Treatment Modality and Outcomes of Antibody-Mediated Rejection in Pediatric Kidney Transplant Recipients: The PARAMOUr Study

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2022

DOI

10.1111/ajt.17073

Journal Title

American Journal of Transplantation

Department

Pediatrics

Abstract

Purpose: Antibody-mediated rejection (AMR) is the leading cause of graft failure in kidney transplantation, but evidence for effective treatments is limited. Methods: PARAMOUr is a retrospective cohort study of 123 pediatric kidney transplant recipients treated for AMR at 14 Pediatric Nephrology Research Consortium centers 12/31/2009 to 12/31/2019 and followed for one year post-treatment. This study examined the association between treatment regimen and outcome at one year after diagnosis. Effect modification by estimated glomerular filtration rate (eGFR) at diagnosis, donor specific antibody (DSA) class, and pathology was assessed. Results: 88.6% of patients were treated with IVIg, 68.3% with rituximab, 64.2% received plasmapheresis, and 28.5% received bortezomib. 27.6% of patients reached the composite outcome of graft failure or eGFR <20 ml/min/1.73m2 by one year after AMR diagnosis. There were no significant differences in outcome by treatment, whether treatments were analyzed individually or in combination. There was no effect modification by eGFR at diagnosis, predominant DSA class, or pathology findings. Median change in eGFR one year from diagnosis was -2 ml/min/1.73m2 (IQR -11 to 10 ml/min/1.73m2); 37.7% had a decline in eGFR >5 ml/min/1.73m2 while 62.3% had a stable or increased eGFR. An eGFR <30 m/min/1.73m2 at diagnosis was associated with a worse prognosis (RR composite outcome 5.6, IQR 2.9-10.8, p<0.001) but was not associated with treatment choice. Conclusions: Specific treatment regimen was not associated with outcome, but 61% of patients did show a stable or improved eGFR after treatment. eGFR at the time of AMR diagnosis was most strongly associated with outcome. Further research on effective treatments for antibody mediated rejection are needed to improve longterm kidney allograft survival. (Table Presented).

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