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

Miettinen, Jenni; Peräsaari, Juha; Lauronen, Jouni; Qvist, Erik; Valta, Helena; Pakarinen, Mikko P.; Merenmies, Jussi; Jalanko, Hannu

doi:10.1007/s00467-012-2101-4

Cited by 27 publications

(27 citation statements)

References 31 publications

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“…These reports support the implementation of post‐transplant screening for HLA antibodies. This is in contrast to the study performed by Miettinen et al in which the presence of post‐transplant HLA‐DSA was common in children after Tx, not predicting deterioration and poor graft outcome. In addition, Miettinen et al reported no significant difference in GFR decline between DSA‐pos and DSA‐neg patients, while we found that the mean last GFR was significantly lower in the DSA‐pos group.…”

Section: Discussioncontrasting

confidence: 99%

“…This is in contrast to the study performed by Miettinen et al in which the presence of post‐transplant HLA‐DSA was common in children after Tx, not predicting deterioration and poor graft outcome. In addition, Miettinen et al reported no significant difference in GFR decline between DSA‐pos and DSA‐neg patients, while we found that the mean last GFR was significantly lower in the DSA‐pos group. In our study, the non‐significant difference in the time to 25% GFR decline, in DSA‐pos and DSA‐neg patients, could be explained by the disproportional distribution and low numbers of patients in both groups.…”

Section: Discussioncontrasting

confidence: 99%

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Evaluation of the current post‐transplantation Human Leukocyte Antigen antibody screening in pediatric renal transplant recipients

Demirok

Ranzijn

Lardy

et al. 2019

Pediatric Transplantation

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The necessity of post‐transplant monitoring for donor‐specific antibodies (DSAs) is unclear. This study evaluates the clinical relevance of post‐transplantation donor‐specific HLA antibodies in pediatric renal transplant recipients, aiming at better stratification of patients at risk of graft dysfunction and better recommendations for post‐transplant monitoring. A cohort of 68 pediatric kidney recipients, involving 76 transplantations between 2004 and 2014, was studied retrospectively. All patients were screened for HLA antibodies at 1, 3, 6, and 12 months after transplantation and yearly thereafter. Samples testing positive were further analyzed to detect DSA. A biopsy was performed on clinical indication. We studied the baseline characteristics of the patients with biopsy, with DSA, and with rejection. We assessed the effect of post‐transplant DSA on clinical outcome, including antibody‐mediated acute rejection and GFR decrease. In our cohort, the prevalence of DSA was 19% (13/68 transplantations). Most patients with HLA antibodies after transplantation were DSA‐positive (76%; 13/17). A clear association between DSA and subsequent rejection was found. At the end of the study period, a significantly lower GFR was found in patients with biopsy, DSA, or rejection. Based on our observations, we recommend routine post‐transplantation screening for HLA and DSA. The presence of DSA justifies a renal biopsy even in the absence of clinical signs of rejection.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Evaluation of the current post‐transplantation Human Leukocyte Antigen antibody screening in pediatric renal transplant recipients

Demirok

Ranzijn

Lardy

et al. 2019

Pediatric Transplantation

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“…Therefore, non-DSA against class I (among widely produced HLA antibodies) and, in contrast, DSA against DQ could be readily detected, which corresponds to previous reports. [31][32][33][34] Antibody-binding level based on DQ a/b-combination should be considered, 35 because DQ DSA were reported to be associated with inferior graft outcome. 36,37 Furthermore, the graft condition could be modified by other factors, such as the ability of complement activation and the acquisition of accommodation.…”

Section: Discussionmentioning

confidence: 98%

Neither pre-transplant rituximab nor splenectomy affects de novo HLA antibody production after renal transplantation

Ashimine

Watarai

Yamamoto

et al. 2014

Kidney International

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The long-term effect of rituximab and splenectomy on de novo HLA antibody production and chronic antibody-mediated rejection after renal transplantation is uncertain. In order to gain insight on this, we studied 92 ABO-incompatible and 228 ABO-identical/compatible consecutive renal transplant patients and determined their de novo HLA antibody production and graft outcome. Patients with pretransplant donor-specific antibodies had been excluded. ABO-incompatible transplants included 30 recipients treated with rituximab, 51 by splenectomy, or 11 with neither, due to low anti-A or -B antibody titer. Graft survival in ABO-identical/compatible patients (97.7% at 5 years) was significantly higher than in ABO-incompatible (87.0% at 5 years), rituximab (96.7% at 3 years), or splenectomy (85.7% at 5 years) patients. Only four patients had clinical chronic antibody-mediated rejection (two each identical/compatible and incompatible). There was no significant difference in prevalence of de novo HLA antibody, including donor-specific and nondonor-specific antibodies among ABO-identical/compatible patients (13.9%), patients receiving rituximab (14.3%) or splenectomy (13.2%), or among those receiving cyclosporine, tacrolimus, mycophenolate mofetil, mizoribine, and everolimus. Renal function remained stable in most recipients with de novo HLA antibody. Thus, neither pretransplant splenectomy nor rituximab treatment has an inhibitory effect on de novo HLA antibody production during medium-term follow-up. Further study on long-term effects is needed.

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“…De novo donor-specific antibodies (DSA) can be detected also in pediatric patients and they have been associated with decreased long-term graft function [52,53]. However, contradictory results on the importance of DSA have been published [54].…”

Section: Acute Rejectionmentioning

confidence: 99%

Renal transplantation in infants

2015

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Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.

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

Abstract: Detection of HLA antibodies is common in children after RTx, and this finding, as such, does not predict any deterioration of graft function.

Cited by 27 publications

References 31 publications

Evaluation of the current post‐transplantation Human Leukocyte Antigen antibody screening in pediatric renal transplant recipients

Evaluation of the current post‐transplantation Human Leukocyte Antigen antibody screening in pediatric renal transplant recipients

Neither pre-transplant rituximab nor splenectomy affects de novo HLA antibody production after renal transplantation

Renal transplantation in infants

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