Donor‐specific antibodies by flow single antigen beads in pediatric living donor kidney transplants: Single center experience

Abstract

Flow PRA and SAB are now routinely performed to identify HLA antibodies in the recipient sera. The presence of DSA is considered a risk factor for graft failure. However, this risk is not clearly defined. We reviewed all the pediatric recipients of living donor kidney transplants since Flow PRA and Flow SAB became routinely done at our institution. All children had negative CDC and Flow XMs. Comparison of clinical outcome was done between those with and without pretransplant DSA. Six children had positive DSA by Flow SAB. They received thymoglobulin, steroids, tacrolimus, and MMF. Five had anti-HLA class I antibodies and one anti-HLA class II. Only one child had an AR. Graft survival: 100% at last visit with GFR >70 mL/min/1.73 m(2). A control group without DSA was used for comparison (n = 44). They received our standard protocol: basiliximab, tacrolimus, MMF, and steroids. AR rate was 9%. Both groups had similar follow-up time, and patient and graft survival rates. In our small series, we saw excellent outcome despite the presence of DSA pretransplant. No unequivocal ideal to establish the ideal immunosuppressive regimen for this cohort of patients has been established and the long-term outcome of these recipients has not been delineated.

Donor-specific HLA antibodies and graft function in children after renal transplantation

“…The significance of pretransplant HLA-DSA has been examined in two studies. Roberti et al [20] saw an excellent outcome of six children with HLA-DSA before living donor RTx, and Verghese et al [21] found impaired renal allograft survival in ten children with pretransplant HLA-DSA. The significance of posttransplant HLA-DSA has been addressed in only one paediatric study: Emonds et al analysed retrospectively postoperative HLA-DSA in ten children who had lost their deceased donor kidney grafts due to rejection 2-68 months after RTx.…”

“…The significance of HLA-DSA before RTx has been reported in two studies [20,21], and one study has examined the role of posttransplant HLA-DSA on graft survival [22]. The aim of our study was to examine how commonly HLAab are detected in paediatric RTx patients posttransplant by analysing routine serum samples taken at various times after RTx.…”

Impaired graft survival in pediatric renal transplant recipients with donor-specific antibodies detected by solid-phase assays

“…While the SAB assays are extremely sensitive and specific for the detection of DSA, they are capable of detecting HLA alloantibodies that are not evident in cell‐based FCXM. While some describe these FCXM‐negative/SAB‐positive alloantibodies as clinically irrelevant (6), others found these antibodies to be associated with impaired graft function (7, 8). To address the uncertainty of the clinical relevance of FCXM‐negative/SAB‐positive alloantibodies, we designed a retrospective study of pediatric renal allograft recipients to assess the prevalence of low levels of DSA that are undetected by cross‐match but positive by SAB in pediatric renal transplant recipients.…”

Treatment Update of Sensitized Pediatric Kidney Transplant Recipients: A Review

“…Some small studies have been performed in children and the results are inconsistent. 5,35,36 which protocol is better? As mentioned before, each protocol has some advantages and some disadvantages.…”

“…However, controversies remain regarding the association between the results of this test and the outcome of transplant. 5 It is thought that CDC-AHG is sufficient for predicting hyperacute rejection. Patients with low titer anti-HLA antibodies with negative CDC and positive flow cytometry may be involved by acute cellular and/or humeral rejection but not involved by hyperacute rejection.…”