Sahin Garip, Temiz Gökhan, Ozkurt Sultan, Bal Cengiz, Bozaci Ilter, Bayrak Torun Canan, Akay Olga Meltem, Uslu Sema, Yalcin Ahmet Ugur, Gulbas Zafer, Kiper Haluk
From the Department of Nephrology, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey.
Exp Clin Transplant. 2018 Apr;16(2):160-165. doi: 10.6002/ect.2016.0105. Epub 2016 Jun 3.
In chronic kidney disease, both bleeding and thrombotic complications are observed, although with expected recovery after a successful transplant. Adiponectin has protective properties with respect to atherogenesis and inflammation. Plasma adiponectin levels are markedly elevated among patients with end-stage renal disease and are lower after kidney transplant. However, this topic is still debated in the literature. Here, we evaluated the effect of transplant on platelet function markers (P-selectin and platelet aggregation) and adiponectin in renal transplant patients.
Our study included 14 renal transplant patients. Preoperative and week 1, month 1, month 6, year 1, and year 2 samples after transplant were studied. In addition to plasma adiponectin, P-selectin levels, and platelet aggregation tests, biochemical tests and coagulation parameters were also studied.
We observed a significant decrease in adiponectin levels 2 years after transplant. Platelet function tests with ADP and collagen were significantly improved, and no changes in P-selectin, ristocetin, and epinephrine levels were observed.
According to our findings, glomerular filtration rate has an important effect on platelet function, but adiponectin levels became normal only in the second year after transplant. Late improvement of low-density lipoprotein cholesterol and adiponectin after transplant suggested to us that patients with kidney transplant may still have risk of cardiovascular events, especially in the first years.
在慢性肾脏病中,出血和血栓形成并发症均有发生,尽管成功移植后有望恢复。脂联素对动脉粥样硬化和炎症具有保护作用。终末期肾病患者的血浆脂联素水平显著升高,而肾移植后则降低。然而,该话题在文献中仍存在争议。在此,我们评估了移植对肾移植患者血小板功能标志物(P-选择素和血小板聚集)及脂联素的影响。
我们的研究纳入了14例肾移植患者。对术前以及移植后第1周、第1个月、第6个月、第1年和第2年的样本进行了研究。除了血浆脂联素、P-选择素水平和血小板聚集试验外,还研究了生化试验和凝血参数。
我们观察到移植后2年脂联素水平显著降低。用二磷酸腺苷(ADP)和胶原进行的血小板功能试验显著改善,而P-选择素、瑞斯托菌素和肾上腺素水平未观察到变化。
根据我们的研究结果,肾小球滤过率对血小板功能有重要影响,但脂联素水平仅在移植后第二年恢复正常。移植后低密度脂蛋白胆固醇和脂联素的后期改善提示我们,肾移植患者仍可能有心血管事件风险,尤其是在最初几年。