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Development of an IFN-γ ELISpot Assay to Assess Varicella-Zoster Virus-specific Cell-mediated Immunity Following Umbilical Cord Blood Transplantation
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Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After

R Ettenger1, H Chin2, K Kesler2

  • 1Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|December 19, 2016
PubMed

Insights

Pediatric kidney transplant recipients with lower weight and BMI at transplant are at higher risk for viral infections. However, viral infections did not impact alloimmune complications or graft survival in this study.

Area of Science:

  • Pediatric Nephrology
  • Transplant Immunology
  • Infectious Diseases

Background:

  • The Immune Development in Pediatric Transplantation (IMPACT) study aimed to understand factors influencing outcomes in pediatric kidney transplant recipients.
  • Key areas of investigation included alloimmunity, immune development, and clinical outcomes.

Purpose of the Study:

  • To evaluate the relationships between alloimmunity, protective immunity, immune development, physical parameters, and clinical outcomes in children post-kidney transplantation.
  • To identify risk factors for complications such as acute rejection and viral infections.

Main Methods:

  • Prospective evaluation of 106 pediatric kidney transplant recipients within the first year post-transplant.
  • Assessment of biopsy-proven acute rejection (BPAR), de novo donor-specific antibody (dnDSA) formation, viremia, viral infections, T cell immunophenotyping, and anthropometrics (BMI/weight Z scores).

Main Results:

  • Excellent outcomes with 98% graft survival and no deaths.
  • Rejection and dnDSA occurred in 24% and 22% of patients, respectively.
  • Viral infections were common (73%), with underweight patients at transplantation showing significantly lower weight and BMI Z scores, a difference that persisted at 12 months.
  • Pre-transplant viral serologies and subsequent viremia were not associated with BPAR or dnDSA.

Conclusions:

  • Underweight status at the time of kidney transplantation is a significant risk factor for developing viral infections in pediatric recipients.
  • Viremia and viral infections were not associated with alloimmune events like rejection or dnDSA formation.
  • Despite high rates of viral disease, pediatric kidney transplantation demonstrated excellent graft survival in the IMPACT study.

Keywords:
clinical research/practiceinfection and infectious agentskidney transplantation/nephrologynutritionpediatricsrejectiontranslational research/scienceviral

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