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)
Year: 2024
Type: article
Study design: Observational Study
Abstract: 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.
Source: Pediatric Nephrology
Authors: Alexander Fichtner, Laura Gauché, Caner Süsal, Thuong Hien Tran, Rüdiger Waldherr, Kai Krupka, Isabella Guzzo, Andrea Carraro, Jun Oh, Matthias Zirngibl, Marcus Weitz, Jens König, Anja Büscher, Laszlo Berta, Thomas Simon, Atif Awan, Krisztina Rusai, Rezan Topaloglu, Licia Peruzzi, Nikoleta Printza, Jon Jin Kim, Lutz T. Weber, Anette Melk, Lars Pape, Susanne Rieger, Christian Patry, Britta Höcker, Burkhard Tönshoff, for the CERTAIN study group
Institutions: Heidelberg University, Koç University, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, University of Padua, Azienda Ospedale - Università Padova, Universität Hamburg, University Children's Hospital Tübingen, University of Tübingen, University of Münster, University Hospital Münster, Essen University Hospital, Semmelweis University, Centre Hospitalier Universitaire de Toulouse, Temple Street Children's University Hospital, Medical University of Vienna, Hacettepe University, Ospedale Regina Margherita, Aristotle University of Thessaloniki, Nottingham University Hospitals NHS Trust, University of Cologne, University Hospital Cologne, Medizinische Hochschule Hannover
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,190
OpenAlex ID: W4402581294