IGG3 anti-HLA donor-specific antibodies and graft function in pediatric kidney transplant recipients
Gilad Hamdani
Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Search for more papers by this authorJens W. Goebel
Nephrology Division, Children’s Hospital Colorado, Aurora, CO, USA
Search for more papers by this authorPaul Brailey
Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
Search for more papers by this authorElizabeth A. Portwood
Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
Search for more papers by this authorCorresponding Author
David K. Hooper
Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Correspondence
Alin L. Girnita, Hoxworth Blood Center, University of Cincinnati, Cincinnati, OH, USA.
Email: [email protected]
and
David K. Hooper, Division of Nephrology and Hypertension, Cincinnati Children’s Medical Center, Cincinnati, OH, USA.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Alin L. Girnita
Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
Correspondence
Alin L. Girnita, Hoxworth Blood Center, University of Cincinnati, Cincinnati, OH, USA.
Email: [email protected]
and
David K. Hooper, Division of Nephrology and Hypertension, Cincinnati Children’s Medical Center, Cincinnati, OH, USA.
Email: [email protected]
Search for more papers by this authorGilad Hamdani
Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Search for more papers by this authorJens W. Goebel
Nephrology Division, Children’s Hospital Colorado, Aurora, CO, USA
Search for more papers by this authorPaul Brailey
Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
Search for more papers by this authorElizabeth A. Portwood
Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
Search for more papers by this authorCorresponding Author
David K. Hooper
Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Correspondence
Alin L. Girnita, Hoxworth Blood Center, University of Cincinnati, Cincinnati, OH, USA.
Email: [email protected]
and
David K. Hooper, Division of Nephrology and Hypertension, Cincinnati Children’s Medical Center, Cincinnati, OH, USA.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Alin L. Girnita
Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
Correspondence
Alin L. Girnita, Hoxworth Blood Center, University of Cincinnati, Cincinnati, OH, USA.
Email: [email protected]
and
David K. Hooper, Division of Nephrology and Hypertension, Cincinnati Children’s Medical Center, Cincinnati, OH, USA.
Email: [email protected]
Search for more papers by this authorFunding information
This study was supported by the Casey Lee Ball Foundation.
Abstract
Anti-HLA DSAs are associated with ABMR and graft loss in KT recipients, yet the influence of DSA IgG subclass on outcomes in pediatric KT recipients is not completely understood. We performed a single-center retrospective chart review of pediatric KT recipients with anti-HLA DSAs, aiming to study the association between specific DSA IgG subclasses and graft outcomes, including ABMR and significant graft dysfunction (graft loss or 50% decrease in eGFR). Thirty-six patients (mean age 15.4y) with DSAs initially detected 1 month-14.3 years post-transplantation were followed for a median of 2.8 years. Rates of IgG1, 2, 3, and 4 subclass detection were 92%, 33%, 58%, and 25%, respectively. Twenty-two patients (61%) had clinical ABMR, whereas 19% had subclinical ABMR, and 13 (36%) experienced significant graft dysfunction. Patients with IgG3+ DSAs had a higher risk of graft dysfunction compared with IgG3- patients (52% vs 13%, P = .03). In a multiple Cox proportional regression analysis, the presence of IgG3+ DSA was independently associated with significant graft dysfunction (HR 10.45, 95% CI 1.97-55.55, P = .006). In conclusion, IgG3 subclass DSAs are associated with graft dysfunction and may be useful for risk stratification and treatment decisions in DSA-positive pediatric KT recipients.
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