of 9 PRA positive patients were determined. Natural killer cells (Natural Killer, NK), T-lymphocytes, B lymphocytes, the activation of the determination of Phase, Flow Cytometry device (Beckman Coulter Navios-model, USA), HLA-DR, CD3, CD4, CD8, CD16, CD56, CD25 CD127, CD45, CD57, CD19 lymphocyte markers was determined using the profile. This profile was decoupled according to the tissue type of the patients and their subgroups within themselves and the difference was compared statistically. The relationship between organ rejections and lymphocyte profile, which are common in PRA positive patients, was questioned by SPSS 23 analysis. A comparison of CD4+CD25low and CD4+HLA-DR+ T cell surface marker values, which identify activated CD4+ cells according to the PRA, transplant and rejection status of CRF patients, was performed.

When the results obtained were examined statistically: CD4+CD25low and CD4+HLA-DR+ T cell surface marker median values were found to be higher in PRA positive patients compared to PRA negative patients according to the PRA status of CRF patients (z=4.025; p<0.001; r=0.821). When the percentage values of class I and class II of positive patients belonging to CRF patients were compared with CD4+CD25low and CD4+HLA-DR+ T cell surface marker values, there was no significant difference between the variables. According to the transplantation status of CRF patients, CD4+CD25low T cell surface marker hydrangeas are higher in patients with transplantation than in non-transplant patients (z=2.578, p=0.009, r=0.520). No significant difference was obtained for CD4+HLA-DR+ T cell surface marker hydrangeas (z=0.550, p=0.608, r=0.110). CD4+CD25low and CD4+HLA-DR+ T cell surface marker median values were found to be higher in patients with rejection compared to non-rejection patients, but there was no statistically significant variability (z=1.776, p=0.095, r=0.562). It is understood from the effect size value (r=0.562; r>0.50 large effect size) that a significant difference will be obtained when the number of patients is increased. The locus numbers of the patients belonging to HLA-A, HLA-B and HLA-DRB1 tissue types and their PRA status were statistically examined by Chi-Square analysis. No significant differences were observed in terms of HLA-A, HLA-B and HLA-DRB1 locus numbers in patients with positive or negative PRA test results.

The obtained results are evaluated within the scope of the study; according to the state of PRA CRF patients with CD4+CD25low and CD4+HLA-DR+ T cell surface markers for patient monitoring of the value of an additional parameter that can be used as suggested, however, by increasing the number of patients and multivariate statistical analysis is required.