Journal
TRANSPLANT INTERNATIONAL
Volume 27, Issue 7, Pages 667-673Publisher
WILEY-BLACKWELL
DOI: 10.1111/tri.12316
Keywords
Antibody-mediated rejection; de novo HLA antibodies; HLA donor-specific antibodies; HLA matching; pediatric kidney transplantation
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Funding
- Regione Lombardia
- Ministero della Salute, Ricerca Finalizzata
- Istituto G. Gaslini, Ricerca Corrente
- Fondazione IRCCS Policlinico S. Matteo, Ricerca Corrente
- Associazione Italiana Ricerca sul Cancro (AIRC)
- La Nuova Speranza Onlus
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy
- Fondazione Malattie Renali del Bambino, Genova, Italy
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Data on the different HLA-antibody (Ab) categories in pediatric kidney recipients developing de novo donor-specific Abs (DSA) after transplantation are scarce. We retrospectively evaluated 82 consecutive nonsensitized pediatric recipients of a first kidney graft for de novo HLA Ab occurrence and antigen specificity. At a median follow-up of 6 years, 29% of patients developed de novo DSA, while 45% had de novo non-DSA. DSA appeared at 25-month median time post-transplant and were mostly directed toward HLA-DQ antigens. Considering each HLA antigen, the estimated rate of DQ DSA (7.55 per 100 person-years) was much higher than the rates observed for non-DQ DSA. The HLA-DQ Ab recognized determinants of the DQ chain in 70% of cases, chain in 25% of cases, and both chains in one patient. Non-DSA peaked earlier than DSA, and were largely directed against HLA class I specificities that belonged to HLA-A- and HLA-B-related cross-reacting epitope groups (CREG) in 56% of cases. Our results indicate a need for evaluating HLA-DQ compatibilities in kidney allocation, in order to minimize post-transplant development of de novo DSA, known to be responsible for antibody-mediated rejection and graft loss.
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