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1 -Year Protocol Biopsies in Pediatric Kidney Transplant Children: Are Unfavorable Histological Lesions Related to No Adherence?

M. L. Monteverde1, J. M. Velasco1, V. Solernou2, J. P. Ibanez1, C. Cernadas3, A. B. Chaparro4, Y. L. Marcos5

1Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina, 2Pathology, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina, 3Teaching and Investigation, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina, 4Nephrology, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina, 5Hemoteraphy, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina

Meeting: 2020 American Transplant Congress

Abstract number: C-052

Keywords: Kidney transplantation, Pediatric, Protocol biopsy

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session C: Kidney: Pediatrics

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

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*Purpose: In adults with kidney transplantation (KT), histological findings in surveillance biopsies at 1-year post KT are independent correlate to short and long-term graft survival. Donor- specific antibodies (dnDSA) are associated with antibody- mediated rejection. Non-adherence (NOA) to treatment, is a risk factor for dnDSA. Studies in children with KT with protocol biopsy are scarce.Purpose: To evaluate prevalence of histological lesions favorable (FAV) and unfavorable (UNFAV) for graft survival in protocol biopsies of KT children 1 year after KT and identify risk variables of these lesions.

*Methods: Prospective cohort study with all recipients of a 1st KT between 06/01/2018 and 05/30/2019. According to their histological risk, lesions were grouped in “FAV” and “UNFAV”. “FAV” were: 1) minor morphological changes, with absence of inflammation and / or fibrosis and / or chronic glomerulopathy or glomerulonephritis, 2) Acute Interstitial inflammation without interstitial fibrosis or glomerular changes 3) Mild Interstitial fibrosis with absence of interstitial inflammation. “UNFAV” lesions were: 1) moderate-severe interstitial fibrosis without inflammation 2) acute or chronic active rejection mediated by antibodies or T cells 3) de novo glomerular disease 4) polyoma virus-associated nephropathy. Simultaneous to the biopsy, presence of dn-DSA was sought. TAC and / or SRL variation coefficient (VC) >25% was considered a surrogate of NOA.

*Results: 38 children were included, 76% with “FAV” (Minimal morphological changes, n= 23, mild fibrosis, n= 6) and 23% with “UNFAV” histology. One had recurrence of disease, three acute vascular rejection, (2/3 subclinical rejection; 1/3 DSA+) and four moderate fibrosis (2 had graft hydronephrosis and 2 had previous AR,1DSA+). Mean eGFR in patients with “UNFAV” was 39 ± 12.1 ml / min/ 1.73m2 vs 65.3 ± 18 ml / min / 1.73m2 in those with “FAV” (p=0.0003). Both groups had similar pre KT clinical and demographic characteristics. UNFAV patients had higher incidence of previous AR: 33% vs 0% (p=0.01) TAC or SRL VC was < 25% in 71% of patients (n = 27), those with irregular intake had CV > 25% (n=11). Children with VC> 25% had higher risk of an “UNFAV” lesion in protocol biopsy (OR: 4.8; p=0,04) and higher prevalence of DSA (18% vs 0%; p=0.02)

*Conclusions: In this cohort patients “FAV” lesions, negative dnDSA and TAC VC <25% were the most prevalent. Children with UNFAV had lower eGFR. Those with TAC or SRL VC>25% had higher risk of an “UNFAV” lesion, and higher prevalence of DSA. Follow-up of this cohort is imperative.

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To cite this abstract in AMA style:

Monteverde ML, Velasco JM, Solernou V, Ibanez JP, Cernadas C, Chaparro AB, Marcos YL. 1 -Year Protocol Biopsies in Pediatric Kidney Transplant Children: Are Unfavorable Histological Lesions Related to No Adherence? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/1-year-protocol-biopsies-in-pediatric-kidney-transplant-children-are-unfavorable-histological-lesions-related-to-no-adherence/. Accessed April 23, 2021.

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