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Complement-Binding Donor-Specific Anti-HLA Antibodies : Biomarker for Immunologic Risk Stratification in Pediatric Kidney Transplantation Recipients

Complement-Binding Donor-Specific Anti-HLA Antibodies : Biomarker for Immunologic Risk Stratification in Pediatric Kidney Transplantation Recipients


Title: Complement-Binding Donor-Specific Anti-HLA Antibodies : Biomarker for Immunologic Risk Stratification in Pediatric Kidney Transplantation Recipients
Author: Sigurjónsdóttir, Vaka Kristín
Purington, Natasha
Chaudhuri, Abanti
Zhang, Bing M.
Fernandez-Vina, Marcelo
Pálsson, Runólfur
Kambham, Neeraja
Charu, Vivek
Piburn, Kim
Maestretti, Lynn
... 4 more authors Show all authors
Date: 2022-03-16
Language: English
Scope:
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Faculty of Medicine
Other departments
Office of Division of Clinical Services I
Series: Transplant International; 35()
ISSN: 0934-0874
DOI: https://doi.org/10.3389/ti.2021.10158
Subject: Nýrnalæknisfræði; Nýrnaígræðsla; Börn; antibody-mediated rejection; children; immunosuppression; kidney allograft; transplant outcomes; Transplantation
URI: https://hdl.handle.net/20.500.11815/3184

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Citation:

Sigurjónsdóttir , V K , Purington , N , Chaudhuri , A , Zhang , B M , Fernandez-Vina , M , Pálsson , R , Kambham , N , Charu , V , Piburn , K , Maestretti , L , Shah , A , Gallo , A , Concepcion , W & Grimm , P C 2022 , ' Complement-Binding Donor-Specific Anti-HLA Antibodies : Biomarker for Immunologic Risk Stratification in Pediatric Kidney Transplantation Recipients ' , Transplant International , vol. 35 , 10158 . https://doi.org/10.3389/ti.2021.10158

Abstract:

Antibody-mediated rejection is a common cause of early kidney allograft loss but the specifics of antibody measurement, therapies and endpoints have not been universally defined. In this retrospective study, we assessed the performance of risk stratification using systematic donor-specific antibody (DSA) monitoring. Included in the study were children who underwent kidney transplantation between January 1, 2010 and March 1, 2018 at Stanford, with at least 12-months follow-up. A total of 233 patients were included with a mean follow-up time of 45 (range, 9–108) months. Median age at transplant was 12.3 years, 46.8% were female, and 76% had a deceased donor transplant. Fifty-two (22%) formed C1q-binding de novo donor-specific antibodies (C1q-dnDSA). After a standardized augmented immunosuppressive protocol was implemented, C1q-dnDSA disappeared in 31 (58.5%). Graft failure occurred in 16 patients at a median of 54 (range, 5–83) months, of whom 14 formed dnDSA. The 14 patients who lost their graft due to rejection, all had persistent C1q-dnDSA. C1q-binding status improved the individual risk assessment, with persistent; C1q binding yielding the strongest independent association of graft failure (hazard ratio, 45.5; 95% confidence interval, 11.7–177.4). C1q-dnDSA is more useful than standard dnDSA as a noninvasive biomarker for identifying patients at the highest risk of graft failure.

Description:

Funding Information: VS was a Tashia and John Morgridge Endowed Postdoctoral Fellow of the Stanford Maternal and Child Health Research Institute. VS also received Young Scientist Award at Landspitali?The National University Hospital. Publisher Copyright: Copyright © 2022 Sigurjonsdottir, Purington, Chaudhuri, Zhang, Fernandez-Vina, Palsson, Kambham, Charu, Piburn, Maestretti, Shah, Gallo, Concepcion and Grimm.

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