title: Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After Pediatric Kidney Transplantation.
abstract: The Immune Development in Pediatric Transplantation (IMPACT) study was conducted to evaluate relationships among alloimmunity, protective immunity, immune development, physical parameters, and clinical outcome in children undergoing kidney transplantation. We prospectively evaluated biopsy-proven acute rejection (BPAR), de novo donor-specific antibody (dnDSA) formation, viremia, viral infection, T cell immunophenotyping, and body mass index (BMI)/weight Z scores in the first year posttransplantation in 106 pediatric kidney transplant recipients. Outcomes were excellent with no deaths and 98% graft survival. Rejection and dnDSAs occurred in 24% and 22%, respectively. Pretransplant cytomegalovirus (CMV) and Epstein-Barr virus (EBV) serologies and subsequent viremia were unrelated to BPAR or dnDSA. Viremia occurred in 73% of children (EBV, 34%; CMV, 23%; BMK viremia, 23%; and JC virus, 21%). Memory lymphocyte phenotype at baseline was not predictive of alloimmune complications. Patients who developed viral infection had lower weight (-2.1) (p = 0.028) and BMI (-1.2) (p = 0.048) Z scores at transplantation. The weight difference persisted to 12 months compared with patients without infection (p = 0.038). These data indicate that there is a high prevalence of viral disease after pediatric kidney transplantation, and underweight status at transplantation appears to be a risk factor for subsequent viral infection. The occurrence of viremia/viral infection is not associated with alloimmune events.
authors.affiliation: Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA.
authors.forename: R
authors.initials: R
authors.lastname: Ettenger
authors.affiliation: Rho Inc, Chapel Hill, NC.
authors.forename: H
authors.initials: H
authors.lastname: Chin
authors.affiliation: Rho Inc, Chapel Hill, NC.
authors.forename: K
authors.initials: K
authors.lastname: Kesler
authors.affiliation: Transplantation Branch, NIAID National Institutes of Health, Bethesda, MD.
authors.forename: N
authors.initials: N
authors.lastname: Bridges
authors.affiliation: Department of Pediatrics and Pathology, Stanford University, Palo Alto, CA.
authors.forename: P
authors.initials: P
authors.lastname: Grimm
authors.affiliation: Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA.
authors.forename: E F
authors.initials: EF
authors.lastname: Reed
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: M
authors.initials: M
authors.lastname: Sarwal
authors.affiliation: Department of Pediatrics and Pathology, Stanford University, Palo Alto, CA.
authors.forename: R
authors.initials: R
authors.lastname: Sibley
authors.affiliation: Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA.|Departments of Surgery and Pediatrics, Duke University, Durham, NC.
authors.forename: E
authors.initials: E
authors.lastname: Tsai
authors.affiliation: Departments of Pediatrics and Surgery, Children's Healthcare of Atlanta and Emory University, Atlanta, GA.
authors.forename: B
authors.initials: B
authors.lastname: Warshaw
authors.affiliation: Departments of Surgery and Pediatrics, Duke University, Durham, NC.|Departments of Pediatrics and Surgery, Children's Healthcare of Atlanta and Emory University, Atlanta, GA.
authors.forename: A D
authors.initials: AD
authors.lastname: Kirk
mesh_terms: D000293:Adolescent; D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications*; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications*; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival / Q000276:immunology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014766:Viremia / Q000150:complications*; D055815:Young Adult
keywords: clinical research/practice; infection and infectious agents; kidney transplantation/nephrology; nutrition; pediatrics; rejection; translational research/science; viral