Age-associated decrease in de novo donor-specific antibodies in renal transplant recipients reflects changing humoral...

Area of Science:

• Transplantation immunology
• Nephrology
• Immunogenetics

Background:

• Older age post-kidney transplant is linked to higher infection/malignancy risks but lower cellular rejection.
• De novo donor-specific anti-HLA antibodies (dnDSA) are critical for long-term graft survival, yet age-related changes remain understudied.

Purpose of the Study:

• To investigate the association between recipient age and the development of dnDSA after kidney transplantation.
• To compare dnDSA incidence in pediatric versus elderly kidney transplant recipients.

Main Methods:

• Retrospective analysis of kidney transplant recipients at University Hospital Zurich (2006-2015).
• Comparison of dnDSA incidence across age groups, focusing on children (<10 years) and older adults (≥60 years).
• Follow-up until March 2016 to assess dnDSA development.

Main Results:

• dnDSA incidence significantly decreased with age; older recipients had a lower risk (HR 0.21, p=0.0224) compared to pediatric recipients.
• Cumulative dnDSA incidence at 10 years was 47.1% in pediatric recipients versus 36% in older recipients.
• Median time to dnDSA development was similar, but annual incidence patterns differed, with older recipients peaking early and children later.

Conclusions:

• Older kidney transplant recipients exhibit reduced humoral immune reactivity, evidenced by a lower risk of dnDSA development.
• Findings suggest a need to reconsider immunosuppression protocols based on age-related immune responses.
• dnDSA were predominantly class II, and cyclosporine use correlated with higher dnDSA rates than tacrolimus.