Cytotoxic antibodies monitoring in kidney transplantation - their clinical relevance and challenges

Vol. 53 No. 3 Suppl., 2012
This supplement was not sponsored by Outside Organizations.

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

C. Gingu, Ana Moise, Ileana Constantinescu, B. Serbanescu, C. Surcel, I. Sinescu

Introduction: The key of the successful renal transplantation is the ability to identify the best immunological match between donor and recipient considering the possibility of rejection phenomenon. The aim was to identify class I and/or class II cytotoxic antibodies in renal-transplanted patients in order to assess the immunological potential for prevention of subclinical or acute rejection episodes. Patients and Methods: We have evaluated ninety-two patients who had kidney transplantation in 2010 in Fundeni Clinical Institute, Bucharest, Romania, concerning HLA matching and anti-HLA immunization status. For HLA genotyping were used molecular biology methods - PCR-SSP (Invitrogen, USA). For cytotoxic antibodies, the methods used were ELISA (GTI Diagnostics, USA) and Luminex (One Lambda, USA). Crossmatch tests between donor cells and recipient serum were performed by ELISA (GTI Diagnostics, USA). Rejection diagnosis was supported by renal biopsy. Results: In the 20 presensitized cases, the rate of acute rejection was 30% while in the 72 unsensitized cases the rejection was 19.4%. The incidence of acute rejection was higher in anti-HLA class I presensitized patients compared with anti-HLA class II (20% and 14.3%, respectively) but there was no significant difference compared to pre-transplant unsensitized patients (19.4%). Sequential post-transplantation monitoring of anti-HLA antibodies has shown in pre-transplant sensitized patients group a constantly increasing of PRA value, while in the pre-transplant unsensitized patients group, 32% developed de novo cytotoxic antibodies. Conclusions: More sensitive and specific methods to detect anti-HLA antibodies before transplantation and sequential post-transplantation monitoring of these antibodies would be useful to identify patients who are at higher risk for allograft failure.

Corresponding author: Constantin Gingu, MD, PhD; e-mail: cgingu@gmail.com

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ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Ancuta Boicea, Anca Patrascu, V. Surlin, D. Iliescu, M. Schenker, Luminita Chiutu

Introduction: Cervical cancer develops from well-defined precursor lesions in a varied period of time. Detected in early or pre-invasive stages, cervical cancer is preventable and curable, so detection of precancerous lesions is very important. Colposcopy with directed biopsy is used in the evaluation and management of patients with cervical lesions, and described as the 'gold standard' for the diagnosis of cervical precancer. Aim: The aim of this study is to assess the accuracy of colposcopic examination and cervical punch biopsy, to determine the correlation between these two methods. Materials and Methods: We examined 245 patients who present malignant findings at colposcopy and biopsy. Colposcopic findings in our study group: 28 (11.4%) cases were CIN I, 50 (20.4%) cases were CIN II, 150 (61.2%) cases were CIN III, 13 (5.3%) cases were micro-invasive carcinoma and four (1.6%) cases were CIS. Histological results in the 245 examined cases were: four (1.6%) cases normal, 26 (10.6%) cases CIN I, 55 (22.4%) cases CIN II, 138 (56.3%) cases CIN III, 15 (6.1%) cases micro-invasive carcinoma and seven (2.8%) cases of CIS. Results: The correlation was 78.5% in the CIN I category, 84% in the CIN II category, 88.6% (133 out of 150 patients) in the CIN III category, 46.1% for micro-invasive carcinoma and 50% for CIS. The colposcopy method incurred fewer false negatives (four patients), giving a general accuracy rate of 98.3%. Sensitivity of colposcopic examination was 83.6%. Conclusions: This study demonstrated high accuracy and correlation between colposcopy and histology, comparable with results from similar studies in the literature. Sensitivity is lower, probably because biopsies were done in all cases, during diagnostic work-up. We also demonstrated the usefulness of these two diagnostic procedures as screening tests in preclinical cervical cancer. In our study, there were cases of under or over diagnose; the benefit of colposcopy and directed biopsy is to avoid over treatment of low-grade lesion, and under treatment of high-grade lesion.

Corresponding author: Ancuta Boicea, MD, PhD resident; e-mail: ssm11ssm@yahoo.com

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