Sensitization Factors Of AECAs And Their Correlation With Adverse Events After Renal Transplantation

Objective: To investigate the sensitization factors of AECAs positive patients before renal transplantation,and to explore the effect of preoperative AECAs and postoperative new AECAs on renal function in renal transplant patients after six months.Methods: In the first part,85 patients waiting for allogeneic kidney transplantation were selected in the People’s Liberation Army 309 Hospital from October 2015 to August 2016.The preoperative serum was collected and the clinical data such as sex,age,body mass index,cause of renal failure,type and time of dialysis,preoperative creatinine level,pregnancy,transfusion and transplantation were recorded.The expression of AECAs in serum was detected by indirect immunofluorescence assay.According to the test results,the patients were divided into AECAs positive group and AECAs negative group.The positive rate of preoperative AECAs was measured and the effect of preoperative sensitization on AECAs was analyzed.In the second part,85 patients with allogeneic renal allografts were selected as the study subjects.Serum levels were collected at 1d,3d,7d,15 d and 1m after operation.The expression of AECAs was detected by indirect immunofluorescence.At the same time,the serum creatinine value,as well as the occurrence of adverse events such as DGF,rejection and infection,were recorded.The patients were divided into three groups according to the test results: AECAs(Pre+/Post +)group,AECAs(Pre-/Post +)group and AECAs(Pre-/Post-)group.The correlation between the expression of AECAs and the occurrence of adverse events was analyzed.Data were analyzed by IBM SPSS Statistics 20 statistical software.The measurement data were expressed as mean ± standard deviation(χ ± s).Measurement data were compared using two independent samples t-test or ANOVA.The count data were compared by χ2 test and corrected χ2 test or Fisher exact test.P <0.05 indicates that the difference was statistically significant.Results: During 85 patients waiting for renal transplantation,19 patients had positive AECAs expression in peripheral blood,and the positive rate was 22.4%.Among the 19 positive patients,there were 3 types of positive results: 12 cases(63.2%)of the perinuclear fluorescent granules,5 cases(26.3%)of anti-cytoplasmic antibody and 2 cases(10.5%)of anti-nuclear antibody.There was no significant difference in sex,age,body mass index,dialysis type,dialysis time,preoperative creatinine level and primary disease(P> 0.05).There was no significant difference between AECAs positive group and AECAs negative group(P = 0.37;P = 0.34)under the influence of independent sensitization factors such as transfusion and pregnancy.Patients were divided into sensitized groups(previous history of transfusion or pregnancy)and non-sensitized groups(previous without transfusion and pregnancy history).There were 28 patients with sensitization,including 10 patients(35.7%)with AECAs and 57 patients with non-sensitized patients.Among them,9 patients(15.8%)with AECAs positive and AECAs were significantly higher than those without AECAs,there was statistically significant difference between the two groups(χ2 = 4.295,P = 0.038).All of the 85 patients underwent allogeneic renal transplantation in our hospital.A total of 19 AECAs positive patients were positive at all time points after operation.Preoperative 66 AECAs negative patients at each time point is detected 10 patients had AECAs turn positive,the remaining 56 patients before and after each time point detection AECAs were negative.Of the 10 patients with AECAs(Pre-/Post+),3 patients developed AECAs on the 2-3 days postoperatively,2 patients developed AECAs on the 4-7 days postoperative,and 5 patients developed AECAs on the 8-15 th days after surgery.AECAs(Pre+/ Post+)group,AECAs(Pre-/Post+)group and AECAs(Pre-/Post-)group were compared.,there was no significant difference in gender,age,body mass index,dialysis type,duration of dialysis,primary disease and so on(P> 0.05).There was no significant difference in the type,gender,age,body mass index and cold ischemia time in donor kidney(P> 0.05).and there were no significant differences in the application of preoperative induction and postoperative immunosuppressive therapy too(P> 0.05).The incidence of AECAs(Pre-/Post+)group rejection was higher than that of the other two groups,AECAs(Pre-/Post+)30% vs AECAs(Pre+/Post+)5.3% vs AECAs(Pre-/Post-)17.9%,But did not reach the statistical difference(P = 0.21).The incidence of postoperative infection was also not statistically significant in the three groups(P = 0.31).However,the incidence of DGF(70%)and duration(54 ± 42.5 days)in AECAs(Pre-/Post+)were significantly higher than those in the other two groups(P <0.05),The level of creatinine in AECAs(Pre-/Post+)group was higher than that in the other two groups at 1 week(P=0.02),1 month(P=0.04),3 months(P=0.01)and 6 months(P=0.02)after renal transplantation.The difference was statistically significant.Conclusion: The results of this study show that(1)the positive rate of AECAs in patients with a history of sensitization such as transfusion,pregnancy and transplantation is significantly increased,and the positive results are mainly perinuclear fluorescence granule,anti-cytoskeleton antibody and antinuclear antibody type.(2)Postoperative de novo AECAs can increase the risk of DGF after renal transplantation,prolong the duration of DGF,and affect the recovery of transplanted renal function within six months after operation.