Incidence, risk factors, management strategies, and outcomes of antibody-mediated rejection in pediatric kidney transplant recipients-a multicenter analysis of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN).

Autor: Fichtner A; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany. alexander.fichtner@med.uni-heidelberg.de., Gauché L; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany., Süsal C; Heidelberg University, Medical Faculty Heidelberg, Institute of Immunology, Transplantation Immunology, Heidelberg, Germany.; Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey., Tran TH; Heidelberg University, Medical Faculty Heidelberg, Institute of Immunology, Transplantation Immunology, Heidelberg, Germany., Waldherr R; Heidelberg University, Medical Faculty Heidelberg, Department of Pathology, Heidelberg, Germany., Krupka K; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany., Guzzo I; Pediatric Nephrology and Renal Transplant Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy., Carraro A; Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy., Oh J; Department of Pediatric Nephrology, University Children's Hospital, Hamburg, Germany., Zirngibl M; Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany., Weitz M; Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany., König J; Department of General Pediatrics, University Children's Hospital Münster, Münster, Germany., Büscher A; Clinic for Paediatrics III, Essen University Hospital, Essen, Germany., Berta L; Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary., Simon T; Pediatric Nephrology, Toulouse University Hospital, Toulouse, France., Awan A; Temple Street Children's University Hospital, Dublin, Ireland., Rusai K; Division of Paediatric Nephrology and Gastroenterology, Department of Paediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria., Topaloglu R; Haceteppe University, Ankara, Turkey., Peruzzi L; Pediatric Nephrology Dialysis and Transplantation Unit, Regina Margherita Children's Hospital, Turin, Italy., Printza N; 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece., Kim JJ; Department of Paediatric Nephrology, Nottingham University Hospital, Nottingham, UK., Weber LT; Pediatric Nephrology, Children's and Adolescents' Hospital, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany., Melk A; Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany., Pape L; Clinic for Paediatrics III, Essen University Hospital, Essen, Germany., Rieger S; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany., Patry C; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany., Höcker B; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany., Tönshoff B; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2024 Sep 16. Date of Electronic Publication: 2024 Sep 16.
DOI: 10.1007/s00467-024-06487-2
Abstrakt: Background: This study by the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) was designed to determine the incidence, risk factors, current management strategies, and outcomes of antibody-mediated rejection (ABMR) in pediatric kidney transplant recipients (pKTR).
Methods: We performed an international, multicenter, longitudinal cohort study of data reported to the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) registry. Three hundred thirty-seven pKTR from 21 European centers were analyzed. Clinical outcomes, including kidney dysfunction, rejection, HLA donor-specific antibodies, BK polyomavirus-associated (BKPyV) nephropathy, and allograft loss, were assessed through 5 years post-transplant.
Results: The cumulative incidence of de novo donor-specific class I HLA antibodies (HLA-DSA) post-transplant was 4.5% in year 1, 8.3% in year 3, and 13% in year 5; the corresponding data for de novo class II HLA-DSA were 10%, 22.5%, and 30.6%, respectively. For 5 years post-transplant, the cumulative incidence of acute ABMR was 10% and that of chronic active ABMR was 5.9%. HLA-DR mismatch and de novo HLA-DSA, especially double positivity for class I and class II HLA-DSA, were significant risk factors for ABMR, whereas cytomegalovirus (CMV) IgG negative recipient and CMV IgG negative donor were associated with a lower risk. BKPyV nephropathy was associated with the highest risk of graft dysfunction, followed by ABMR, T-cell mediated rejection, and older donor age.
Conclusions: This study provides an estimate of the incidence of de novo HLA-DSA and ABMR in pKTR and highlights the importance of BKPyV nephropathy as a strong risk factor for allograft dysfunction.
(© 2024. The Author(s).)
Databáze: MEDLINE
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