Correlação entre incompatibilidade HLA e rejeição nos transplantes cardíacos realizados no Instituto Nacional de Cardiologia
Correlação entre incompatibilidade HLA e rejeição nos transplantes cardíacos realizados no Instituto Nacional de Cardiologia
Data
2014
Autores
Schtruck, Lígia Beatriz Chaves Espinoso
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: O presente estudo tem como objetivo principal correlacionar o número de incompatibilidades HLA com a frequência de rejeição celular aguda, nos primeiros seis meses após o transplante cardíaco. O objetivo secundário é detectar a presença de anticorpos neoformados pelo receptor, tanto para antígenos HLA, quanto não-HLA (MICA). Métodos: estudo de Coorte. A população foi composta por todos os pacientes adultos transplantados no Instituto Nacional de Cardiologia (INC) no período de 01/01/2008 e 31/12/2013, excluídos os receptores ou doadores sem HLA determinado. Do total de 39 transplantes foram incluídos 25 pacientes e seus respectivos doadores, realizada pesquisa de neoanticorpos por citometria de fluxo em 21 receptores (quatro haviam falecido na ocasião do estudo). Determinado os loci: HLA-A, HLA-B e HLA DR do doador e do receptor pela metodologia de PCR- RSSO. Classificados em 6 grupos, de acordo com o número de incompatibilidades entre alelos HLA. Pesquisa de anticorpos neoformados por citometria de fluxo e imunofluorescência. Biópsias endomiocárdicas coradas pela técnica de hematoxilina- eosina e coloração especial de tricrômio de Gomori, analisadas e classificadas de acordo com os achados histológicos definidos pela International Society of Heart and Lung Transplantation (ISHLT). Resultados: Não houve correlação significativa entre o numero de incompatibilidades e a frequência de rejeição celular aguda nos primeiros seis meses apos o transplante, quando analisado o numero de incompatibilidades HLA de maneira global (p:0,350). Ao analisarmos separadamente a incompatibilidade no locus HLA-DR, encontramos uma frequência de rejeição significativamente maior (p: 0,054). Não houve interferência dos outros fatores analisados: idade, raça, tipagem sanguínea, sexo (doador x receptor), causa do óbito do doador, viremia por CMV, presença de neoanticorpos anti-HLA e MICA. Conclusão: Foi encontrada correlação significativa entre incompatibilidade HLA-DR e maior numero de episódios de rejeição celular aguda nos primeiros 6 meses após transplante cardíaco. Em quatro dos 21 receptores analisados foi detectada presença de neoanticorpos, todos sem evidência de rejeição confirmada por biópsia endomiocárdica.
Introduction: This study aims to correlate the number of HLA mismatches with the frequency of acute cellular rejection in the first six months after heart transplantation. The secondary objective is to detect in the receptor the presence of neo antibodies against antigens HLA and non HLA (MICA). Methods: Cohort study. The population consisted of all adult patients transplanted at the National Institute of Cardiology (INC) between 01/01/2008 and 31/12/2013, excluding receptors or donors without definition of HLA. Of the 39 transplants were included 25 patients and their donors, performed neo antibodies by flow cytometry on 21 receptors (4 had died at the time of the study). Found loci: HLA A, HLA B and HLA DR donor and recipient RSSO by PCR methodology. Classified into six groups according to the number of HLA incompatibilities. Research neo formed antibodies were by flow cytometry and immunofluorescence. Endomyocardial biopsies stained with hematoxylin eosin technique and special staining Gomori's trichrome, analyzed and classified according to the histological findings defined by the International Society of Heart and Lung Transplantation (ISHLT). Results: There was no significant correlation between the number of incompatibilities and the frequency of acute cellular rejection in the first 6 months after transplantation when analyzing the number of HLA mismatches globally (p: 0.350). When analyze separately the mismatch in HLA DR locus, we found a significantly higher rejection rate (p: 0.054). There was no interference from the other factors analyzed: age, race, blood type, sex (donor x receiver), cause of the donor's death, CMV viremia, the presence of neo antibodies anti HLA and anti MICA. Conclusion: We found a significant correlation between HLA DR mismatch and greater number of episodes of acute cellular rejection in the first 6 months after heart transplantation. In 4 of the 21 analyzed receptors was detected presence of neo antibodies, all without evidence of rejection confirmed by endomyocardial biopsy.
Introduction: This study aims to correlate the number of HLA mismatches with the frequency of acute cellular rejection in the first six months after heart transplantation. The secondary objective is to detect in the receptor the presence of neo antibodies against antigens HLA and non HLA (MICA). Methods: Cohort study. The population consisted of all adult patients transplanted at the National Institute of Cardiology (INC) between 01/01/2008 and 31/12/2013, excluding receptors or donors without definition of HLA. Of the 39 transplants were included 25 patients and their donors, performed neo antibodies by flow cytometry on 21 receptors (4 had died at the time of the study). Found loci: HLA A, HLA B and HLA DR donor and recipient RSSO by PCR methodology. Classified into six groups according to the number of HLA incompatibilities. Research neo formed antibodies were by flow cytometry and immunofluorescence. Endomyocardial biopsies stained with hematoxylin eosin technique and special staining Gomori's trichrome, analyzed and classified according to the histological findings defined by the International Society of Heart and Lung Transplantation (ISHLT). Results: There was no significant correlation between the number of incompatibilities and the frequency of acute cellular rejection in the first 6 months after transplantation when analyzing the number of HLA mismatches globally (p: 0.350). When analyze separately the mismatch in HLA DR locus, we found a significantly higher rejection rate (p: 0.054). There was no interference from the other factors analyzed: age, race, blood type, sex (donor x receiver), cause of the donor's death, CMV viremia, the presence of neo antibodies anti HLA and anti MICA. Conclusion: We found a significant correlation between HLA DR mismatch and greater number of episodes of acute cellular rejection in the first 6 months after heart transplantation. In 4 of the 21 analyzed receptors was detected presence of neo antibodies, all without evidence of rejection confirmed by endomyocardial biopsy.
Description
Palavras-chave
Transplante cardíaco, Rejeição, HLA, Incompatibilidade HLA, Heart transplantation, Rejection, HLA, HLA mismatching
Citação
Schtruck LBCE. Correlação entre incompatibilidade HLA e rejeição nos transplantes cardíacos realizados no Instituto Nacional de Cardiologia. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2015.