HLA Antibody in Transplant Recipients During Transition from Paediatrics.
1Renal, Sheffield Kidney Institute, Sheffield, United Kingdom
2Renal, Queens Medical Centre, Sheffield, United Kingdom
3Histocompatibility and Immunogenetics, National Health Service blood and transplantation, Sheffield, United Kingdom.
Meeting: 2016 American Transplant Congress
Abstract number: 406
Keywords: Alloantibodies, Graft failure, Graft survival, Kidney transplantation
Session Information
Session Name: Concurrent Session: Kidney AMR: Predicting the Patient at Risk
Session Type: Concurrent Session
Date: Tuesday, June 14, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Location: Ballroom B
Objective:Adolescent transplant recipients in transition from paediatric to adult units are known to be at high risk of graft failure. Detection of HLA antibody is an important biomarker for graft failure but the frequency of allosensitisation has not been studied in this group.
Methods:Retrospective review of transplant recipients in transition to a single adult centre 1995-2015. Clinical and laboratory data was extracted from electronic patient records. Patients were screened for HLA antibody at transition and thereafter annually. The method of antibody screening evolved over the study period, since 2004 by Luminex. Two patients with no antibody screen at transition were assumed to be negative. Non-adherence in the adult clinic was assessed by two surrogate markers: non-attendance to clinic and undetectable CNI levels.
Results:There were 48 transition patients with a mean age of 18.5yrs, of which 42 were from a single paediatric centre and 7 were regrafts. Median follow-up was 5 years.
| At Transition (%) | At or after Transition (%) | |
| No HLA Ab | 31 (65%) | 20 (42%) |
| HLA Ab | 17 (35%) | 28 (58%) |
| Donor Specific HLA Ab | 10 (21%) | 17 (35%) |
Median eGFR at transfer (51 vs.73ml/min/1.73sqm, p=0.007) and graft failure (47% vs.10%, p=0.006) was worse in the group with HLA Ab at transition, although proteinuria was similar. 75% of graft failures were immunological. Acute rejection after transition was commoner in the HLA Ab group (47% vs.14% p=0.034). There were 345 recorded clinic non-attendances and multiple episodes in the same patient (>2) were associated with graft failure (40% vs.4% p=0.005) and HLA Ab (58% vs.14%, p=0.005). Undetectable serum CNI levels were common (74 episodes in 19 patients) but did not predict graft failure in this cohort
Discussion:When transition patients enter the adult service they already have a high prevalence of allosensitisation that continues to rise. This is likely to be a factor in the subsequent high graft failure rate. Clinic non-attendance is associated with allosensitisation and graft failure.
CITATION INFORMATION: Kaki S, Lunn A, Goodwin J, Key T, McKane W. HLA Antibody in Transplant Recipients During Transition from Paediatrics. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Kaki S, Lunn A, Goodwin J, Key T, McKane W. HLA Antibody in Transplant Recipients During Transition from Paediatrics. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/hla-antibody-in-transplant-recipients-during-transition-from-paediatrics/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress