title: Acute antibody-mediated rejection in pediatric kidney transplants: a single center experience.
abstract: aAMR is a potentially devastating complication of kidney transplantation. The incidence of aAMR in children, while thought to be rare, is not well defined, and there is a paucity of data on treatment regimens in children. We retrospectively reviewed the outcomes of our pediatric patients that were treated for aAMR between 2007 and 2009. Three adolescent Hispanic males were found to have aAMR. All three received deceased donor transplants, and all three verbalized non-adherence. Treatment consisted of rituximab, solumedrol, PE, and IVIgG in one patient, and PE, IVIgG, and bortezomib in two patients. The only side effect of therapy noted was mild hypotension with rituximab that resolved after decreasing the infusion rate. There were no reported infections two yr after treatment, and all of the viral monitoring in these patients remained negative.
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Twombley
authors.forename: Lonnie
authors.initials: L
authors.lastname: Thach
authors.forename: Annelise
authors.initials: A
authors.lastname: Ribeiro
authors.forename: Catherine
authors.initials: C
authors.lastname: Joseph
authors.forename: Mouin
authors.initials: M
authors.lastname: Seikaly
mesh_terms: D000293:Adolescent; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D002648:Child; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000737:chemistry; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage; D010349:Patient Compliance; D010951:Plasma Exchange; D011719:Pyrazines / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011719:Pyrazines; D000069283:Rituximab; D008776:Methylprednisolone Hemisuccinate; D000069286:Bortezomib
keywords: adolescents; anti-HLA antibody; antibodies; antibody mediated rejection; outcome; pediatric kidney transplant