Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After Pediatric Kidney Transplantation

Abstract

The Immune Development in Pediatric Transplantation (IMPACT) study was conducted to evaluate relationships among alloimmunity, protective immunity, immune development, physical parameters, and clinical outcome in children undergoing kidney transplantation. We prospectively evaluated biopsy-proven acute rejection (BPAR), de novo donor-specific antibody (dnDSA) formation, viremia, viral infection, T cell immunophenotyping, and body mass index (BMI)/weight Z scores in the first year posttransplantation in 106 pediatric kidney transplant recipients. Outcomes were excellent with no deaths and 98% graft survival. Rejection and dnDSAs occurred in 24% and 22%, respectively. Pretransplant cytomegalovirus (CMV) and Epstein-Barr virus (EBV) serologies and subsequent viremia were unrelated to BPAR or dnDSA. Viremia occurred in 73% of children (EBV, 34%; CMV, 23%; BMK viremia, 23%; and JC virus, 21%). Memory lymphocyte phenotype at baseline was not predictive of alloimmune complications. Patients who developed viral infection had lower weight (-2.1) (p = 0.028) and BMI (-1.2) (p = 0.048) Z scores at transplantation. The weight difference persisted to 12 months compared with patients without infection (p = 0.038). These data indicate that there is a high prevalence of viral disease after pediatric kidney transplantation, and underweight status at transplantation appears to be a risk factor for subsequent viral infection. The occurrence of viremia/viral infection is not associated with alloimmune events.

Keywords: clinical research/practice; infection and infectious agents; kidney transplantation/nephrology; nutrition; pediatrics; rejection; translational research/science; viral.

Figure 1

Consort Diagram

Figure 2. Growth Z scores (mean with SE) by Viremia Status

Shown are parameters of growth (height/ length) and nutritional status (weight and BMI) for children undergoing kidney transplantation. Children without viremia (white bar) and children experiencing viremia (black bar).

Figure 3. Growth and nutritional Z scores (mean with SE) in pure groups

Shown are parameters of growth (height/ length) and nutritional status (weight and BMI) for children undergoing kidney transplantation segregated by assignment to pure outcome groups as defined in the Methods. Children without rejection or viremia (Normal; white bar); children experiencing rejection (gray bar); children experiencing viremia + viral infection (column A, black bar), children experiencing viral infection (column B, black bar), children experiencing high level viremia (column C, black bar).

Figure 4. Flow Cytometry by BPAR (mean with SE)

Shown are parameters of T-cells for children undergoing kidney transplantation. Children without BPAR (gray dot line) and children experiencing BPAR (solid black line).