Incidence, risk factors, management strategies and outcomes of antibody-mediated rejection in pediatric kidney transplant recipients – a multicenter analysis of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN)

Author:

Fichtner Alexander1ORCID,Gauché Laura1,Süsal Caner2,Tran Thuong Hien1,Waldherr Rüdiger1,Krupka Kai1,Guzzo Isabella3,Carraro Andrea4,Oh Jun5,Zirngibl Matthias6,Weitz Marcus6,König Jens7,Büscher Anja8,Berta Laszlo9,Simon Thomas10,Awan Atif11,Rusai Krisztina12,Topaloglu Rezan13,Peruzzi Licia14,Printza Nikoleta15,Kim Jon Jin16,Weber Lutz T.17,Melk Anette18,Pape Lars8,Rieger Susanne1,Patry Christian1,Höcker Britta1,Tönshoff Burkhard1

Affiliation:

1. Heidelberg University Medical Faculty Heidelberg: Universitat Heidelberg Medizinische Fakultat Heidelberg

2. Koc University: Koc Universitesi

3. Bambino Gesu Pediatric Hospital: Ospedale Pediatrico Bambino Gesu

4. Padua University Hospital: Azienda Ospedale Universita Padova

5. University Hospital Hamburg-Eppendorf: Universitatsklinikum Hamburg-Eppendorf

6. University Hospitals Tubingen: Universitatsklinikum Tubingen

7. University Hospital Munster: Universitatsklinikum Munster

8. University Hospital Essen: Universitatsklinikum Essen

9. Semmelweis University of Medicine: Semmelweis Egyetem

10. University of Toulouse: Universite de Toulouse

11. Temple Street Children's University Hospital: Children's Health Ireland at Temple Street

12. Medical University of Vienna: Medizinische Universitat Wien

13. Hacettepe University: Hacettepe Universitesi

14. University of Turin: Universita degli Studi di Torino

15. Aristotle University of Thessaloniki Department of Medicine: Aristoteleio Panepistemio Thessalonikes Tmema Iatrikes

16. Nottingham University Hospitals NHS Trust

17. Medical Faculty of the University of Cologne: Universitat zu Koln Medizinische Fakultat

18. Hannover Medical School: Medizinische Hochschule Hannover

Abstract

Abstract Background. This study by the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) was designed to determine the incidence, risk factors, current management strategies and outcomes of antibody-mediated rejection (ABMR) in pediatric kidney transplant recipients (pKTR). Methods. We performed an international, multicenter, longitudinal cohort study of data reported to the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) registry. 337 pKTR from 21 European centers were analyzed. Clinical outcomes, including renal dysfunction, rejection, HLA donor-specific antibodies, BK polyomavirus-associated (BKPyV) nephropathy, and allograft loss, were assessed through 5 years posttransplant. Results. The cumulative incidence of de novo donor-specific class I HLA antibodies (HLA-DSA) posttransplant was 4.5% in year 1, 8.3% in year 3 and 13% in year 5; the corresponding data for de novo class II HLA-DSA were 10%, 22.5%, and 30.6%, respectively. During 5 years posttransplant, the cumulative incidence of acute ABMR was 10% and that of chronic active ABMR was 5.9%. HLA-DR mismatch and de novo HLA-DSA, especially double positivity for class I and class II HLA-DSA, were significant risk factors for ABMR, whereas cytomegalovirus (CMV) IgG negative recipient and CMV IgG negative donor were associated with a lower risk. BKPyV nephropathy was associated with the highest risk of graft dysfunction, followed by ABMR, T-cell mediated rejection and older donor age. Conclusions. This study provides an estimate of the incidence of de novo HLA-DSA and ABMR in pKTR and highlights the importance of BKPyV nephropathy as a strong risk factor for allograft dysfunction.

Publisher

Research Square Platform LLC

Reference30 articles.

1. Antibody-mediated rejection of solid-organ allografts;Loupy A;N Engl J Med,2018

2. Incidence, risk factors, treatment, and consequences of antibody-mediated kidney transplant rejection: A systematic review;Hart A;Clin Transpl,2021

3. Süsal C, Fichtner A, Tönshoff B, Mehrabi A, Zeier M, Morath C (2017) Clinical relevance of HLA antibodies in kidney transplantation: recent data from the Heidelberg transplant center and the Collaborative Transplant Study. J Immunol Res 2017:5619402

4. Relationship among viremia/viral infection, alloimmunity, and nutritional parameters in the first year after pediatric kidney transplantation;Ettenger R;Am J Transpl,2017

5. Long-term care of the pediatric kidney transplant recipient;Fernandez HE;Clin J Am Soc Nephrol,2022

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3