Purpose: Evaluate the efficacy and safety of acute antibody mediated rejection (AMR) treatment modalities in pediatric kidney transplant recipients (KTR).

Methods: A single-center retrospective chart review of pediatric KTR who received a kidney transplant between 5/1/13 to 9/30/17 was conducted. Patients < 18 years old at the time of transplant experiencing first episode of acute AMR and treated with immune globulin (IVIG), plasmapheresis (PP), corticosteroids, rituximab, and/or rabbit anti-thymocyte globulin (rATG) were included. Endpoints were collected for > 3 months from acute AMR treatment and up to 12 months, if available.

Results: 12 pediatric KTR were included that were 13.3 (±5.7) years old, 50% male, 9.5 (IQR 5.3 – 24.3) mo. since transplant, 10/12 (83%) received basiliximab vs. rATG for induction, and a median tacrolimus trough of 6.5 (IQR 4.9 – 8.8) ng/mL was found at diagnosis of acute AMR. 79 pediatric kidney transplants occurred during this timeframe. 10/12 (83%) received rituximab, 6/12 (50%) received rATG and all received IVIG and PP for rejection treatment. Patients received cumulative IVIG dose of 1916.7 (IQR 1174 – 3205) mg/kg and 5.5 (IQR 5 – 7.75) PP sessions. Histologic findings included 9/12 (75%) C4d deposits, 9/12 (75%) fibrosis and 10/12 (83)% mixed T-cell rejection. Renal function reported in Table 1. 2.3 (±2.8) total infections per patient occurred. Refer to Table 2 for all adverse events. There was no incidence of death or graft loss.

Conclusion: Findings suggest majority of patients received rituximab in addition to IVIG, PP and corticosteroids for the treatment of acute AMR, which led to a significant improvement in eGFR from the time of diagnosis to 3 mo. follow up. Reassuringly, improvement in renal function was maintained from 3- vs. 12-mo. post AMR diagnosis. AMR treatment was relatively safe with the most common AE being UTIs and hematologic effects.

CITATION INFORMATION: Kincaide E., Hitchman K., Hall R., Yamaguchi I., Crowther B. Efficacy and Safety of Acute Antibody Rejection Treatment in Pediatric Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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