Inovatīvu biomarķieru izvērtējums agrīnā periodā pēc nieres transplantācijas
No Thumbnail Available
Date
2020
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
PĒTĪJUMA NOSAUKUMS: Inovatīvu biomarķieru izvērtējums agrīnā periodā pēc nieres transplantācijas.
ATSLĒGAS VĀRDI: Nieres transplantācija, biomarķieri, KIM-1, NGAL, Il-18, MIG, CXCL9, CXCL10, IP-10.
IEVADS: Nieru transplantācija (NT) nodrošina ilgāku dzīvildzi un labāku dzīves kvalitāti nekā dialīze pacientiem ar hronisku nieru slimību beigu stadijā. Šīs pētījums ir nozīmīgs, jo neskatoties uz transplantācijas priekšrocībām un imūnsupresīvās ārstēšanas uzlabojumiem, pacientiem joprojām rodas komplikācijas pēc transplantācijas, kas izraisa transplantāta mazspēju un atgrūšanu. Ja var pierādīt, ka biomarķieru līmenis agrīnā periodā pēc nieres transplantācijas precīzi paredz bojājuma ilgumu un ilgāku transplantāta funkciju, tie varētu būt ļoti noderīgi kā surogātmarķieri. Tāpēc biomarķieru novērtējums katram pacientam brīdina par nelielām izmaiņām transplantāta, un var nodrošināt personalizēto imūnsupresijas terapiju.
PĒTĪJUMA MĒRĶIS: Izpētīt dažādu nieru bojājuma biomarķieru noteikšanas lietderību pacientiem agrīnā periodā pēc nieres transplantācijas.
MATERIĀLI UN METODES: Retrospektīvā pētījumā tika iekļauti pacienti, kam tika veikta nieru transplantācija no mirušiem vai dzīviem donoriem laika posmā no 01.01.2018 līdz 31.12.2019. Tikai pacienti, kas piekrita papildus analīžu ņemšanai (biomarķieru paneļa novērtēšanai) tika iekļauti pētījumā. Visi laboratorisko izmeklējumu rezultāti un biomarķieru panelis tika izvērtēti pirmā, otrā, 15. un 60. dienā pēc nieru transplantācijas. Nieru transplantāta funkcija tika izvērtēta pēc aGFĀ, izmantojot CKD-EPI vienādojumu. Dati tika analizēti izmantojot IBM SPSS Statistics priekš Macintosh 25.0. ® Dati tika aprēķināti un demonstrēti kā vidējā (M) ± standartnovirze (SD) datiem, kas atbilst normālajam sadalījumam vai mediāna (Me) un starpkvartiļu apgabals (IQR) datiem, kas neatbilst normālajam sadalījumam priekš kvantitatīviem mainīgiem. Spirmena korelācijas tests (rs) tika izmantots, lai noteiktu saistību starp specifisko seruma un urīna biomarķiera līmeni un aprēķināto GFĀ.
REZULTĀTI: Pētījumā tika iekļauti 24 recipienti ( 58% vīrieši, 42% sievietes, vidējais vecums 42,6 ± 12,6 gadi) un astoņi dzīvie donori (25% vīrieši, 75% sievietes, vidējis vecums 54,4 ± 10,3 gadi). aGFĀ vērtības pēc nieru transplantācijas 1. dienā (7.5 ml/min/1.73 m2 ; 7.0 – 12.5; p <0.001); 2. dienā (17.0 ml/min/1.73 m2; 10.2 – 28.7; p <0.001); 15. dienā (58.1 ± 27.3 ml/min/1.73 m2; p = 0.050); 60. dienā (59.5 ± 23.4 ml/min/1.73 m2; p = 0.173). Nieru transplantāta funkcija, kas tika novērtēta ar aGFĀ, parādīja transplantāta funkcijas normalizāciju 15 dienu laikā pēc nieru transplantācijas.
Tika konstatēta negatīva korelācija starp seruma KIM-1 un aGFĀ līmeņiem 15. dienā pēc NT (rs = -0,507; p = 0,064, n=14) un starp seruma NGAL un aGFĀ līmeņiem 60. dienā pēc NT (rs = -0,755; p = 0,031, n=8). Pastāv pozitīva korelācija starp CXCL9 līmeni urīnā un aGFĀ 60. dienā pēc NT (rs = 0,707; p = 0,050, n=8). Novērojot biomarķieru izmaiņas gareniskā
TITLE: Assessment of innovative biomarkers in early period after kidney transplantation. KEYWORDS: Kidney transplantation, biomarkers, KIM-1, NGAL, Il-18, MIG, CXCL9, CXCL10, IP-10. INTRODUCTION: Kidney transplantation provides longer survival and improved quality of life compared to dialysis in patients with end-stage renal disease (ESRD). This study is emerging because despite transplantation benefits and improvements in immunosuppressive treatment, recipients still experience posttransplant complications, leading to graft failure and loss. If biomarker levels in the immediate post-transplant period can be shown to accurately predict duration of injury and longer-term graft function, they could be very useful as surrogate markers. Therefore, an assessment of biomarkers for each individual patient would warn about minor changes in the graft and personalized immunosuppressive therapy can be provided. AIM OF THE STUDY: Assess the utility of novel renal injury biomarkers in early period after kidney transplantation. MATERIALS AND METHODS: Retrospective study included recipients who underwent kidney transplantation from deceased or living donors in the time period from 01.01.2018 till 31.12.2019. Only those patients who agreed to perform additional sampling (for biomarker panel evaluation) were enrolled in the study. All the laboratory test results and biomarker panel were evaluated at one, two, 15, 60 days post kidney transplantation. Kidney graft function was assessed by eGFR, calculated by CKD-EPI equation. Data was analyzed using IBM SPSS Statistics for Macintosh, Version 25.0.® Data were calculated and presented as mean (M) ± standard deviation (SD) for data corresponding to the normal distribution or median (Me) and interquartile range (IQR) for data not corresponding to the normal distribution for quantitative variables. Spearman correlation (rs) test was used for the strength of the association between specific serum and urine biomarker levels and estimated GFR. RESULTS: Study included total of 24 recipients (58% males, 42% females, mean age 42.6 ± 12.6 years) and eight live donors (25% males, 75% females, mean age 54.4 ± 10.3 years). Values of eGFR post-KT on the 1st day (7.5 ml/min/1.73 m2 ; 7.0 – 12.5; p <0.001); 2nd day (17.0 ml/min/1.73 m2; 10.2 – 28.7; p <0.001); 15th day (58.1 ± 27.3 ml/min/1.73 m2; p = 0.050); 60th day (59.5 ± 23.4 ml/min/1.73 m2; p = 0.173). The kidney graft function assed by eGFR, showed normalization of graft function within 15 days post kidney transplantation. Negative correlation was found between serum KIM-1 and eGFR levels on day 15 post-KT (rs = -0.507; p = 0.064, n=14) and between serum NGAL and eGFR levels on day 60 post-KT (rs = -0.755; p = 0.031, n=8). There is a positive correlation between the level of CXCL9 in urine and eGFR on day 60 post-KT (rs = 0.707; p = 0.050, n=8). While observing biomarkers changes on longitudinal basis in every recipient, NGAL levels showed to be a very sensitive and ear
TITLE: Assessment of innovative biomarkers in early period after kidney transplantation. KEYWORDS: Kidney transplantation, biomarkers, KIM-1, NGAL, Il-18, MIG, CXCL9, CXCL10, IP-10. INTRODUCTION: Kidney transplantation provides longer survival and improved quality of life compared to dialysis in patients with end-stage renal disease (ESRD). This study is emerging because despite transplantation benefits and improvements in immunosuppressive treatment, recipients still experience posttransplant complications, leading to graft failure and loss. If biomarker levels in the immediate post-transplant period can be shown to accurately predict duration of injury and longer-term graft function, they could be very useful as surrogate markers. Therefore, an assessment of biomarkers for each individual patient would warn about minor changes in the graft and personalized immunosuppressive therapy can be provided. AIM OF THE STUDY: Assess the utility of novel renal injury biomarkers in early period after kidney transplantation. MATERIALS AND METHODS: Retrospective study included recipients who underwent kidney transplantation from deceased or living donors in the time period from 01.01.2018 till 31.12.2019. Only those patients who agreed to perform additional sampling (for biomarker panel evaluation) were enrolled in the study. All the laboratory test results and biomarker panel were evaluated at one, two, 15, 60 days post kidney transplantation. Kidney graft function was assessed by eGFR, calculated by CKD-EPI equation. Data was analyzed using IBM SPSS Statistics for Macintosh, Version 25.0.® Data were calculated and presented as mean (M) ± standard deviation (SD) for data corresponding to the normal distribution or median (Me) and interquartile range (IQR) for data not corresponding to the normal distribution for quantitative variables. Spearman correlation (rs) test was used for the strength of the association between specific serum and urine biomarker levels and estimated GFR. RESULTS: Study included total of 24 recipients (58% males, 42% females, mean age 42.6 ± 12.6 years) and eight live donors (25% males, 75% females, mean age 54.4 ± 10.3 years). Values of eGFR post-KT on the 1st day (7.5 ml/min/1.73 m2 ; 7.0 – 12.5; p <0.001); 2nd day (17.0 ml/min/1.73 m2; 10.2 – 28.7; p <0.001); 15th day (58.1 ± 27.3 ml/min/1.73 m2; p = 0.050); 60th day (59.5 ± 23.4 ml/min/1.73 m2; p = 0.173). The kidney graft function assed by eGFR, showed normalization of graft function within 15 days post kidney transplantation. Negative correlation was found between serum KIM-1 and eGFR levels on day 15 post-KT (rs = -0.507; p = 0.064, n=14) and between serum NGAL and eGFR levels on day 60 post-KT (rs = -0.755; p = 0.031, n=8). There is a positive correlation between the level of CXCL9 in urine and eGFR on day 60 post-KT (rs = 0.707; p = 0.050, n=8). While observing biomarkers changes on longitudinal basis in every recipient, NGAL levels showed to be a very sensitive and ear
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Nieres transplantācija, biomarķieri, KIM-1, NGAL, Il-18, MIG, CXCL9, CXCL10, IP-10, Kidney transplantation, biomarkers, KIM-1, NGAL, Il-18, MIG, CXCL9, CXCL10, IP-10