Treatment Modality and Outcomes of Antibody-Mediated Rejection in Pediatric Kidney Transplant Recipients: The PARAMOUr Study

R. Engen¹, A. Jain², N. Hayde³, A. Mansuri⁴, M. Kallash⁵, S. McEwen⁶, R. Garro⁷, C. Peterson⁸, R. Zahr⁹, L. Harshman¹⁰, D. Puliyanda¹¹, S. Solomon¹², K. Twombley¹³, I. Ashoor¹⁴

¹Pediatrics, University of Wisconsin Madison, Madison, WI, ²Wayne State University, Detroit, MI, ³Albert Einstein College of Medicine, New York, NY, ⁴Augusta University, Augusta, GA, ⁵The Ohio State University, Columbus, OH, ⁶University of Minnesota, Minneapolis, MN, ⁷Emory University, Atlanta, GA, ⁸University of Utah Health, Salt Lake City, UT, ⁹The University of Tennessee Health Science Center, Memphis, TN, ¹⁰University of Iowa, Iowa City, IA, ¹¹Cedars-Sinai Medical Center, Los Angeles, CA, ¹²New York Medical College, Valhalla, NY, ¹³Medical University of South Carolina, Charleston, SC, ¹⁴Louisiana State University, New Orleans, LA

Meeting: 2022 American Transplant Congress

Abstract number: 814

Keywords: IVIG, Pediatric, Plasmapheresis, Rejection

Topic: Clinical Science » Kidney » 43 - Kidney: Pediatrics

Session Information

Session Name: Kidney: Pediatrics

Session Type: Poster Abstract

Date: Saturday, June 4, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 5:30pm-7:00pm

Location: Hynes Halls C & D

*Purpose: Antibody-mediated rejection (AMR) is the leading cause of graft failure in kidney transplantation, but evidence for effective treatments is limited.

*Methods: PARAMOUr is a retrospective cohort study of 123 pediatric kidney transplant recipients treated for AMR at 14 Pediatric Nephrology Research Consortium centers 12/31/2009 to 12/31/2019 and followed for one year post-treatment. This study examined the association between treatment regimen and outcome at one year after diagnosis. Effect modification by estimated glomerular filtration rate (eGFR) at diagnosis, donor specific antibody (DSA) class, and pathology was assessed.

*Results: 88.6% of patients were treated with IVIg, 68.3% with rituximab, 64.2% received plasmapheresis, and 28.5% received bortezomib. 27.6% of patients reached the composite outcome of graft failure or eGFR <20 ml/min/1.73m² by one year after AMR diagnosis. There were no significant differences in outcome by treatment, whether treatments were analyzed individually or in combination. There was no effect modification by eGFR at diagnosis, predominant DSA class, or pathology findings. Median change in eGFR one year from diagnosis was -2 ml/min/1.73m² (IQR -11 to 10 ml/min/1.73m²); 37.7% had a decline in eGFR >5 ml/min/1.73m² while 62.3% had a stable or increased eGFR. An eGFR <30 m/min/1.73m² at diagnosis was associated with a worse prognosis (RR composite outcome 5.6, IQR 2.9-10.8, p<0.001) but was not associated with treatment choice.

*Conclusions: Specific treatment regimen was not associated with outcome, but 61% of patients did show a stable or improved eGFR after treatment. eGFR at the time of AMR diagnosis was most strongly associated with outcome. Further research on effective treatments for antibody mediated rejection are needed to improve long-term kidney allograft survival.

To cite this abstract in AMA style:

Engen R, Jain A, Hayde N, Mansuri A, Kallash M, McEwen S, Garro R, Peterson C, Zahr R, Harshman L, Puliyanda D, Solomon S, Twombley K, Ashoor I. Treatment Modality and Outcomes of Antibody-Mediated Rejection in Pediatric Kidney Transplant Recipients: The PARAMOUr Study [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/treatment-modality-and-outcomes-of-antibody-mediated-rejection-in-pediatric-kidney-transplant-recipients-the-paramour-study/. Accessed March 26, 2023.

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