Antibody-mediated kidney transplant rejection in HLA-sensitised patients

Uvod: Studije su pokazale da je transplantacija bubrega u senzibiliziranih primatelja povezana s većom učestalošću odbacivanja presatka. Cilj ovog istraživanja bio je usporediti značajke odbacivanja bubrega u senzibiliziranih bolesnika u odnosu na standardne primatelje bubrega. ----- Ispitanici i metode: Retrospektivno je analizirano ukupno 217 bolesnika s presađenim bubregom, od kojih je 101 bio senzibiliziran na HLA antigene donora. Ispitanici su praćeni od 8. mjeseca 2007. do 4. mjeseca 2016. godine. Analizirani su broj pojedinačnih epizoda i učestalost tipova odbacivanja presatka, preživljenje presatka te primijenjeno liječenje odbacivanja. ----- Rezultati: Broj pojedinačnih epizoda odbacivanja u senzibiliziranih bolesnika iznosio je 0,4 ± 1,37, a u nesenzibiliziranih 0,41 ± 0,93 na 100 dana praćenja, bez statistički značajne razlike među navedenim skupinama (p = 0,34). U skupini senzibiliziranih bolesnika, granično odbacivanje bilo je prisutno u 58,49%, T-stanično u 28,30%, a odbacivanje posredovano protutijelima u 13,21% biopsija bubrega. U nesenzibiliziranih bolesnika, granično je odbacivanje bilo prisutno u 61,65%, T-stanično u 32,33%, a odbacivanje posredovano protutijelima u 6,02% biopsija bubrega (p = 0,15). Odbacivanje posredovano protutijelima bilo je granično učestalije u senzibiliziranih primatelja presatka (p = 0,056). Usporedbom ovisnosti gubitka presatka o vremenu proteklom od transplantacije nije pronađena značajna razlika ni u ranom ni u srednjem ni u kasnom posttransplantacijskom razdoblju, a analizom primijenjene terapije odbacivanja nije uočena značajna razlika u liječenju pojedinačne epizode odbacivanja među navedenim skupinama bolesnika. ----- Zaključak: Broj pojedinačnih epizoda odbacivanja presatka na 100 dana praćenja između skupine bolesnika senzibiliziranih na HLA antigene i nesenzibiliziranih bolesnika istovjetan je. Senzibilizirani bolesnici imaju granično veću učestalost odbacivanja posredovanog protutijelima. Ne postoji značajna razlika u preživljenju presatka ovisno o vremenu proteklom od transplantacije među navedenim skupinama. Također, nema značajne razlike u primijenjenom liječenju pojedinačne epizode odbacivanja među istraživanim skupinama.Introduction: Studies have shown that kidney transplantation in HLA-sensitized patients is associated with the higher frequency of kidney rejection. The aim of this study is to compare the characteristics of kidney rejection between patients sensitised to HLA-antigens and standard kidney recipients. ----- Participants and methods: A retrospective study including 217 participants, 101 of which were HLA-sensitised, was conducted. The follow-up period lasted from August 2007 to April 2016. The total number of kidney rejection episodes, the frequency of different types of rejection, time-dependent graft survival, and therapy used in rejection treatment were analysed. ----- Results: The total number of kidney rejection episodes per 100 days of the follow-up was 0.4 ± 1.37 for the sensitised patients group and 0.41 ± 0.93 for the non-sensitised patients group, with no statistically significant difference between the two studied groups (p = 0.34). In the group of participants sensitised to HLA-antigens, borderline rejection occurred in 58.49%, T-cell rejection in 28.30%, and humoral rejection in 13.21% of kidney biopsies. In the group of non-sensitised patients, borderline rejection occurred in 61.65%, T-cell rejection in 32.33%, and humoral rejection in 6.02% of kidney biopsies (p = 0.15). Humoral rejection was marginally more frequent in patients sensitised to HLA-antigens (p = 0.056). There were no statistically significant differences found in time-dependent graft survival between the abovementioned groups of patients, neither in the early, nor in the intermediate or the late posttransplantation period. Between the two groups of patients which were the basis of the analysis, no significant difference was found in the medicines given to treat a single episode of kidney rejection. ----- Conclusion: The two analysed group of patients exhibit no statistical difference in the number of episodes of kidney rejection per 100 days of the follow-up. Patients sensitised to HLA-antigens have marginally higher proportion of humoral kidney rejection. Furthermore, there is no significant difference in the time-dependent graft survival and no significant difference in the medicines given to treat a single episode of rejection between the two abovementioned groups of patients