Incidence of De Novo Donor Specific Antibodies and Treatment Response for AMR in Pediatric Kidney Transplant Recipients
1Children's Healthcare of Atlanta, Atlanta, GA, 2Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, 3Emory University Hospital, Atlanta, GA, 4Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
Meeting: 2019 American Transplant Congress
Abstract number: D103
Keywords: Antibodies, Kidney, Pediatric, Rejection
Session Information
Session Name: Poster Session D: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Antibody-mediated rejection (AMR) is a significant complication in renal transplant patients. The aim of this study was to evaluate the incidence of de novo donor specific antibodies (dnDSA) with and without AMR at a large pediatric kidney transplant center.
*Methods: A retrospective chart review of pediatric patients transplanted between 2012 and 2016 was performed. Surveillance biopsies were done at 6, 12, and 24 months post-transplantation with universal screening of DSA. Banff scores were collected from pathology reports and reviewed by a single pathologist blinded to the original diagnosis using Banff 2017 criteria. Mean fluorescent intensity (MFI) values for each Luminex bead representing donor-specific alleles were recorded. The mean MFI was calculated for each allele at the time of diagnosis and compared to the mean MFI obtained approximately one month after treatment for AMR.
*Results: A total of 131 patients met inclusion criteria for review. dnDSA was common with cumulative incidence of 28.6% at 36 months post-transplant (Figure 1). Class II DSAs were more prevalent at all time points assessed. The mean time to detection of dnDSA was 193.2 days (range 21-363) post-transplant. During the study period, 453 biopsies (178 indication; 275 surveillance) were performed. Forty-two patients met full criteria for AMR (32%), but 16 of these had no detectable dnDSA. Conversely, there were 10 patients with dnDSA without histologic features of AMR. There was variation in the treatment of AMR. The most common therapy used was immunoglobulin (n=25), followed by anti-thymocyte globulin (17), rituximab (14), plasmapheresis (11), bortezomib (4), and eculizumab (1). Overall, the MFI for class I or class II dnDSA was significantly decreased following treatment (Figure 2).
*Conclusions: dnDSA is common in pediatric renal transplant recipients within the first 3 years post-transplant. Despite variation in treatment modalities for AMR, we found significant decrease in MFI values by 1 month post-treatment. The sustainability of this response needs further evaluation.
To cite this abstract in AMA style:
Gattis S, Liverman R, Serluco A, Yin J, Sullivan HC, Bray RA, Gebel HM, Jernigan S, George R, Winterberg PD, Garro R. Incidence of De Novo Donor Specific Antibodies and Treatment Response for AMR in Pediatric Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-of-de-novo-donor-specific-antibodies-and-treatment-response-for-amr-in-pediatric-kidney-transplant-recipients/. Accessed May 13, 2025.« Back to 2019 American Transplant Congress