الفهرس 
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Abstract
This study was conducted on 43 donors and 43 recepients (who underwent KT after they were diagnosed as they had ESRD) from transplantation unit in Assuit University Urology Hospital, Assiut University during the period from September 2018 to September 2022. All transplants required a negative flowcytometric crossmatch for IgG T cell and B cell, and ABO blood group compatibility.
This study aimed at studing the impact of HLA-DQ mismatch on acute rejection of kidney transplantation. Renal transplant recipients were subjected to follow up for 15-16 weeks post transplantation during which, data was collected with special emphasis on acute rejection and immunosuppressive therapy.
All study participants were subjected to Pretransplant investigations:
1) ABO blood grouping results of donor and recipient were collected from patients’ files.
2) HLA typing (A, B, DR) results of donor and recipient (using Luminex microbead method) were collected from patients’ files.
3) Flow cytometry and complement dependent cytotoxic cross matching results prior to transplantation (using FACSCanto TM II Flow Cytometer) were collected from patients’ files.
4) Panel Reactive Antibody (PRA) classes I and II (using Luminex microbead method).
Investigations for recipients 15-16 weeks post-transplantation:
1) Urea and creatinine tests.
2) 24 h urinary protein test.
3) Detection of IgG antibodies to HLA class I & class II in serum (PRA).
4) DNA typing of HLA Class II alleles (HLA DQ) for recipient donor pairs).
5) Kidney biopsy was done post-transplantation for recipients who developed proteinuria and had high level of serum creatinine.
The study revealed that the pre-transplantation PRA were present in 6/43 recipients (14%) and negative in 37/43 recipients (86%). With follow up of these 6 recipients post-transplantation, 3 of them became negative for PRA, one of them became negative for class I PRA but developed denovo PRA against class II, one of them became negative PRA for class II but developed denovo PRA against class I and one of them continue to have positive PRA class I with increasing MFI > 10000 compared with pre-transplantation MFI < 3000 and developed devovo PRA against class II with MFI > 10000 and developed AMR and TCMR.
In the 37 recipients who had negative pre-transplantation PRA, the PRA was still negative post-transplantation in 15/37 recipients (40.5%) and the remaining 22/37 recipients (59.5%) developed de novo PRA post- transplantation. De novo PRA were 8/37 class I (21.6%), 6/37 class II (16.2%) and 8/37 mixed class I and II (21.6%). Rejection occurred in 4/43 recipients (9.3%) with different class I & II MFI. First recipient had negative class I and II PRA. Second recipient had negative class I and class II PRA MFI was< 3000. Third recipient had positive both class I and class II PRA, MFI was 3000-10000 and >10000 respectively. Forth recipient had positive both class I and II PRA, MFI was >10000.
This study showed that 25 (60.5%) of the 43 recipients developed at least one post-transplant PRA, 2 (4.7%) recipients had DQ PRA alone (DQ-only), 11 (25.6%) recipients developed A,-B, and/or -DR antibody without a DQ antibody present (non DQ), and 12 (27.9%) recipients developed a DQ antibody in addition to other non DQ antibodies (DQ + non DQ). The overall incidence of biopsy-proven acute rejection during the follow-up period was 9.3% (4/43), with recipients experiencing acute rejection had statistically significant higher percent in the DQ + non DQ groups (30.8%) compared with the other groups (0%) (P-value: 0.0171).
There was no statistical significant relation between rejection and donor and recipient age, donor gender, degree of relation between donors and recipients, ABO, causes of ESRD, HLA class I (A, B) matching, HLA class II (DR) matching, PRA class I, anti HLA-DQ2, anti HLA-DQ6, anti HLA-DQ7 and anti HLA-DQ8. Recipients with positive PRA class II had statistically significant higher percent of rejection (25.0%) compared to (0.0%) of those with negative PRA class II (p-value: 0.029). Recipients with positive anti HLA-DR Abs had statistically significant higher percent of rejection (28.6%) compared to (0.0%) of those with negative anti HLA-DR Abs (p-value: 0.016). Recipients with positive anti HLA-DQ Abs had statistically significant higher percent of rejection (28.6%) compared to (0.0%) of those with negative anti HLA-DQ Abs (p-value: 0.016). Recipients with positive anti HLA-DQ4 Abs or anti HLA-DQ5 Abs had statistically significant higher percent of rejection (50%) compared to (5.1%) of those without anti HLA-DQ4 Abs or anti HLA-DQ5 Abs (p-value: 0.037). They had 18.5 times increased risk of rejection. Recipients with positive anti HLA-DQ9 Abs had statistically significant higher percent of rejection (30%) compared to (3.0%) of those without anti HLA-DQ9 Abs (p-value: 0.034). They had 13.71 times increased risk of rejection.
Recipients who received kidney from HLA-DQ mismatched donors had higher incidence (57%) of anti HLA-DQ5 antibodies and anti HLA-DQ6 antibodies compared to those with HLA-DQ matched donors (0.0%) (p-value: 0.018).. There is no statistical significant difference between matched and mismatched DQ regarding urea, creatinine, proteinuria, rejection, anti HLA-DQ2 Abs, anti HLA-DQ4 Abs, anti HLA-DQ7 Abs, anti HLA-DQ8 Abs and anti HLA-DQ9 Abs.
There is no significant relation between 15-16 weeks post transplant creatinine level and donor and recipient age, degree of relation, ABO group, causes of ESRD, HLA class I matching, HLA class II (DR) matching, PRA class I and PRA class II. Kidney transplant recipient from female donor had statistically significant higher percent of increased creatinine level (50.0%) compared to (6.7%) of recipients from male donor. They had 14 times increase risk of increase creatinine. However, this is not associated with increased frequency of acute rejection during 15-16 weeks post transplantation.