1
|
Waldecker CB, Zgoura P, Seibert FS, Gall S, Schenker P, Bauer F, Rohn B, Viebahn R, Babel N, Westhoff TH. Biopsy findings after detection of de novo donor-specific antibodies in renal transplant recipients: a single center experience. J Nephrol 2021; 34:2017-2026. [PMID: 33866524 PMCID: PMC8610940 DOI: 10.1007/s40620-021-01040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Background De novo donor-specific antibodies (DSA) are associated with an increased risk of antibody-mediated rejection and a substantial reduction of allograft survival. We hypothesized that detection of DSA should prompt a biopsy even in the absence of proteinuria and loss of estimated glomerular filtration rate (eGFR). However, data on a population without proteinuria or loss of kidney function is scant, and this is the main novelty of our study design. Methods Single center retrospective analysis on biopsy findings after detection of de novo DSA. One-hundred-thirty-two kidney and pancreas-kidney transplant recipients were included. Eighty-four of these patients (63.6%) underwent allograft biopsy. At the time of biopsy n = 50 (59.5%) had a protein/creatinine ratio (PCR) > 300 mg/g creatinine and/or a loss of eGFR ≥ 10 ml/min in the previous 12 months, whereas 40.5% did not. Diagnosis of rejection was performed according to Banff criteria. Results Seventy-seven (91.7%) of the biopsies had signs of rejection (47.6% antibody mediated rejection (ABMR), 13.1% cellular, 20.2% combined, 10.7% borderline). Among subjects without proteinuria or loss of eGFR ≥ 10 ml/min/a (n = 34), 29 patients (85.3%) showed signs of rejection (44.1% antibody mediated (ABMR), 14.7% cellular, 11.8% combined, 14.7% borderline). Conclusion The majority of subjects with de novo DSA have histological signs of rejection, even in the absence of proteinuria and deterioration of graft function. Thus, it appears reasonable to routinely perform an allograft biopsy after the detection of de novo DSA. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01040-y.
Collapse
Affiliation(s)
- Christoph B Waldecker
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Panagiota Zgoura
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Felix S Seibert
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Sabina Gall
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Peter Schenker
- Department of Surgery, Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Herne, Germany
| | - Frederic Bauer
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Benjamin Rohn
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Richard Viebahn
- Department of Surgery, Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Herne, Germany
| | - Nina Babel
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Timm H Westhoff
- Medizinische Klinik I, Medical Department I, Marien Hospital Herne University Clinic, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| |
Collapse
|
2
|
Kim YH. Pediatric heart transplantation: how to manage problems affecting long-term outcomes? Clin Exp Pediatr 2021; 64:49-59. [PMID: 33233874 PMCID: PMC7873392 DOI: 10.3345/cep.2019.01417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/08/2020] [Indexed: 11/27/2022] Open
Abstract
Since the initial International Society of Heart Lung Transplantation registry was published in 1982, the number of pediatric heart transplantations has increased markedly, reaching a steady state of 500-550 transplantation annually and occupying up to 10% of total heart transplantations. Heart transplantation is considered an established therapeutic option for patients with end-stage heart disease. The long-term outcomes of pediatric heart transplantations were comparable to those of adults. Issues affecting long-term outcomes include acute cellular rejection, antibody-mediated rejection, cardiac allograft vasculopathy, infection, prolonged renal dysfunction, and malignancies such as posttransplant lymphoproliferative disorder. This article focuses on medical issues before pediatric heart transplantation, according to the Korean Network of Organ Sharing registry and as well as major problems such as graft rejection and cardiac allograft vasculopathy. To reduce graft failure rate and improve long-term outcomes, meticulous monitoring for rejection and medication compliance are also important, especially in adolescents.
Collapse
Affiliation(s)
- Young Hwue Kim
- Department of Pediatric Cardiology, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|