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Donor-specific Antibody Surveillance and Graft Outcomes in Pediatric Kidney Transplant Recipients

Rachel M Engen1, Giulia E Park2, Cooper S Schumacher3

  • 1Department of Pediatrics, University of Washington, Seattle, WA.

Transplantation
|June 5, 2018
PubMed

Insights

Screening for de novo donor-specific antibodies (dnDSA) in pediatric kidney transplant recipients did not predict graft loss. However, dnDSA detected during routine screening was linked to rejection, unlike dnDSA found due to symptoms.

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • De novo donor-specific antibodies (dnDSA) are linked to kidney transplant rejection and graft loss.
  • DSA screening is recommended for all kidney transplant recipients.
  • The clinical significance of dnDSA detected during routine screening in stable patients is unclear.

Purpose of the Study:

  • To investigate the clinical significance of dnDSA detected through screening versus for-cause testing in pediatric kidney transplant recipients.
  • To determine the association between dnDSA and graft function, rejection, and graft loss.

Main Methods:

  • One hundred three pediatric kidney transplant recipients underwent DSA screening every 3 months for 2 years post-transplant.
  • dnDSA was monitored, with treatment only for biopsy-proven rejection.
  • Follow-up averaged 4.4 years post-transplant.

Main Results:

  • Twenty percent of patients developed dnDSA detected by screening; 13% developed dnDSA detected by for-cause testing.
  • Screening-detected dnDSA correlated with increased rejection, microvascular inflammation, and C4d staining.
  • Screening-detected dnDSA was not associated with reduced estimated glomerular filtration rate or graft loss.
  • For-cause detected dnDSA significantly increased the risk of graft function decline and graft loss.

Conclusions:

  • The clinical impact of dnDSA in kidney transplantation depends on how it is detected.
  • dnDSA detected during routine screening in stable pediatric kidney transplant recipients did not predict graft loss.
  • Further research is needed to define the role of dnDSA screening in pediatric kidney transplantation.
Abstract

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