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Clinical and histopathologic features of antibody‐mediated rejection among pediatric renal transplant recipients with preformed vs de novo donor‐specific antibodies
Author(s) -
Steggerda Justin A.,
Kim Irene K.,
Haas Mark,
Zhang Xiaohai,
Kang Alexis,
Pizzo Helen,
Kamil Elaine,
Jordan Stanley,
Puliyanda Dechu
Publication year - 2017
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13079
Subject(s) - medicine , immunosuppression , donor specific antibodies , biopsy , antibody , urology , gastroenterology , kidney , kidney transplantation , immunology
Preformed and de novo donor specific antibodies ( pDSA and dn DSA ) are risk factors for ABMR . This study compares the effects of pDSA vs dn DSA in pediatric kidney transplant recipients. Sixteen pediatric patients with biopsy‐proven ABMR were evaluated. Strong DSA ( MFI >10 000) was recorded at transplant, rejection, and follow‐up. DSA s with the highest MFI were termed iDSA s. Allograft biopsies were scored according to Banff 2013 criteria. Seven of 16 (44%) patients had pDSA at transplant; 9 (56%) developed dn DSA . Patients with pDSA developed ABMR earlier (median = 63 vs 1344 days, P = .017), while patients with dn DSA were more likely to have strong Class II iDSA (100% vs 28%, P = .009). Viral infection or non‐adherence was more common in patients developing dn DSA (88.8% vs 28.6%, P < .01). Pathology in those with pDSA s demonstrated worse transplant glomerulitis (g score 1.57 ± 0.98 vs 0.56 ± 0.73, P = .031); however, those with dn DSA s exhibited higher C4d+ ABMR ( P = .013). Patients developing dn DSA s showed ABMR later post‐transplant with predominance of HLA ‐Class II iDSA s. Inadequate immunosuppression likely contributes to dn DSA formation. Patients with no DSA who have unprotocolized decreases in immunosuppression should be screened for dn DSA as it could lead to early intervention and potentially better outcomes.