Evaluation of the current post-transplantation Human Leukocyte Antigen antibody screening in paediatric renal transplant recipients

A. Demirok, C. Ranzijn, N.M. Lardy, S. Florquin, A.H.M. Bouts

Wednesday 13 march 2019

14:00 - 14:02h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: The necessity of post-transplant monitoring for donor specific antibodies (DSA) is unclear. This study evaluates the clinical relevance of post-transplantation donor specific HLA antibodies in pediatric renal transplant recipients, aiming at better stratification of patients at risk of graft dysfunction, and better recommendations for post-transplant monitoring.

Methods: A cohort of 68 pediatric kidney recipients, involving 76 transplantations between 2004 and 2014, was studied retrospectively. All patients were screened for HLA antibodies at 1, 3, 6 and 12 months after transplantation, and yearly thereafter. Samples testing positive were further analyzed to detect DSA. A biopsy was performed on clinical indication. We studied the baseline characteristics of the patients with biopsy, with DSA, and with rejection. We assessed the effect of post-transplant DSA on clinical outcome, including antibody-mediated acute rejection and GFR decrease.

Results: In our cohort the prevalence of DSA was 19% (13/68 transplantations). Most patients with HLA antibodies after transplantation were DSA-positive (76%; 13/17). A clear association between DSA and subsequent rejection was found. At the end of the study period, a significant lower GFR was found in patients with biopsy, DSA or rejection.

Conclusions: Based on our observations we recommend routine post-transplantation screening for HLA and DSA. The presence of DSA justifies a renal biopsy even in the absence of clinical signs of rejection.