Böbrek Nakli Yapılan Hastalarda Böbrek Biyopsi Sonuçlarının Prognoza Etkisi

Abstract

ABSTRACT Boga I., Prognostic Significance of Renal Allograft Biopsies in Renal Transplant Recipients. Thesis in Internal Medicine, Hacettepe University Medical Faculty, Ankara, 2017. Renal transplantation is the ideal renal replacement modality. Allograft biopsy is the gold standard to establish the underlying cause of renal dysfunction in renal transplant recipients. Renal biopsy may reveal several diagnoses which may not be predicted prior to biopsy. Furthermore prognostic significance of renal allograft biopsies in renal transplant recipients is not clear. All graft biopsies of 1135 renal transplant recipients that had been followed in Hacettepe University Nephrology Department between December 1975 and December 2016 were evaluated. A total of 325 biopsies had been done to 269 patients. 179 of 269 patients (66.5%) were male. The mean age of the patients was 32.2 ± 11.7 years. Acute cellular rejection was the most prevalent diagnosis during the first five years after transplantation. Chronic humoral rejection, glomerulonephritis and calcineurin inhibitor (CNI) toxicity were common after five years. Probability of glomerulonephritis increased with increasing proteinuria. Serum creatinine at the time of biopsy was higher in patients with acute humoral rejection compared to patients with acute cellular rejection (4.1 ± 2.8 mg/dL vs. 2.8 ± 2.0 mg/dL, p=0.03). Risk of graft failure was higher in patients with acute humoral rejection compared to patients with acute cellular rejection (p < 0.05). CNI toxicity was more common in patients under cyclosporine treatment compared to patients under tacrolimus treatment (24.8% vs. 16.1%; p=0.04). Although mean serum levels of cyclosporine and tacrolimus during one year prior to renal biopsies were higher in patients with CNI toxicity compared to patients without CNI toxicity, this difference was not statistically significant. Keywords: graft biopsy, prognosis, acute rejection, calcineurin inhibitor, calcineurin inhibitor toxicity