SIGNIFICANCE OF PANEL REACTIVE ANTIBODIES IN PATIENTS AWAITING KIDNEY TRANSPLATATION

Cilj istraživanja: Unosom stranih antigena HLA naš organizam stvara protutijela HLA, poznati čimbenik rizika odbacivanja presatka. Prisutnost tih protutijela u serumima pacijenata izražava se kao postotak panel reaktivnih protutijela (PRA). Cilj ovog istraživanja bio je procijeniti PRA u pacijenata koji očekuju prvo presađivanje bubrega te uočiti utjecaj PRA na vrijeme nošenja presatka. Materijali i metode: Istraživanje je obavljeno u Laboratoriju za tipizaciju tkiva Centra za transfuzijsku medicinu KBC-a Split na uzorcima seruma pacijenata na listi čekanja bubrega iz dijalitičkog centra KBC Split. Za utvrđivanje panel reaktivnih antitijela (%PRA) koristili smo test mikrolimfocitotoksičnosti, dok smo za specifičnost antiseruma HLA ispitanika koristili panel limfocita od 50 prethodno tipiziranih osoba serološkim ili molekularnim metodama (PCR-SSO, PCR-SSP). Rezultati: 4 od 15 pacijenata s liste čekanja senzibilizirani su na HLA antigene. Od četiri senzibilizirana pacijenta dva pacijenta su visoko senzibilizirana (95% i 63%). Kod pacijenta sa 16% senzibilizacije, analizom screeninga utvrđena je specifična senzibilizacija na antigen HLA-B57(17). Zaključak: Potrebno je dovesti na minimum nekompatibilnost između primatelja i darivatelja organa redovitim praćenjem pacijenta na listi čekanja za transplantaciju. Visoki PRA velika je prepreka kod transplantacije organa, dok specifična senzibilizacija ukazuje na potpunu neprihvatljivost organa. Ključne riječi: HLA, protutijela, senzibilizacija, transplantacija bubregaThe aim of the study: By introducing foreign HLA antigens, our body produces HLA antibodies, a known risk factor for transplant rejection. The presence of these antibodies in the serum of patients is expressed as a percentage of panel reactive antibodies (PRA). The aim of this study was to evaluate PRA in patients awaiting first kidney transplantation and to detect the PRA's influence on transplant survival. Materials and Methods: The research was carried out at Laboratory for Tissue Typing at University Hospital Centre Split on serum samples of patients on the kidney transplant waitlist from the University Hospital Centre Split dialysis centre. For the detection of the panel reactive antibodies (%PRA), we used Complement Dependent Cytotoxicity test, while, for an identification of specific HLA antibodies, we used panel of lymphocytes previously typed 50 individuals with serological or molecular methods (PCR-SSO, PCR-SSP). Results: 4 out of 15 patients on waitlist are sensitized to HLA antigens. Two patients, out of four sensitized, were highly sensitized (95% and 63%). In a patient with 16% sensitization, screening analysis determined specific sensitization to the antigen HLA-B57(17). Conclusion: It is necessary to minimize the incompatibility between the recipient and the organ donor by regular monitoring of the patient on the waitlist for transplantation. High PRA is a major obstacle to an organ transplantation, while specific sensitization indicates completely unacceptable organ. Key words: HLA, antibodies, sensitization, kidney transplantatio