Date: Sunday, April 30, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
The potential benefits of HLA epitope based matching are greatest for pediatric recipients, however, there is little published data on the association of epitope mismatches (EpMM) and clinical outcomes in pediatric renal transplantation.
We undertook a retrospective, registry based study of pediatric renal allograft recipients over 25 years in Victoria Australia examining the relationship between donor/recipient EpMM, as defined by Duquesnoy's eplets, and clinical outcomes. Where high resolution molecular typing was not available across all HLA-A,B,DRB1/3/4/5,DQA1 and DQB1 loci, these were assigned based on population frequencies and known linkage disequilibrium. Outcome measures included: time to graft failure, donor specific antibody (DSA) formation and time to re-transplantation following failed graft.
150 patients were included in the cohort, with a mean age of 9.14 years and a median follow up of 10.8 years.
61 children (41.1%) experienced graft failure. Class I and total EpMM were associated with a significantly increased hazard for graft failure on multivariate analysis (HR 1.08 and 1.02 per eplet, 2.07 and 1.17 per 10 eplets, respectively, p<0.05). These associations were stronger when considering only antibody verified EpMM (HR 1.13 and 1.03 per eplet, 3.28 and 1.38 per 10 eplets, respectively, p<0.05).
Class specific EpMM was associated with DSA formation in multivariate analysis for both class I (OR 1.14 per eplet, 3.81 per 10 eplets, p<0.05) and class II (OR 1.07 per eplet, 1.97 per 10 eplets, p<0.05). A stronger association was again seen when considering only antibody verified eplets (OR 1.23 and 1.15 per eplet for class I and II respectively, p<0.05).
Class II and total EpMM were associated with reduced odds of re-transplantation following graft failure on multivariate analysis (OR 0.95 per eplet, 0.59 per 10 eplets for class II and 0.95 per eplet, 0.61 per 10 eplets for total, p<0.05).
EpMM are associated with important clinical outcomes in pediatric renal transplantation including DSA formation, graft survival and retransplantation rates. These associations are stronger when considering only antibody verified EpMM. Therefore, strategies to improve eplet matching have the potential to improve these outcomes.
CITATION INFORMATION: Sypek M, Hiho S, Cantwell L, Hughes P, Le Page A, Kausman J. HLA Eplet Mismatches Predict DSA Formation, Graft Survival, and Re-Transplantation Rate in Pediatric Renal Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Sypek M, Hiho S, Cantwell L, Hughes P, Le A, Kausman J. HLA Eplet Mismatches Predict DSA Formation, Graft Survival, and Re-Transplantation Rate in Pediatric Renal Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/hla-eplet-mismatches-predict-dsa-formation-graft-survival-and-re-transplantation-rate-in-pediatric-renal-transplantation/. Accessed February 23, 2019.
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