title: Pediatric kidney recipients may benefit from monitoring for donor-specific antibodies.
abstract: There are limited data regarding the presence of DSAs and their effect on graft function in pediatric renal transplantation. The role for serial DSA monitoring in routine clinical practice is unclear. All patients attending a regional transplant clinic were tested for DSAs, measured using Luminex single/mixed antigen beads. Any patient having a positive result subsequently underwent historic testing on samples previously obtained. DSA-positive patients underwent prospective monitoring of DSAs, and correlation with clinical events was studied. Nine of a total of 50 patients (18%) were DSA-positive, of whom six had graft dysfunction. The DSA-positive cohort had significantly increased episodes of AR (p = 0.01). There were two graft losses in the DSA-positive group and none in the DSA-negative group. Eight of the DSA-positive group had potentially reduced exposure to IS because of either adherence issues or clinical indications. DSAs were associated with increased risk of rejection. There appears to be a role for serial monitoring of DSAs in patients where there has been a reduced exposure to IS so that early intervention with optimized IS can be considered.
authors.affiliation: Department of Paediatric Nephrology, The University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK.
authors.forename: Deepa
authors.initials: D
authors.lastname: Athavale
authors.forename: Judith
authors.initials: J
authors.lastname: Worthington
authors.forename: Nicholas J A
authors.initials: NJ
authors.lastname: Webb
authors.forename: Denise
authors.initials: D
authors.lastname: Roberts
authors.forename: Susan
authors.initials: S
authors.lastname: Martin
authors.forename: Mohan
authors.initials: M
authors.lastname: Shenoy
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006084:Graft Rejection; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D010349:Patient Compliance; D015995:Prevalence; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000276:immunology / Q000601:surgery*; D012307:Risk Factors; D014019:Tissue Donors; D066027:Transplant Recipients
chemical_list: D000906:Antibodies; D006680:HLA Antigens
keywords: acute rejection; donor-specific antibody; immunosuppression; serial DSA monitoring