Impact of active antibody-mediated rejection treatment on donor-specific antibodies in pediatric kidney transplant recipients

Elisabeth Kincaide, Kelley Hitchman, Reed Hall, Ikuyo Yamaguchi, Yanli Ding, Barrett Crowther

Research output: Contribution to journalArticlepeer-review

Abstract

AMR is a major cause of graft loss after kidney transplantation. We evaluated a retrospective cohort of 13 pediatric kidney transplant patients diagnosed with active AMR. All 13 patients were treated with plasmapheresis (PP), IVIg, and rituximab. Anti-HLA DSAs were measured at the time of transplantation, AMR diagnosis, 30 days post-rejection treatment, 90 days post-rejection treatment, and 24 ± 12 months post-AMR. A total of 68 DSAs were identified from 13 patients at the time of active AMR diagnosis. The primary objective of this study was to differentiate treatment response rates between class I and class II anti-HLA DSA post-AMR treatment. Overall, DSAs were significantly reduced at 30 days, and the reduction was sustained at 90 days post-treatment, even for class II anti-HLA and strongly positive DSAs. A significant difference between class I and class II anti-HLA DSA was observed at 30 days; however, between class significance was lost at 90-day follow-up due to continued class II anti-HLA DSA treatment response. Low DSA strength was predictive of treatment response. eGFR demonstrated significant improvement 90 days after AMR diagnosis compared to the initial value at the time of AMR, and the effect was sustained for 12 months. These results suggest that the AMR treatment is effective in pediatric kidney transplant recipients with an early diagnosis of active AMR across both class I and class II anti-HLA DSAs.

Original languageEnglish (US)
Article numbere13590
JournalPediatric Transplantation
Volume23
Issue number8
DOIs
StatePublished - Dec 1 2019

Keywords

  • AMR
  • IVIG
  • anti-HLA DSAs
  • pediatric kidney transplant
  • plasmapheresis
  • rituximab

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Fingerprint Dive into the research topics of 'Impact of active antibody-mediated rejection treatment on donor-specific antibodies in pediatric kidney transplant recipients'. Together they form a unique fingerprint.

Cite this