Donor-specific anti-HLA antibodies in pediatric renal transplant recipients with creeping creatinine: Prevalence, histological correlations, and impact on patient and graft survival

Marta Lidia Monteverde, Alicia Chaparro, Julio Goldberg, Cintia Yanina Marcos, Karim Padros, Ziomara Balbarrey, Liliana Briones, David Rush
  • Pediatric Transplantation, July 2015, Wiley
  • DOI: 10.1111/petr.12556

What is it about?

Our study is similar to DeKAF study that analyzed adult kidney transplant patients with long-term deteriorating allograft function. We did not start from the time of transplant and looked for de novo-DSA. We looked at patients with late creeping creatinine and described presence of DSA, biopsy findings and prevalence of C4d.

Why is it important?

The association of a more rapid decline in renal function in children with concomitant T cell mediated rejection (TCMR) and DSA causing chronic antibody mediated rejection (CAMR) has not to our knowledge been reported. NA rate was 45%, higher in adolescents (60%).


Dr Marta Lidia Monteverde
Hospital JP Garrahan

DSA- mediated injury and complement activation were frequent in children biopsed for late creeping creatinine. Strategies to improve allograft survival in this population may include a greater tequirement for HLA for class II HLA matching, a cautious approach to minimization studies in miss match patients and an icreased surveillance of NA patients.

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