Title: The Clinical Impact of Humoral Immunity in Pediatric Renal Transplantation
Authors: Chaudhuri, Abanti ×
Ozawa, Mikki
Everly, Matthew J
Ettenger, Robert
Dharnidharka, Vikas
Benfield, Mark
Mathias, Robert
Portale, Anthony
McDonald, Ruth
Harmon, William
Kershaw, David
Vehaskari, V Matti
Kamil, Elaine
Baluarte, H Jorge
Warady, Bradley
Li, Li
Sigdel, Tara K
Hsieh, Szu-Chuan
Dai, Hong
Naesens, Maarten
Waskerwitz, Janie
Salvatierra, Oscar
Terasaki, Paul I
Sarwal, Minnie M #
Issue Date: Mar-2013
Publisher: Williams & Wilkins
Series Title: Journal of the American Society of Nephrology vol:24 issue:4 pages:655-64
Abstract: The development of anti-donor humoral responses after transplantation associates with higher risks for acute rejection and 1-year graft survival in adults, but the influence of humoral immunity on transplant outcomes in children is not well understood. Here, we studied the evolution of humoral immunity in low-risk pediatric patients during the first 2 years after renal transplantation. Using data from 130 pediatric renal transplant patients randomized to steroid-free (SF) or steroid-based (SB) immunosuppression in the NIH-SNSO1 trial, we correlated the presence of serum anti-HLA antibodies to donor HLA antigens (donor-specific antibodies) and serum MHC class 1-related chain A (MICA) antibody with both clinical outcomes and histology identified on protocol biopsies at 0, 6, 12, and 24 months. We detected de novo antibodies after transplant in 24% (23% of SF group and 25% of SB group), most often after the first year. Overall, 22% developed anti-HLA antibodies, of which 6% were donor-specific antibodies, and 6% developed anti-MICA antibody. Presence of these antibodies de novo associated with significantly higher risks for acute rejection (P=0.02), chronic graft injury (P=0.02), and decline in graft function (P=0.02). In summary, antibodies to HLA and MICA antigens appear in approximately 25% of unsensitized pediatric patients, placing them at greater risk for acute and chronic rejection with accelerated loss of graft function. Avoiding steroids does not seem to modify this incidence. Whether serial assessments of these antibodies after transplant could guide individual tailoring of immunosuppression requires additional study.
ISSN: 1046-6673
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Nephrology
× corresponding author
# (joint) last author

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