Study on Antibody-Mediated Rejection in Pediatric Kidney Transplants
Author Information
Author(s): Fichtner Alexander, Gauché Laura, Süsal Caner, Tran Thuong Hien, Waldherr Rüdiger, Krupka Kai, Guzzo Isabella, Carraro Andrea, Oh Jun, Zirngibl Matthias, Weitz Marcus, König Jens, Büscher Anja, Berta Laszlo, Simon Thomas, Awan Atif, Rusai Krisztina, Topaloglu Rezan, Peruzzi Licia, Printza Nikoleta, Kim Jon Jin, Weber Lutz T., Melk Anette, Pape Lars, Rieger Susanne, Patry Christian, Höcker Britta, Tönshoff Burkhard, for the CERTAIN study group
Primary Institution: Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children’s Hospital, Heidelberg, Germany
Hypothesis
What are the incidence, risk factors, management strategies, and outcomes of antibody-mediated rejection in pediatric kidney transplant recipients?
Conclusion
The study estimates the incidence of de novo HLA-DSA and ABMR in pediatric kidney transplant recipients and highlights BKPyV nephropathy as a significant risk factor for allograft dysfunction.
Supporting Evidence
- The cumulative incidence of acute ABMR was 10% and chronic active ABMR was 5.9% at 5 years post-transplant.
- HLA-DR mismatch and de novo HLA-DSA were significant risk factors for ABMR.
- BKPyV nephropathy was associated with the highest risk of graft dysfunction.
- Patient and graft survival rates at 5 years post-transplant were 98.7% and 95.6%, respectively.
- Only 3.9% of patients had been desensitized for pretransplant donor-specific HLA-DSA.
Takeaway
This study looked at kids who got kidney transplants and found that some got sick from their new kidneys because of certain antibodies, especially if they had a virus called BKPyV.
Methodology
An international, multicenter, longitudinal cohort study analyzing data from the CERTAIN registry over 5 years post-transplant.
Potential Biases
Potential biases due to the retrospective nature and variability in immunosuppressive regimens across centers.
Limitations
The study is retrospective and lacks centralized laboratory assessment of HLA-DSA.
Participant Demographics
Median age at transplantation was 10.9 years; 59.9% were male.
Statistical Information
P-Value
p<0.05
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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