2016 - IPTA Fellows Meeting

Mini-Oral Abstract Presentations

14.41 - Late Acute Rejection In Pediatric Renal Transplant Recipients

Presenter: Begüm, Avci, Ankara, Turkey
Authors: Begüm Avci, Esra Bask?n, Asl? Kantar, Kaan Güllero?lu, Handan Özdemir, Gökhan Moray, Mehmet Haberal

Late Acute Rejection In Pediatric Renal Transplant Recipients

Begüm Avcı1, Esra Baskın1, Aslı Kantar1, Kaan Gülleroğlu1, Handan Özdemir2, Gökhan Moray3, Mehmet Haberal3.

1Pediatric Nephrology, Baskent University, Ankara, Turkey; 2Pathology, Baskent University, Ankara, Turkey; 3General Surgery, Baskent University, Ankara, Turkey

Purpose: Both early and late acute (antibody mediated and T cell mediated) rejections are major causes of renal allograft dysfunction. Despite significant improvement in the rates of early acute rejection (EAR) and better short term graft survival, the incidence of late acute rejection and long term graft survival has not chanced significantly. Late acute rejection (LAR) is defined as first rejection episode occuring after the first six months of transplantation. LAR episodes are more common in children and it has worse prognosis than early acute rejection. Risk factors associated with LAR are not well defined in pediatric renal transplant patients. We aimed to investigate clinical, demographic and pathological risk factors of LAR in our center.

Methods: We retrospectively evaluated 69 episodes of biopsy-confirmed acute rejection in 34 kidney transplant recipients in last 6 years (a total of 120 patients). Recipients were stratified by early acute rejection (<6 months after transplantation n=12) and LAR (>6 months after transplantation n=22). Information about age and gender, donor type, modality and duration of dialysis, causes of renal failure, immunosuppressive drugs, HLA missmatch, viral markers, delayed graft function, anti HLA antibodies, eGFR, rejection type, renal biopsy findings and treatments were recorded. Donor spesific antibody (DSA) levels were measured by Luminex methods. Clinical, demographic and pathological risk factors were compare in recipients with LAR, EAR and without rejection group.

Result: The median time to acute rejection was 22 days (range 1-134 days) in the early group and 28 months (range 6.2-54 months) in the late group (p<0.05). Recipients with LAR had significantly reduced graft survival compared with recipient with EAR and without rejection group at four year (76%, 87% and 92% respectively, p<0.001). Graft loss was significantly higher in LAR group (6/22 LAR, 1/12 EAR). The LAR group was characterized by increased occurrence of de novo donor-specific antibodies (42% vs 13% p<0.05), and nonadherence (35% vs 5% p<0.05) compared with EAR group.

Conclusion: We concluded late acute rejections are associated with worse prognosis and inferior graft survival. Development of de novo DSA, non adherence or suboptimal immunosuppression and recurrent acute rejection episodes are important risk factors for LAR. Close monitoring of these patients, making an early diagnosis and intensive treatment of LAR may help improve graft survival and long term outcome.

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