Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Characterize class I and class II donor specific antibodies (DSA) response to acute antibody mediated rejection (AMR) treatment in pediatric kidney transplant recipients (KTR).
Methods: A single-center retrospective chart review of pediatric KTR receiving a renal transplant between 5/1/13 to 9/30/17 was conducted. Patients < 18 years old at transplant experiencing first episode of acute AMR and received treatment were included. DSA were identified by single antigen bead Luminex® assays at: time of transplant, acute AMR diagnosis, ~30 days post treatment, and ~90 days post treatment. DSA categorized as weak: 1000 – 2999 mean fluorescence intensity (MFI); moderate: 3000 – 9999; strong: > 10,000. Treatment response was defined as MFI decrease ≥30% from diagnosis to ~30 days post treatment.
Results: 62 DSA were identified from 12 patients [25 (40%) Class I and 37 (60%) Class II]. 100% of DSA were treated with IVIG and PP. 50 (80%) received rituximab. The same 51/62 (82%) DSA achieving > 30% MFI reduction also achieved a categorical shift. Multivariate analysis revealed rituximab (p=0.0041) and lower MFI (p=0.0017) at diagnosis as independent predictors of treatment response. Univariate analysis reported in Table 1. Diagnosis by protocol biopsy and documented non-adherence at diagnosis were not predictors of treatment response. Matched pairs analysis for DSA MFI reduction reported in Table 2.
Conclusion: Rituximab and lower MFI at AMR diagnosis were positive predictors of DSA MFI reduction. Treatment resulted in a significant reduction in MFI from AMR diagnosis to 30 days post treatment, without DSA MFI rebound at 90 days. The same DSA achieved > 30% and categorical shift, indicating > 30% is an appropriate AMR treatment target. Class I DSA were more likely to respond to treatment. As DSA with higher MFIs were less likely to respond to treatment, a more timely AMR diagnosis could lead to an improved response.
CITATION INFORMATION: Kincaide E., Hitchman K., Hall R., Yamaguchi I., Crowther B. Acute Antibody Mediated Rejection Treatment Impact on Class I and Class II Anti-HLA Antibodies in Pediatric Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Kincaide E, Hitchman K, Hall R, Yamaguchi I, Crowther B. Acute Antibody Mediated Rejection Treatment Impact on Class I and Class II Anti-HLA Antibodies in Pediatric Kidney Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/acute-antibody-mediated-rejection-treatment-impact-on-class-i-and-class-ii-anti-hla-antibodies-in-pediatric-kidney-transplant-recipients/. Accessed May 30, 2020.
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