PEDIATRIC RENAL TRANSPLANTATION USING FLOWCYTOMETRY CROSSMATCH AND

HLA IMMUNOFENOTYPING BASED ON DNA FOR SCREENING TEST: A CASE REPORT

Rudy Eka A Putra*, Besut Daryanto**, Kurnia Penta Seputra**, Paksi Satyagraha**, Atma
Gunawan***, Hani Susianti****
*) Urology Resident at Urology Department Medical Faculty Brawijaya University Saiful Anwar
General Hospital Malang
**) Urology Staff at Urology Department Medical Faculty Brawijaya University Saiful Anwar
General Hospital Malang
***) Internal Medicine Staff at Internal Medicine Department Medical Faculty Brawijaya
University Saiful Anwar General Hospital Malang
****) Clinical Patologic Staff at Clinical Patologic Department Medical Faculty Brawijaya
University Saiful Anwar General Hospital Malang
ABSTRACT
Introduction and objectives : Renal transplantation is the most successful treatment option for
children with kidney failure. Patient survival at 1, 5 and 10 years was respectively 99%, 97%
and 96%. Successful renal transplantation can almost restore a childs normal life. Renal
transplantation has beneficial effect both in economic and physiologic aspects. During this time
we use the CM CDC and serological HLA immunofenotyping for renal transplant screening, risk
of rejection between donors and recipients as high. Therefore for this case used the technique
of FXCM and HLA based on DNA immunofenotyping to reduce the risk of high rejection that are
useful to increase the number of success of renal transplantion. We report the experience of a
kidney transplant surgery in children using the screening flowcytometry cross matching and
HLA immunofenotyping based on DNA to predict graft rejection between the recipient and the
donor at dr Saiful Anwar Hospital in Malang were the first conducted in Indonesia.
Materials and methods : We evaluated a 15 year old female adolescent with end stage chronic
kidney disease. We predicted graft rejection using flowcytmetry and HLA ABDR typing between
the recipient and the donor.
Results : A 15-years old female adolescent with end stage chronic kidney disease. She
underwent hemodyalisis for 3 months and planned for renal transplantation. Flowcytometry-
based crossmatch analysis from T and B cell lymphocyte showed negative crossmatch. HLA-
ABDR immunofenotyping using PCR-SSP (Polymerase Chain Reaction- based Sequence
Specific Primers) method showed mismatch 3/6.. A kidney organ from her mother transplanted
at donor using end to end anastomose method. Tension occurs in during operation and the
recipient kidney donors was installed mesh to increase vascularization of the kidney . After
transplantation procedure, she got immunosuppressive treatment. A 4 month follow up showed
no graft rejection and normal daily activity, but there is increasing renal function test at 4 month
and the results of the re-evaluation in the recipient is ureteral stenosis , then we performed
ureterorenoscopy with Holmium laser and inserted of DJ stent in a patient .
Conclusions : Flowcytometry based crossmatch analysis could be used for predicting graft
rejection between recipient and donor. There is no graft rejection reactions among recipients
and donors in terms of preparation crossmatch kidney transplants. Kidney transplantation is a
better therapy for end-stage renal failure in children as compared to dialysis in terms of cost
benefit, survival, reduced dialysis-related morbidity and quality of life. Renal transplantation in
children by using flowcytometry shows the results that can be applied to other recipients.
Keywords : pediatric renal transplantation, HLA based on DNA, FXCM, mesh