Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Little is known about how donor specific antibody (DSA) clearance correlates with outcomes in pediatric antibody mediated rejection (AMR). There is also little data on how different AMR treatments affect DSA clearance.
*Methods: We collected data from 6 centers within the Pediatric Nephrology Research Consortium to review treatment patterns and outcomes. Pediatric renal transplant recipients between 0 to 18 years old at time of transplant with biopsy proven AMR between 12/31/2009-12/31/2017 and followed for 12 consecutive months were included. DSA clearance was defined as the percentage that DSA decreased within a year post treatment. Categorical variables are presented as relative frequencies and normally distributed continuous variables are presented as means ± standard deviations with differences assessed by two-tailed t-tests. Descriptive statistics were evaluated by frequencies, medians and ranges or means and confidence intervals. P values for race, gender and donor type were obtained by comparing to SRTR data.
*Results: We have reviewed 42 AMR episodes to date from 40 patients. Baseline data is available in table 1.
African Americans (AA), males and those with decreased donor (DD) grafts were most common in our cohort. There was data on DSA within a year of treatment on 37 episodes. Class II was the dominant DSA in 81.1 % (30/37) and Class I was dominant in 19.9 % (9/37). DQ was the most common immunodominant DSA (iDSA) 64.9% (24/37). Total percent of iDSA that was cleared with any treatment was 27.38%. There was no difference in the % of iDSA cleared between those that received bortezomib vs. no bortezomib (36.95% vs. 40.21%), or between those that received thymoglobulin vs. no thymoglobulin (30.68% vs. 41.68%). There was no difference in 1 yr GFR between those that cleared >50% of the iDSA vs <50% (34.8 vs 34.8; p=0.99).
*Conclusions: Class II DSA are the most common iDSA seen in Pediatric AMR and DQ was the most common class II iDSA seen in our cohort. There was no correlation between clearance of DSA and 1 year GFR. There was no difference in the iDSA clearance between medications used to treat the DSA. AA, males and those with DD grafts were most common in our cohort. Larger studies are needed to confirm our findings.
To cite this abstract in AMA style:Ashoor I, Garro R, Solomon S, Jain A, Kallash M, Twombley K. Significance of DSA Clearance in Antibody Mediated Rejection in Pediatric Kidney Transplant Recipients on 1 Year Outcomes: Interim Results from PARAMOUr “Pediatric Renal AMr Outcomes” Study [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/significance-of-dsa-clearance-in-antibody-mediated-rejection-in-pediatric-kidney-transplant-recipients-on-1-year-outcomes-interim-results-from-paramour-pediatric-renal-amr-outcomes/. Accessed December 1, 2020.
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