Circulating De Novo Donor Specific Antibodies and Carotid Intima-Media Thickness in Pediatric Kidney Transplant Recipients

K. Sgambat¹, S. Clauss², A. Moudgil¹

¹Nephrology, Children's National, Washington DC, DC, ²Cardiology, Children's National, Washington DC, DC

Meeting: 2019 American Transplant Congress

Abstract number: C230

Keywords: Antibodies, Arteriosclerosis, Kidney, Pediatric

Session Information

Session Name: Poster Session C: Kidney: Pediatrics

Session Type: Poster Session

Date: Monday, June 3, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Emerging evidence suggests that circulating de novo donor specific anti-HLA antibodies (dnDSA) may be associated with increased risk of accelerated systemic arteriosclerosis and major cardiovascular (CV) events in adults (Loupy et al. Circ Res. 2015:117:470-482), but this has not been studied in children. The purpose of this study was to investigate association of dnDSA with carotid intima-media thickness (CIMT) in pediatric kidney transplant recipients.

*Methods: This prospective controlled cohort study included 38 pediatric kidney transplant recipients and 20 race-matched healthy controls. Participants had CIMT, blood pressure, and lipid panel measured at 18 and 30 months post-transplant, and monitoring for dnDSA occurred at 6, 18, and 30 months post-transplant. CIMT of transplant recipients with dnDSA was compared to CIMT of transplant recipients without dnDSA and to controls by Wilcoxon rank-sum. Additionally, multivariate analysis for association of CIMT with dnDSA, after adjustment for age, sex, African American race, hypertension, and dyslipidemia was performed by generalized estimating equation (GEE) regression.

*Results: Of 38 transplant recipients (age 11.3+0.7 years), 8 patients (21%) developed dnDSA. Transplant recipients with dnDSA had higher CIMT (0.49cm) compared to those without dnDSA (0.45cm), p=0.03 (see Figure). CIMT of those without dnDSA did not differ from race-matched healthy controls (0.45 cm). Results of the multivariate analysis are shown in the Table. Children with dnDSA had 5.5% higher CIMT compared to those without dnDSA, after adjusting for African American race, sex, age, hypertension, and dyslipidemia. In addition, African American transplant recipients had 9.2% higher CIMT than transplant recipients of other races. Hypertension and dyslipidemia were not significant in the multivariate analysis.

*Conclusions: Circulating dnDSA are associated with increased CIMT in pediatric kidney transplant recipients, after adjusting for traditional CV risk factors.

Association of CIMT with post-transplant dnDSA, adjusted analysis
Variable	% change in CIMT(95% CI)	p value
dnDSA	5.5(1.4-9.7)	0.009
African American race	9.2(5.7-12.8)	0.0001
Hypertension	1.5(-1.9-5.1)	0.37
Dyslipidemia	0.5(-2.7-3.9)	0.73
Sex	-1.2(-4.9-2.4)	0.51
Age	-1.2(-4.6-2.2)	0.49

To cite this abstract in AMA style:

Sgambat K, Clauss S, Moudgil A. Circulating De Novo Donor Specific Antibodies and Carotid Intima-Media Thickness in Pediatric Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/circulating-de-novo-donor-specific-antibodies-and-carotid-intima-media-thickness-in-pediatric-kidney-transplant-recipients/. Accessed November 21, 2024.

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