The Clinical Value Of Platelet Parameters To The Diaglosis Of Acute Rejection After Renal Transplantation

Background Renal transplantation is the most effective treatment for end-stage renal failure.With the application of immunosuppressive agents and advances in technology related to organ transplantation,the success rate of renal transplantation can be as high as 90%.But the risk of acute rejection(AR)increases when the concentration of immunosuppressant failed to meet the target concentration required,immunosuppressive agents suddenly reduced,vomiting,diarrheaing or other risk factors happen,affecting the long-term survival of organ.Early detection and therapy is of significantly important to improve the survival time of renal.Acute rejection(AR)refers to the rejection occurrs 1 week after renal transplantation.The clinical feature of acute rejection is significantly decreased urine output compared with the previous,elevated body temperature,blood pressure was higher than before,bursting pain of renal transplant area,obviously increasing of serum creatinine than ever before.Further more,doppler ultrasound indicated that the graft renal resistance index increased(>0.75)and the pathology of transplanted renal biopsy is in line with Banff standard.Our group found that five parameters of platelet in patients after renal transplantation have certain regular pattern in the early postoperative period.And platelet activation plays an important role in them.However,the specific mechanism remains to be further explored.This study retrospectively observes the changes of five parameters of platelet in AR group on the day renal transplantation diagnoses,including 53 cases of AR group and 186 cases of control group(patients without acute rejection after renal transplantation).The all-variable model is selected to classify the risk factors of acute rejection using the binary logistic regression analysis and plotting the ROC curve to analyze the sensitivity and specificity of each platelet parameter for the diagnosis of acute rejection.Then we evaluate the clinical value of the five parameters of platelet in predicting the acute rejection.Objectives To observe the changes of platelet parameters in patients with acute rejection after renal transplantation and explore the relationship between the parameters of platelet and acute rejection.Method The clinical data of 239 uremic patients from January 2010 to June 2017 are retrospectively analyzed within 2 months after allograft renal transplantation.The renal transplant recipients including 53 patients(AR group)with acute rejection,35 of them are male patients,18 of them are female patients,aged from 16 to 58(40.4± 1.3)years old.The AR group are diagnosed acute rejection after 6?26(13.5 ± 0.7)days after renal transplantation.The primary disease including 13 cases of hypertensive nephropathy,27 cases of chronic glomerulonephritis,5 cases of diabetic nephropathy and 8 cases of IgA nephropathy.In addition,186 patients(control group)without acute rejection after renal transplantation were enrolled,including 125 male patients and 61 female patients,ranging from 21 to 69(42.2 ? 0.8)years old.The primary disease included hypertensive nephropathy Cases,89 cases of chronic glomerulonephritis,18 cases of diabetic nephropathy,29 cases of IgA nephropathy,10 cases of polycystic kidney disease,11 cases of obstructive nephropathy.All 239 cases received donations after cardiac death and they received regular dialysis treatment or regular hemodialysis before renal transplantation.The Inclusion criteria are the followings:donors' blood types consist with recipients,lymphocytotoxicity test and panel reactive antibodies(PRA)is negative.Further more,mismatch 1 to 4 sites of 6 sites of HLA.The immunosuppressant regiments including intravenous infusion of anti-human thymus lymphocyte globulin(ATG)and methylprednisolone(MP)immunization after renal transplantation,taking the combination of mycophenolate mofetil(MMF),tacrolimus(Tac)and prednison(pred)orally.The exclusion criterias are the followings:the use of anti-platelet aggregation drugs during the observation period,infectious recipients during the observation period.Result There is no significant difference in parameters of platelet between AR group and control group before operation(P>0.05).On the day diagnosis of acute rejection,the MPV,PDW and P-LCR were significantly higher than those of control group(P<0.05),while there is no statistical difference(P>0.05)in parameters of PLT and PCT indexes between the AR group and control group.Logistic regression analysis was used to analyze the risk factors of acute rejection.P-LCR(P<0.05,OR=1.130)and PDW(P<0.05,OR = 1.498)were all risk factors of acute rejection.Factors such as gender,age,MPV,PCT and PLT had no significant effect on acute rejection(P>0.05).The ROC curve of platelet parameters on the day of acute rejection after renal transplantation suggest that the area under the ROC curve of P-LCR predicted acute rejection was 0.789,the best cut-off value was 28.85%,the sensitivity was 69.8%and the specificity was 80.6%.The area under the ROC curve of PDW predicted acute rejection was 0.654,the best cutoff value was 10.45fL,the sensitivity was 83.0%and the specificity was 54.3%.Conclusion The detection of P-LCR and PDW after renal transplantation will be helpful for the early detection and early intervention of acute rejection after renal transplantation.The occurrence of acute rejection of renal allograft should be warned when the index above the optimal threshold.The combination of P-LCR and PDW may be helpful for improving the diagnostic accuracy of diagnosing acute rejection.