Application of an epitope-based allocation system in pediatric kidney transplantation.
Donor-recipient HLA mismatch remains a leading cause for sensitization and graft loss in kidney transplantation. HLA compatibility at an epitope level is emerging as an improved method of matching compared with current HLA antigen allocation. A novel epitope-based allocation approach to prospectively exclude donors with high-level mismatches was implemented for pediatric KTRs on the DD waiting list. Nineteen consecutive transplants were followed for 12 months, including eight DD KTRs listed with eplet exclusions, as well as three DD KTRs and eight LD KTRs without exclusions. KTRs with eplet exclusions had estimated GFR of 78.5 mL/min/1.73 m2, no episodes of rejection, and time to transplant 6.55 months. HLA-A, HLA-B, HLA-DR antigen mismatches were similar between all groups. KTRs with exclusions had significantly lower class II eplet mismatches (20.4) than the contemporary DD KTRs without exclusions (63.7) and DD KTRs transplanted in the preceding decade (46.9). dnDSAs were identified in two of eight DD KTRs with exclusions, two of three DD KTRs without exclusions and five of eight LD KTRs. Epitope-based allocation achieved timely access to transplantation, low class II eplet mismatches, and low rates of dnDSAs in the first year. This strategy requires longer follow-up and larger numbers, but has the potential to reduce anti-HLA sensitization and improve both graft survival and opportunities for future retransplantation.
Department of Nephrology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia. Joshua.Kausman@rch.org.au.|Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. Joshua.Kausman@rch.org.au.|University of Melbourne, Melbourne, Victoria, Australia. Joshua.Kausman@rch.org.au.
Joshua Y
JY
Kausman
Department of Nephrology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.|Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.
Amanda M
AM
Walker
Victorian Immunogenetics and Transplantation Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia.
Linda S
LS
Cantwell
Department of Nephrology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.|Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.
Catherine
C
Quinlan
Department of Nephrology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.
Matthew P
MP
Sypek
Department of Nephrology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.|Department of Nephrology, Austin Health, Melbourne, Victoria, Australia.
Francesco L
FL
Ierino
D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000276:immunology*; D002648:Child; D000939:Epitopes / Q000276:immunology*; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000276:immunology / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D000906:Antibodies; D000939:Epitopes; D006680:HLA Antigens
donor-specific antibody; epitope; kidney; pediatric; transplant