Turkiye Klinikleri Journal of Internal Medicine

.: REVIEW
Böbrek Transplantasyonunda Rejeksiyon Mekanizmaları ve Biyobelirteçleri
Rejection Mechanisms and Bioindicators in Kidney Transplantation
Tülay KILIÇASLAN AYNAa,b, İbrahim PİRİMa,b
aTıbbi Biyoloji ve Genetik AD, İzmir Kâtip Çelebi Üniversitesi Tıp Fakültesi,
bDoku Tipleme Laboratuvarı Kliniği, Tepecik Eğitim ve Araştırma Hastanesi, İzmir, TÜRKİYE
Turkiye Klinikleri J Intern Med. 2019;4(1):13-24
doi: 10.5336/intermed.2018-63273
Article Language: TR
Full Text
ÖZET
 Organ transplantasyonu, organ yetmezliklerinin tedavisinde önemli bir seçenektir. Dünyada ve ülkemizde böbrek transplantasyonu en çok yapılan organ transplantasyonudur. Hem kadavra donörün hem de canlı donörün organ kaynağı olarak kullanılması son dönem böbrek yetmezliği olan birçok hastanın nakil olmasına imkân sağlamaktadır. Transplante edilen organın normal fonksiyonlarını yapabilmesi hastanın yaşam kalitesini yükselttiği gibi, ülke ekonomisine de katkı sağlamaktadır. Uzun ömürlü bir böbrek sağkalımı için transplantasyon immünolojisinin iyi anlaşılması önemlidir. Bu bağlamda değerlendirme için hasta ve donör arasındaki doku uyumu, immün sistem hücrelerinin yabancı organı tanıma mekanizmaları, bu süreçte görev alan hücreler, moleküller göz önünde bulundurulmalıdır. Son yıllarda geliştirilen hücresel ve solid faz tekniklerinin birlikte kullanımı ile anti-insan lökosit antijenleri antikorların saptanması, özellikle hiper akut rejeksiyonların önüne geçen önemli bir yeniliktir. Ancak, uzun dönemde ortaya çıkan rejeksiyonlar ve graft yetmezlikleri hâlen organ nakil merkezleri için bir sorun olmaya devam etmektedir. Bilim insanlarının, greft ve hasta arasındaki immünolojik ilişkinin anlaşılması amacıyla yeni biyobelirteçler bulma girişimleri devam etmektedir. Bu bağlamda hastadaki bazı genlerin ekspresyon düzeyleri, hasta ve donör arasındaki gen polimorfizm farklılıkları ve protein ekspresyon düzeyindeki değişiklikler kan ve idrar örneklerinde değerlendirilmektedir. Ayrıca, son birkaç yıldır greft dokusundaki harabiyet nedeni ile kan ve idrara geçen serbest donör DNA'ları bu amaçla araştırılmaktadır. Bu çalışmada, T ve B-hücrelerinin temel rol oynadığı immün yanıt tipleri ile böbrek rejeksiyon mekanizmaları ve yeni biyobelirteçler hakkında bilgi verilmesi amaçlanmıştır.

Anahtar Kelimeler: Böbrek transplantasyonu; doku-organ reddi; sinyal iletimi; gen ekspresyonu; biyobelirteçler
ABSTRACT
 Organ transplantation is a significant option for organ failure treatment. In our country and all around the world, kidney transplantation is the most common solid organ transplantation. The availibility of deceased as well as related donors allows a number of patients with end stage renal failure to be tranpslanted. Normal functionality of allografts will increase life quality of the patients as well as contribute to national economy. The well understood of transplantation immunology is important for long-term graft survival. Thus, histocompatibility of recipient and donor, recognition mechanisms of immune system cells for allograft, the cells and molecules that play roles in this process, and production of donor specific antibody should be considered for the evaluation. Recently, the detection of anti-human leukocyte antigen antibodies by utilization of cellular and solid phase techniques together has been an important novelty that prevents especially hyperacute rejections. However, ling-term rejections and graft failures are still issues for organ transplant centres. Scientist continue their attempts to find new biomarkers in order to understand the immunological relationship between the graf and the patient. In this context, expression levels of some genes in the patient, the gene polymorphism differences between donor and recipient, and the alterations at protein expression levels are evaluated in blood and urine samples. In recent years, cell free donor DNAs that pass through blood and urine due to graft tissue destruction, have been invesigated. In this review, the information about immüne response types in which T and B-cells play the main role and rejection mechanisms and new biomarkers will be given.

Keywords: Kidney transplantation; graft rejection; signal transduction; gen expression; biyomarkers
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