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Updated: Aug 7, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Donor specific antibody surveillance among pediatric kidney transplant programs: A report from the improving renal
Emily J Steinbach1, Gina M Barletta2, Hiren P Patel3
1Division of Nephrology, Dialysis, and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.
Insights
Pediatric kidney transplant centers vary in donor specific antibody (DSA) monitoring and management protocols. This survey highlights current practices and provides a reference for de novo (dn) DSA surveillance in children.
Area of Science:
- Pediatric Nephrology
- Transplant Immunology
- Organ Transplantation
Background:
- Kidney transplantation (KT) is the primary treatment for pediatric end-stage kidney disease.
- Advances in immunosuppression and donor specific antibody (DSA) testing improve allograft survival.
- However, significant variability exists in DSA surveillance and de novo (dn) DSA management among pediatric KT programs.
Purpose of the Study:
- To survey pediatric transplant nephrologists regarding their practices for DSA surveillance and dnDSA management.
- To identify current trends and variations in monitoring and treatment strategies.
- To establish a reference for pediatric dnDSA monitoring.
Main Methods:
- A voluntary, web-based survey was conducted among pediatric transplant nephrologists in the Improving Renal Outcomes Collaborative (IROC) from 2019-2020.
- The survey collected data on the frequency and timing of routine DSA surveillance.
- It also assessed theoretical management strategies for dnDSA in stable graft function settings.
Main Results:
- 29 out of 30 IROC centers responded.
- DSA screening occurs approximately every 3 months in the first year post-transplant.
- Management decisions are primarily guided by antibody mean fluorescent intensity and trends, with elevated creatinine prompting DSA assessment.
- Most centers (24/29) continue monitoring or intensify immunosuppression upon dnDSA detection in stable grafts.
- 10/29 centers perform allograft biopsies for dnDSA even with stable graft function.
Conclusions:
- This study represents the largest survey of pediatric transplant nephrologist practices concerning DSA monitoring.
- It provides valuable insights into current surveillance and management patterns for dnDSA in pediatric kidney transplant recipients.
- The findings serve as a benchmark for standardizing dnDSA monitoring protocols.
Background:
Kidney transplantation (KT) is the preferred treatment for children with end-stage kidney disease. Recent advances in immunosuppression and advances in donor specific antibody (DSA) testing have resulted in prolonged allograft survival; however, standardized approaches for surveillance DSA monitoring and management of de novo (dn) DSA are widely variable among pediatric KT programs.
Methods:
Pediatric transplant nephrologists in the multi-center Improving Renal Outcomes Collaborative (IROC) participated in a voluntary, web-based survey between 2019 and 2020. Centers provided information pertaining to frequency and timing of routine DSA surveillance and theoretical management of dnDSA development in the setting of stable graft function.
Results:
29/30 IROC centers responded to the survey. Among the participating centers, screening for DSA occurs, on average, every 3 months for the first 12 months post-transplant. Antibody mean fluorescent intensity and trend most frequently directed changes in patient management. Increased creatinine above baseline was reported by all centers as an indication for DSA assessment outside of routine surveillance testing. 24/29 centers would continue to monitor DSA and/or intensify immunosuppression after detection of antibodies in the setting of stable graft function. In addition to enhanced monitoring, 10/29 centers reported performing an allograft biopsy upon detection of dnDSA, even in the setting of stable graft function.
Conclusions:
This descriptive report is the largest reported survey of pediatric transplant nephrologist practice patterns on this topic and provides a reference for monitoring dnDSA in the pediatric kidney transplant population.
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