HLA-DR Upregulation in Pediatric Kidney Transplant Biopsies
Medical University of South Carolina, Charleston, SC
Meeting: 2019 American Transplant Congress
Abstract number: C225
Keywords: HLA-DR antigens, Pediatric, Rejection
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: Renal tubular epithelial cells do not typically express human leukocyte antigen DR (HLA-DR). It’s expression has been associated with different types of tubular injury in adult renal transplant patients including rejection, CNI toxicity and viral infections. This has not been studied in children, and considering that children have different immune systems that adults, it’s significance is unclear. Our center routinely stains for HLA-DR presence in all transplant biopsies. Determine which types of injuries in pediatric kidney transplant patients were associated with HLA-DR expression.
*Methods: A retrospective chart review was conducted of children receiving a kidney transplant biopsy between January, 1st of 2011 to October, 31st of 2016. Inclusion required recipients to have at least received one kidney transplant biopsy and be under the age of 18 at the time of transplant. Data was collected using medical records. Data was collected on for cause and protocol biopsies.
*Results: There were 41 pediatric kidney transplant recipients with 117 biopsies eligible for review. There was increased HLA-DR expression with acute cellular rejection (ACR) and mixed antibody mediated rejection (AMR) and ACR. Interestingly, the glomerular filtration rate (GFR) was lower and there was more fibrosis in the HLA-DR positive group. These results suggest that HLA-DR expression in renal tubular epithelia cells was associated with ACR and mixed ACR/AMR. HLA-DR expression was also seen more in biopsies with longer times from transplant and was associated with lower GFR and more fibrosis suggesting it might me more associated with later rejection episodes.
| Histologic FIndings | HLA-DR all (n=117) | HLA-DR Positive (n=28) | HLA-DR Negative (n=89) | P |
| b-ACR | 7 (6%) | 4 (14.3%) | 4 (4.5%) | 0.09 |
| ACR | 10 (8.9%) | 7 (25%) | 3 (3.4%) | 0.0017 |
| AMR | 7 (6%) | 3 (10.7%) | 4 (4.5%) | 0.35 |
| ACR/AMR | 10 (8.5%) | 9 (32.1%) | 1 (1.1%) | 0.0001 |
| Isometric Vacuolization | 2 (1.7%) | 0 | 2 (2.2%) | 1 |
| BK | 2 (1.7%) | 1 (3.6%) | 1 (1.1%) | 0.42 |
| Pyelonephritis | 3 (2.6%) | 2 (7.1%) | 1 (1.1%) | 0.14 |
*Conclusions: These results suggest that HLA-DR expression in renal tubular epithelia cells was associated with ACR and mixed ACR/AMR. HLA-DR expression was also seen more in biopsies with longer times from transplant and was associated with lower GFR and more fibrosis suggesting it might be more associated with later rejection episodes. Prospective studies are needed to confirm the significance of these findings.
To cite this abstract in AMA style:
Moussa O, Self S, Bruner E, Twombley K. HLA-DR Upregulation in Pediatric Kidney Transplant Biopsies [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/hla-dr-upregulation-in-pediatric-kidney-transplant-biopsies/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress