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Vericiye Özgü Antikor Pozitif Olgularda Böbrek Nakli: Tek Merkez Deneyimi

Renal Transplantation in Donor Specifi c Antibody Positive Sensitized Patients: Single Center Experience

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2011
DOI: 
10.5262/tndt.2011.1003.08

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
In recent years, there are increasing number of sensitized patients waiting for renal transplantation (RTx) who are donor specifi c antibody (DSA) positive and lymphocyte crossmatch (LCM) negative. In this study, we present our transplantation experience in patients with LCM (-) and DSA (+). We enrolled 4 LCM (-) and panel reactive antibody (PRA) screening positive patients who had a living kidney donor. We evaluated antibodies to determine whether they were DSA or not. If they were DSA, we included these patients in our protocol (DSA level: mean fl uorescein intensity >1000). Two had previous RTx. In our protocol, we started MMF (2gr/day), tacrolimus 0.01 mg/kg, and prednisolone 0.5 mg/kg on day -6. We performed 2 sessions of plasmapheresis (PP) and gave 2 doses of 5 gr/day IVIG. On day -1, 200 mg rituximab was given. On the operation day, the patients received basiliximab. Serum samples were taken on days -6, 0, and 30. All patients had immediate graft function after RTx. Two patients had acute rejection (AR). Average follow up was 4 months and creatinine levels are 0.7-1.3 mg/dl. In conclusion, RTx can be succesfully performed in sensitized patients with DSA. However, there seems to be higher acute rejection risk in these patients.
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Abstract (Original Language): 
Son yıllarda böbrek nakillerinde (BN) duyarlılaşmış hastaların artması ile vericiye özgü antikor (DSA) pozitif ancak lenfosit çapraz karşılaştırma (LÇK) negatif olgular dikkati çeker oranda gözlenmektedir. Biz bu çalışmamızda, LÇK (-)ve DSA (+) olan olgularımızda canlıdan BN uygulamamızı sunuyoruz. Çalışmamıza BN olması planlanan, kompleman bağımlı sitotoksisite (CDC) LÇK negatif ancak panel reaktif antikor (PRA) pozitif olup tanımlama PRA testinde vericiye HLA antijenlerine karşı özgül antikor (klas I veya II) saptanan canlı vericili 4 hasta (ortalama fl öresan şiddeti; MFI > 1000) dahil edildi. Hastaların 2’si daha önce BN uygulanmış olan hastalardı. Hastalara duyarsızlaştırma amaçlı BN öncesi -6. günde mikofenolat mofetil (2gr/gün), takrolimus 0,01 mg/kg, prednisolon 0,5 mg/kg olarak başlandı. 2 seans plazmaferez (PP) ve 5 gr/gün 2 doz IVIG verildi. Daha sonra -1. günde 200 mg rituximab ve operasyon günü basiliximab uygulandı. Hastaların tümünden -6, 0, 30. günlerde serum örnekleri alındı. Tüm hastalara BN gerçekleştirildi. Hastaların tümünde greft işlevi saptanırken iki olguda ilk 1 ay içinde akut rejeksiyon saptandı. Hastaların ortalama takip süreleri 4 ay olup kreatinin düzeyleri 0,7-1,3 mg arasında gözlendi. Sonuç olarak DSA (+) ve LÇK negatif olgularda duyarsızlaştırma uygulaması ile başarılı BN uygulaması yapılabilir. Ancak artmış akut rejeksiyon riski göz önüne alınmalıdır.
FULL TEXT (PDF): 
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  • 3
255-259
  • Turkish

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