Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;102(12):2072-2079.
doi: 10.1097/TP.0000000000002310.

Donor-specific Antibody Surveillance and Graft Outcomes in Pediatric Kidney Transplant Recipients

Rachel M Engen  1 , Giulia E Park  2 , Cooper S Schumacher  3 , Idoia Gimferrer  4 , Paul Warner  4 , Laura S Finn  5 , Noel S Weiss  6 , Jodi M Smith  1
Affiliations

Donor-specific Antibody Surveillance and Graft Outcomes in Pediatric Kidney Transplant Recipients

Rachel M Engen et al. Transplantation. 2018 Dec.

Abstract

Background: The development of de novo donor-specific antibodies (dnDSA) has been associated with rejection and graft loss in kidney transplantation, and DSA screening is now recommended in all kidney transplant recipients. However, the clinical significance of dnDSA detected by screening patients with a stable creatinine remains unclear.

Methods: One hundred three patients younger than 18years receiving a first, kidney alone transplant between December 1, 2007, and December 31, 2013, underwent DSA screening every 3months for 2years posttransplant, with additional testing as clinically indicated. No treatment was given for DSAs in the absence of biopsy-proven rejection.

Results: Twenty (19%) patients had dnDSA first detected on a screening test, and 13 (13%) patients had dnDSA first detected on a for-cause test. Mean follow-up time posttransplant was 4.4years. Screening-detected dnDSA was associated with an increased risk of rejection within 3years, microvascular inflammation, and C4d staining on a 2-year protocol biopsy. In a Cox proportional hazards regression, screening-detected dnDSA was not associated with time to 30% decline in estimated glomerular filtration rate (adjusted hazard ratio, 0.88; 95% confidence interval [CI], 0.30-2.00; P=0.598) or graft loss. dnDSA first detected on for-cause testing was associated with a 2.8 times increased risk of decline in graft function (95% CI, 1.08-7.27; P=0.034) and a 7.34 times increased risk of graft loss (95% CI, 1.37-39.23 P=0.020) compared with those who did not develop dnDSA.

Conclusions: The clinical setting in which dnDSA is first detected impacts the association between dnDSA and graft function. Further research is needed to clarify the role of dnDSA screening in pediatric kidney transplantation.

PubMed Disclaimer

Conflict of interest statement

Disclosures:

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study Flow Diagram
Figure 2
Figure 2
Kaplan-Meier survival curves for (A) time to a 30% decline in estimated glomerular filtration rate and (B) time to graft loss among pediatric kidney transplant patients, subdivided by presence of dnDSA and clinical setting of dnDSA detection.
Figure 2
Figure 2
Kaplan-Meier survival curves for (A) time to a 30% decline in estimated glomerular filtration rate and (B) time to graft loss among pediatric kidney transplant patients, subdivided by presence of dnDSA and clinical setting of dnDSA detection.
See this image and copyright information in PMC

References

    1. Kim JJ, Balasubramanian R, Michaelides G, et al. The clinical spectrum of de novo donor-specific antibodies in pediatric renal transplant recipients. Am J Transplant. 2014;14(10):2350–2358. - PubMed
    1. Meier-Kriesche H-U, Schold JD, Kaplan B. Long-term renal allograft survival: have we made significant progress or is it time to rethink our analytic and therapeutic strategies? Am J Transplant. 2004;4(8):1289–1295. - PubMed
    1. El-Zoghby ZM, Stegall MD, Lager DJ, et al. Identifying specific causes of kidney allograft loss. Am J Transplant. 2009;9(3):527–535. - PubMed
    1. Terasaki PI. A personal perspective: 100-year history of the humoral theory of transplantation. Transplantation. 2012;93(8):751–756. - PubMed
    1. Christiaans MH, Overhof-de Roos R, Nieman F, van Hooff JP, van den Berg-Loonen EM. Donor-specific antibodies after transplantation by flow cytometry: relative change in fluorescence ratio most sensitive risk factor for graft survival. Transplantation. 1998;65(3):427–433. - PubMed

Publication types

MeSH terms