Başkent Üniversitesi Yayınları
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Item Relation Between Pretransplant Serum Levels of Soluble CD30 and Acute Rejection During the First 6 Months After a Kidney Transplant(Başkent Üniversitesi, 2013-06) Shooshtarizadeh, Tina; Ataipour, Yousef; Ossareh, Shahrzad; Mohammadali, AliObjectives: The immunologic status of kidney allograft recipients affects transplant outcome. High levels of pretransplant serum soluble CD30 correlate with an increased risk of acute rejection. Studies show conflicting results. We evaluated the relation between pretransplant serum sCD30 levels with the risk of posttransplant acute kidney rejection in renal transplant recipients. Materials and Methods: This prospective cohort study was performed between March 2010 and March 2011 on 77 kidney transplant recipients (53 men [68.8%], 24 women [31.2%]; mean age, 41 ± 14 y). Serum samples were collected 24 hours before transplant and analyzed for soluble CD30 levels by enzyme-linked immunosorbent assay. Patients were followed for 6 months after transplant. Acute biopsy-proven rejection episodes were recorded, serum creatinine levels were measured, and glomerular filtration rates were calculated at the first and sixth months after transplant. Preoperative serum soluble CD30 levels were compared in patients with and without rejection. Results: The mean pretransplant serum soluble CD30 level was 92.1 ± 47.3 ng/mL. At 6 months’ follow-up, 10 patients experienced acute rejection. Mean pretransplant soluble CD30 levels were 128.5 ± 84 ng/mL versus 86.7 ± 37 ng/mL in patients with and without acute rejection episodes (P = .008). At 100 ng/mL, the sensitivity, specificity, and positive and negative predictive values of pretransplant serum soluble CD30 level to predict acute rejection were 70%, 73.6%, 29.1%, and 94.3%. Conclusions: We showed a significant relation between pretransplant serum soluble CD30 levels and acute allograft rejection. High pretransplant levels of serum soluble CD30 can be a risk factor for kidney transplant rejection, and its high negative predictive value at various cutoffs make it useful to find candidates with a low risk of acute rejection after transplant.Item A New Index for Acute Rejection After Renal Transplant: Notch Receptor-1(Başkent Üniversitesi, 2012-10) Zheng, Kai; Tan, Jianming; Cai, Jinquan; Yang, Shunliang; Wu, Weizhen; Sun, XinghuiObjectives: This study aimed at investigating the relation between expression of Notch receptor-1 (Notch 1) in peripheral blood mononuclear cells and acute rejection after renal transplant. Materials and Methods: Ninety-seven patients receiving a renal transplant were randomly selected. Peripheral blood samples before transplant and days 1, 3, 5, 7, 10, 14, 21, and 30 after transplant were retrospectively observed. Expression of Notch 1 was detected by flow cytometry and real-time quantitative polymerase chain reaction. Results: Expression of Notch 1 was correlated with acute rejection and long-term renal function after transplant (as detected by the level of serum creatinine 6 months after transplant). Expression of Notch 1 in peripheral blood mononuclear cells increased before serum creatinine increased. Expression of Notch 1 can reveal the immune state of recipients after transplant, and Notch 1 expression at early time points after transplant can predict long-term renal function. Conclusions: Notch 1 can serve as an important index for acute rejection and long-term renal function after transplant.Item Impact of the Addition of Maintenance Steroids to a Rapid Steroid Discontinuation Immunosuppressive Protocol Following Acute Renal Transplant Rejection(Başkent Üniversitesi, 2009-12) Arora, Swati; Sureshkumar, Kalathil K.; Dikkala, Sudharani; Marcus, Richard J.Objectives: Rapid steroid discontinuation immunosuppressive protocols are increasingly used in renal transplant. The optimal immunosuppressive regimen in patients who develop acute rejection while on a rapid steroid discontinuation protocol is less clear. We examined our experience of adding maintenance steroid therapy in renal transplant recipients who developed 1 or more acute rejection episode while on a rapid steroid discontinuation protocol. Materials and Methods: The outcome of 145 patients who underwent renal transplant from 2002 to 2007 and initiated a rapid steroid discontinuation protocol was analyzed. Patients were divided into the following 5 groups: (i): acute rejection × 1 and no maintenance steroids, (ii): acute rejection × 1 and started on maintenance steroids, (iii): acute rejection × 2 and no maintenance steroids (iv): acute rejection × 2 and started on maintenance steroids, and (v): no acute rejection Results: Compared with patients with no acute rejection, graft survival was significantly inferior in patients who experienced 2 or more acute rejection episodes—whether they were started on maintenance steroids (P = .003) or not (P = .006)—but was similar in patients who experienced only 1 episode of acute rejection, and were started either on maintenance steroids (P = .87) or were continued on the rapid steroid discontinuation protocol (P = .69). In patients who sustained 2 episodes of acute rejection, addition of maintenance steroids had no impact on graft survival (P = .97). Conclusions: More than 1 episode of acute rejection in renal transplant recipients on rapid steroid discontinuation protocol is associated with poor, long-term, graft survival, which remains unchanged despite starting maintenance steroids. The use of maintenance steroids may not have a positive impact on graft survival after acute rejection.Item Pretransplant Detection of Anti-Endothelial Cell Antibodies Could Predict Renal Allograft Outcome(Başkent Üniversitesi, 2009-06) Ismail, Amani M.; Mansour, Merveet A.; El-Agroudy, Amgad E.; Badawi, Rasha M.Objectives: Endothelial cells that line the vasculature are targets for immune-mediated assault through anti-endothelial cell antibodies. The aim of this work was to detect anti-endothelial cell antibodies and describe the association with kidney allograft rejection and graft survival. Materials and Methods: The study included 60 patients who had undergone live-donor kidney transplant. Inclusion criteria included first kidney transplant, panel reactive antibody titer less than 5%, cause of end-stage renal disease not including vasculitis or systemic lupus erythematosus, and age > 18 years. Patients were classified into 2 groups: 40 patients with anti-endothelial cell antibodies (referred to as the positive group) and 20 patients without anti-endothelial cell antibodies (referred to as the negative group). Results: Serum creatinine level was higher in the positive group at 1 month and 1 year (P = .04). The occurrence of acute rejection was not significantly different in the positive group (18 patients [45.0%]) compared with the negative group (5 patients [25.0%], P = .5). However, the number of acute rejection episodes was higher in the positive group (22 episodes) compared with the negative group (6 episodes, P = .04). In patients who experienced acute rejection, chronic nephropathy was more frequent in the positive group (6 of 18 patients, 33.3%) compared with the negative group (1 of 5 patients, 20.0%) (P = .03). One-year and 5-year graft survival was 91% and 79% in the positive group, and 100% and 91% in the negative group, respectively. The difference at 5 years was significant (P = .04). Conclusions: The presence of anti-endothelial cell antibodies was associated with a higher number of acute rejection episodes and lower long-term graft survival in kidney transplants. It could be an informative test to identify patients at high risk for immunological graft loss.