Avaliação do PRA e CD30s no transplante renal intervivos. Acompanhamento no 1º ano e após 6 anos em pacientes do Hospital Federal de Bonsucesso (Rio de Janeiro, Brasil)

Abstract

The soluble CD30 (CD30s) is a transmembrane glycoprotein that belongs to the tumor necrosis factor family expressed on the T Cells surface. When this marker is cleaved it becomes soluble and can be detected in the circulation. Currently, the value of CD30s pre transplantation has been shown as a good predictor of acute rejection (AR) and graft loss. Few studies have been conducted to review CD30s post-transplant and its correlation with survival and eGFR. To evaluate the effectiveness of the determination of soluble CD30 (CD30s) and panel reactive antibody against HLA (PRA) in six months, one year and six years after renal transplantation in recipients of living donors, and correlate with acute rejection episodes, infectious events, graft loss and death. Evaluate the correlation of these markers with renal allograft survival during these periods. The subjects studied were renal transplant recipients of living donors in Federal Bonsucesso Hospital (HFB) in Rio de Janeiro in 2006 and the period from August 2010 to May 2011, with a previously done work extension. CD30s and PRA were analyzed in samples collected in pre transplant and 7, 14, 21 days, 1, 3, 6, 12 months after transplantation and in patients transplanted in 2006 samples after 6 years of transplantation were used. The estimated glomerular filtration rate (eGFR) was done using MDRD and CKD-epi in 6 months, 1 year and 6 years after transplantation. The patients were divided into 5 groups: no events, graft loss, death, acute rejection and patients with infections. These groups were evaluated with respect to CD30s, PRA I and II and compared two by two. The chi square test was used. When necessary we applied the Yates correction, Fisher's test and the Kruskal-wallis. We considered statistically significant p <0.05.The analyzes were performed using EPI-Info (version 3.5.3). Were included in study 76 subjects with living donors. Forty-seven patients had no event (group 1), seven patients lost their graft (group 2), three patients died (group 3), 11 patients were in the group of acute rejection ( group 4), eight patients had CMV and herpes (group 5). The patients in the RA group had a positive correlation with the values of both CD30s Pre transplant (p = 0.01), as the CD30s post-transplant (p = 0.002) and PRA I and II (p <0.001), respectively, when compared with patients without events. The eGFR with both MDRD and CKD-Epi showed no correlation with pre and post-transplant CD30s neither PRA I and II. The eGFR with the two formulas were lower in the group with RA compared with the group without event after 6 years of transplantation (p = 0.006). The CD30s is a good predictor of RA, as PRA I and II and also another tool that can be used in monitoring post renal transplantation. The RA is an isolated predictor of decreased eGFR for transplantation.