Risk of cellular or antibody-mediated rejection in pediatric kidney transplant recipients with BK polyomavirus replication-an international CERTAIN registry study.

Autor: Fichtner A; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany., Schmidt J; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany., Süsal C; Heidelberg University, Medical Faculty Heidelberg, Department of Transplantation Immunology, Institute of Immunology, Heidelberg, Germany.; Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey., Carraro A; Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman's and Child's Health, University Hospital of Padova, Via Giustiniani 3, 35128, Padua, Italy., Oh J; Department of Pediatric Nephrology, University Children's Hospital, Martinistr. 52, 20246, Hamburg, Germany., Zirngibl M; University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany., König S; Department of General Pediatrics, University Children's Hospital Münster, Waldeyerstraße 22, 48149, Münster, Germany., Guzzo I; Pediatric Nephrology and Renal Transplant Unit, Bambino Gesù Children's Hospital-IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy., Weber LT; Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany., Awan A; Temple Street Children's University Hospital, Dublin 1, Ireland., Krupka K; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany., Schnitzler P; Department of Infectious Diseases, Virology, Heidelberg University, Medical Faculty Heidelberg, Im Neuenheimer Feld 324, Heidelberg, 69120, Germany., Hirsch HH; Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Petersplatz 10, 4009, Basel, Switzerland.; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland., Tönshoff B; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany., Höcker B; Heidelberg University, Medical Faculty Heidelberg, Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany. britta.hoecker@med.uni-heidelberg.de.
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2024 Oct 11. Date of Electronic Publication: 2024 Oct 11.
DOI: 10.1007/s00467-024-06501-7
Abstrakt: Background: In kidney transplant recipients (KTR), BK polyomavirus-associated nephropathy (BKPyVAN) is a major cause of graft loss. To facilitate the clearance of BKPyV-DNAemia, reduction of immunosuppression is currently the treatment of choice but may increase the risk of graft rejection.
Methods: This international CERTAIN study was designed to determine the risk of alloimmune response and graft dysfunction associated with immunosuppression reduction for BKPyV treatment in 195 pediatric KTR.
Results: BKPyV-DNAemia was associated with a more than twofold increased risk of late T cell-mediated rejection (TCMR) (HR 2.22, p = 0.024), of de novo donor-specific HLA antibodies (dnDSA) and/or antibody-mediated rejection (ABMR) (HR 2.64, p = 0.002), and of graft function deterioration (HR 2.73, p = 0.001). Additional independent risk factors for dnDSA/ABMR development were a higher HLA mismatch (HR 2.72, p = 0.006) and re-transplantation (HR 6.40, p = 0.000). Other independent predictors of graft function deterioration were TCMR (HR 3.98, p = 0.003), higher donor age (HR 1.03, p = 0.020), and re-transplantation (HR 3.56, p = 0.013).
Conclusions: These data indicate that reduction of immunosuppression for BKPyV-DNAemia management is associated with increased alloimmune response in pediatric KTR. Therefore, regular dnDSA screening and close monitoring of graft function in case of BKPyV-DNAemia followed by subsequent reduction of immunosuppressive therapy are recommended.
(© 2024. The Author(s).)
Databáze: MEDLINE
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