Investigation of Anti-HLA Antibodies of Highly Sensitized Patients by Single Antigen Bead and C1q Tests.

PURPOSE: The single antigen bead (SAB) test contributes to conventional cellular and solid phase crossmatch tests in renal transplantation. However, the determination of anti-HLA antibodies of the patients may not reflect the pathologic features of these antibodies. Highly sensitized patients produce antibodies against a number of HLAs; therefore, their transplantation chance decreases. In this study, we aimed to evaluate SAB and C1q test results of highly sensitized patients. METHOD: In this study, 33 end-stage renal failure patients with >80% panel reactive antibody were included. Of the patients, 58% (n = 19) were female, and 42% (n = 14) were male. The mean age was 46.2 ± 12.4. All of the serum samples were inactivated by heat before use. SAB and C1q tests were performed according to the manufacturer's instructions. RESULTS: We obtained statistically significant results between the positive bead counts and raw mean fluorescence intensity (MFI) values of 2 tests (P < .01 for class I and II). There was a statistically significant difference between the 2 tests in terms HLA-A, -C, -DR, and -DP MFI values, whereas HLA-B and -DQ MFI values were similar for the 2 tests. CONCLUSION: The difference of raw MFI values between the 2 tests may be due to the fact that the C1q test detects only IgG1 and IgG3 antibodies, whereas the SAB test can detect all IgG subtypes. We considered that anti-HLA-B and -DQ antibodies have high complement-fixing features; these antibodies should be investigated selectively due to the similarity of anti-HLA-B and -DQ antibody MFI values in the 2 tests.

Correlation of the Volume Control Parameters With Health Related Quality of Life in Renal Transplant Patients.

INTRODUCTION: Transplantation is the most effective treatment strategy for end-stage renal failure. We aimed to investigate the correlation of volume control parameters with health-related quality of life (HRQoL) in renal transplantation patients during the pre- and post-transplantation periods. MATERIAL AND METHODS: Seventy-seven patients who underwent renal transplantation from deceased donors between January 2011 and January 2013 were included in the study. The biochemical markers, complete blood count, and creatinine levels were measured during pretransplantation and at post-transplantation month 6. The Turkish version of the Short Form 36 (SF-36) health survey questionnaire was used for the assessment of HRQoL. Blood pressure (BP) and echocardiographic measurements were used to evaluate the volume status. RESULTS: Significant improvements were achieved in all echocardiographic measurements, biochemical parameters except Ca(++), and SF-36 questionnaire domain scores (DSs) except vitality in the post-transplantation period. Systolic BP (SBP), the left atrium index, vena cava inferior collapsibility index (VCCI), and diastolic BP were associated with vitality (P = .02, .03, .05, and .04, respectively); SBP was associated with social functioning (P < .01) and role emotional (P < .01); and left ventricular mass index was associated with mental health (P = .05) DSs during the pretransplantation period. In the post-transplantation period, VCCI, left ventricular mass index, and SBP were associated with general health (P = .02, .05, and .05, respectively); VCCI and SBP were also associated with mental health (P = .05 and .01, respectively); and left atrium index was associated with role emotional (P = .05) DSs. CONCLUSION: Concomitant improvement in the volemic status may contribute to improvements in HRQoL after renal transplantation.

Relationship of Interleukin-10 and Transforming Growth Factor-ß Levels With Short-Term Graft Function After Kidney Transplantation.

INTRODUCTION: We evaluated the relationship of interleukin-10 (IL-10) and transforming growth factor-ß (TGF-ß) levels with graft function in kidney transplantation patients receiving tacrolimus-based immunosuppression during the early post-transplantation period. MATERIAL AND METHODS: There were 112 patients who underwent kidney transplantation from live donors between May 2011 and May 2013. Eight patients had at least 1 of the exclusion criteria, and the remaining 104 patients were included in the study. The recipients underwent evaluation for biochemical markers, complete blood count, and creatinine and cytokine (IL-10, TGF-ß) levels during the pretransplantation and post-transplantation 6 months. RESULTS: The creatinine level was negatively correlated with IL-10 and positively correlated with TGF-ß levels in both the pretransplantation and early post-transplantation period. CONCLUSION: Low serum TGF-ß and high IL-10 levels at post-transplantation month 6 might have a positive effect on graft survival in living donor kidney recipients on tacrolimus-based immunosuppressive treatment.

Evaluation of epithelial chimerism after bone marrow mesenchymal stromal cell infusion in intestinal transplant patients.

Intestinal transplantation is the most effective treatment for patients with short bowel syndrome and small bowel insufficiencies. We evaluated epithelial chimerism after infusion of autologous bone marrow mesenchymal stromal cells (BMSCs) in patients undergoing cadaveric donor isolated intestinal transplantation (I-ITx). BMSCs were isolated from patients' bone marrow via iliac puncture and expanded in vitro prior to infusion. Two out of the 3 patients were infused with autologous BMSCs, and small intestine tissue biopsies collected post-operatively were analyzed for epithelial chimerism using XY fluorescent in situ hybridization and short tandem repeat polymerase chain reaction. We observed epithelial chimeric effect in conditions both with and without BMSC infusion. Although our results suggest a higher epithelial chimerism effect with autologous BMSC infusion in I-ITx, the measurements in multiple biopsies at different time points that demonstrate the reproducibility of this finding and its stability or changes in the level over time would be beneficial. These approaches may have potential implications for improved graft survival, lower immunosuppressant doses, superior engraftment of the transplanted tissue, and higher success rates in I-ITx.

Anemia in living donor kidney transplantation.

BACKGROUND: We evaluated the prevalence of pretransplantation and posttransplantation anemia and its effect on serum creatinine levels among living donor kidney transplant recipients. METHODS: We reviewed retrospectively 170 adult patients who underwent living donor kidney transplantation between 1994 and 2009. We defined anemia as hemoglobin (Hb) ≤12 g/dL for women and ≤13 g/dL for men with severe anemia as Hb <11 g/dL for both men and women (World Health Organization criteria). Patients were also categorized according to Hb levels less than or greater than 10 g/dL for correlation with recipient serum creatinine levels at months 1, 3, 6, and 12. RESULTS: Mean recipient and donor ages were 33 ± 10 and 45 ± 12 years, respectively. Mean cold ischemia time was 76 ± 43 minutes. At the time of transplantation, anemia and severe anemia prevalences were 86.7% and 58.8%, respectively. Anemia was observed in 64 patients (42.1%) at posttransplantation month 3. Pretransplantation severe anemia was a good predictor of both Hb levels and anemia presence posttransplantation. Pretransplantation anemia and severe anemia caused greater requirements for posttransplantation blood transfusions (P < .05). Younger age and female gender were significant risk factors for severe anemia pretransplantation. There was a significant correlation between posttransplantation Hb levels and serum creatinine levels at 12 month (P = .01). Recipient female gender and longer hospital stay were significant risk factors for both anemia and severe anemia posttransplantation. Higher recipient weight and history of acute rejection episode were also significant for posttransplantation severe anemia. CONCLUSION: This study indicated that successful kidney transplantation had a positive effect on Hb levels. Posttransplantation anemia predicted worse graft function in the first month after transplantation.

Comparison of complement-dependent cytotoxic and flow-cytometry crossmatch results before cadaveric kidney transplantation.

AIM: The presence of HLA donor-specific antibodies (DSA) before kidney transplantation decreases graft survival. In this study, we compared crossmatch results of kidney transplantation candidates, for cadaveric renal donation between March 10, 2012, and September 7, 2012. MATERIAL AND METHOD: The 47 kidney transplantation candidates tested for crossmatch included 10 for cadaveric donor organs. Two crossmatch methods were performed: complement-dependent cytotoxic crossmatch (CDCXM) and flow cytometry crossmatch (FCXM). Spleen cells were used as the source of lymphocytes for all crossmatch tests. RESULTS: The T and B cell ratios isolated from spleen were 38.8% and 34.8%, respectively. The concordance ratio of the two methods was 76.6% with 23.4% discordant results. Regarding the discordant results, 4.2% were positive CDCXM but negative FCXM; 191%, negative CDCXM but positive FCXM. All patients displaying positive crossmatches had a previous immunization history. As a result, we speculated that the positive CDCXM but negative FCXM results were due to the washing procedures in the FCXM disturbing antigen-antibody complexes. We suggest at least two different methods to be performed for crossmatch tests before kidney transplantation. CDCXM detects immunoglobulin G1 (IgG1) and IgG3, which are critical for rejection. FCXM is able to detect all IgG subgroups because of its high sensivity. As a result we suggest that both CDCXM and FCXM are preferrable strategies to detect DSAs.