NYMC Faculty Publications

Antibody-Mediated Rejection in Pediatric Kidney Transplant Recipients: A Report From the Pediatric Nephrology Research Consortium

Isa F. Ashoor, Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA.
Rachel M. Engen, Department of Pediatrics, University of Wisconsin Madison, Madison, Wisconsin, USA.
Dechu Puliyanda, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Nicole Hayde, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA.
Caitlin G. Peterson, Division of Pediatric Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, USA.
Rima S. Zahr, Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
Sonia Solomon, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Boston Children's Health Physicians, Valhalla, New York, USA.
Mahmoud Kallash, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
Rouba Garro, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Amrish Jain, Department of Pediatrics, Central Michigan University and Children's Hospital of Michigan, Detroit, Michigan, USA.
Lyndsay A. Harshman, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.
Scott T. McEwen, Division of Pediatric Nephrology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
Asifhusen Mansuri, Department of Pediatrics, Children's Hospital of Georgia, Augusta University, Augusta, Georgia, USA.
Mathew J. Gregoski, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Katherine E. Twombley, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.

Author Type(s)

Faculty

Journal Title

Pediatric Transplantation

First Page

e14734

Document Type

Article

Publication Date

5-1-2024

Department

Pediatrics

Abstract

BACKGROUND: Antibody-mediated rejection (AMR) is a major cause of kidney allograft loss. There is a paucity of large-scale pediatric-specific data regarding AMR treatment outcomes. METHODS: Data were obtained from 14 centers within the Pediatric Nephrology Research Consortium. Kidney transplant recipients aged 1-18 years at transplant with biopsy-proven AMR between 2009 and 2019 and at least 12 months of follow-up were included. The primary outcome was graft failure or an eGFR <20 mL/min/1.73 m at 12 months following AMR treatment. AMR treatment choice, histopathology, and DSA class were also examined. RESULTS: We reviewed 123 AMR episodes. Median age at diagnosis was 15 years at a median 22 months post-transplant. The primary outcome developed in 27.6%. eGFR <30 m/min/1.73 m at AMR diagnosis was associated with a 5.6-fold higher risk of reaching the composite outcome. There were no significant differences in outcome by treatment modality. Histopathology scores and DSA class at time of AMR diagnosis were not significantly associated with the primary outcome. CONCLUSIONS: In this large cohort of pediatric kidney transplant recipients with AMR, nearly one-third of patients experienced graft failure or significant graft dysfunction within 12 months of diagnosis. Poor graft function at time of diagnosis was associated with higher odds of graft failure.

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