Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study

Barton, Kevin; Halani, Khalif; Galbiati, Shirley; Dandamudi, Raja; Hmiel, S. Paul; Dharnidharka, Vikas R.; investigators, Naprtcs

doi:10.1111/petr.13953

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…The association between non-White racial or ethnic identity and rejection was consistently demonstrated across studies from the US and Canada, 8,40,71,72 including after adjusting for sociodemographic, recipient, and donor clinical characteristics. 12,69 Studies also demonstrated this association over time, including increased rates of late first acute rejection (i.e., >12 months from transplant), 73 and within the first 3 years post-transplant among Black children compared to White and Hispanic children. 26 One US study found no difference in the number of rejections across racial groups; however, a larger proportion of Black participants had two or more rejections compared to White recipients or those of other identified racial or ethnic identities.…”

Section: Rejectionmentioning

confidence: 83%

A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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Background: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre-and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. Methods: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. Results: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. Conclusion: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities. K E Y W O R D S social determinants of health, disparity, pediatric organ transplantation 2 of 33 | REA et al. 1 | INTRODUC TI ON Equitable access to organ transplantation and subsequent transplantrelated medical care is a critical goal across healthcare centers. Over the years, studies have identified risk factors impacting listing status and transplant-related outcomes, with greater scrutiny recently on clinical tools impacting organ allocation, selection, and donation processes. 1 These steps are critical in identifying areas of structural racism which continue to impact Black, Indigenous, and people of color as well as the intersectionality of socioeconomic factors within the patient population as a whole. To summarize findings to date, a systematic review of the available literature was conducted. Studies included assessments of SDoH in the evaluation, listing, and post-transplant periods. The US Department of Health and Human Services identifies five domains of SDoH that include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 2 Special consideration was given to dynamic interplay between these factors to better understand social processes underlying health outcomes and identify potential intervention areas. | ME THODS | Search strategyThis systematic review is in accordance with PRISMA guidelines.Comprehensive search strategies were created for Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature, including controlled vocabulary terms from each database combined logically with keywords using Boolean Logic. Terms were extracted per the following concepts: pediatrics, organ transplantation, disparities, and identity (see example searc...

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Section: Rejectionmentioning

confidence: 83%

A systematic review of social determinants of health in pediatric organ transplant outcomes

Rea

West

Dorste

et al. 2022

Pediatric Transplantation

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“…Late episodes may be associated with the reduction of the pharmacodynamic effect of the r-ATG over time, 21 in combination with poor adherence to immunosuppressive medication, a recognized pattern observed in the pediatric population, especially when the frequency of outpatient visits decreases after the transplant surgery. [22][23][24] F I G U R E 4 Survival free of all treated acute rejection episodes.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of single‐dose anti‐thymocyte globulin versus basiliximab induction therapy in pediatric kidney transplant recipients: A retrospective comparative cohort study

Custodio,

Martins,

Viana

et al. 2024

Pediatric Transplantation

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BackgroundThis study aimed to compare the efficacy and safety of basiliximab (BAS) versus a single dose of anti‐thymocyte globulin (r‐ATG) induction therapy in pediatric kidney transplant recipients (KTRs).MethodsThis single‐center retrospective comparative cohort study included all pediatric KTRs from May 2013 to April 2018 and followed up to 12 months. In the first period, all recipients received BAS, while from May 2016, a single 3 mg/kg dose of r‐ATG was instituted. Maintenance therapy consisted of a calcineurin inhibitor plus prednisone plus azathioprine or mycophenolate.ResultsA total of 227 patients were included (BAS, n = 113; r‐ATG, n = 114). The main combination of immunosuppressive drugs was tacrolimus, prednisone, and azathioprine in both groups (87% vs. 88%, p = .718). Patients receiving r‐ATG showed superior survival‐free of the composite endpoint (acute rejection, graft loss, or death; 76% vs. 61%, p = .003; HR 2.08, 1.29–3.34, p = .003) and lower incidence of biopsy‐proven acute rejection (10% vs. 21%, p = .015). There was no difference in the overall incidence of CMV infection (33% vs. 37%, p = .457), PTLD (1% vs. 3%, p = .309), 30‐day hospital readmissions (24% vs. 23%, p = .847), and kidney function at 12 months (86 ± 29 vs. 84 ± 30 mL/min/1.73m2, p = .614).ConclusionsThese data suggest that induction therapy with a single 3 mg/kg dose of r‐ATG is associated with higher efficacy for preventing acute rejection and similar safety profile compared to BAS.

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“…In the pediatric setting, overall results of kidney transplantation remain unsatisfactory in the long run, in particular when passing through the risky years of adolescence. A recent study highlighted the excess of late acute rejection episodes in the NAPRTCS cohort [3], pointing out the need to increase the performances of surveillance modalities after the generally adopted schedules of intensive monitoring of the first 24 months.…”

Section: Introductionmentioning

confidence: 99%

Rejection markers in kidney transplantation: do new technologies help children?

Peruzzi

Deaglio

2023

Pediatr Nephrol

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Recent insights in allorecognition and graft rejection mechanisms revealed a more complex picture than originally considered, involving multiple pathways of both adaptive and innate immune response, supplied by efficient inflammatory synergies. Current pillars of transplant monitoring are serum creatinine, proteinuria, and drug blood levels, which are considered as traditional markers, due to consolidated experience, low cost, and widespread availability. The most diffuse immunological biomarkers are donor-specific antibodies, which are included in routine post-transplant monitoring in many centers, although with some reproducibility issues and interpretation difficulties. Confirmed abnormalities in these traditional biomarkers raise the suspicion for rejection and guide the indication for graft biopsy, which is still considered the gold standard for rejection monitoring. Rapidly evolving new “omic” technologies have led to the identification of several novel biomarkers, which may change the landscape of transplant monitoring should their potential be confirmed. Among them, urinary chemokines and measurement of cell-free DNA of donor origin are perhaps the most promising. However, at the moment, these approaches remain highly expensive and cost-prohibitive in most settings, with limited clinical applicability; approachable costs upon technology investments would speed their integration. In addition, transcriptomics, metabolomics, proteomics, and the study of blood and urinary extracellular vesicles have the potential for early identification of subclinical rejection with high sensitivity and specificity, good reproducibility, and for gaining predictive value in an affordable cost setting. In the near future, information derived from these new biomarkers is expected to integrate traditional tools in routine use, allowing identification of rejection prior to clinical manifestations and timely therapeutic intervention. This review will discuss traditional, novel, and invasive and non-invasive biomarkers, underlining their strengths, limitations, and present or future applications in children.

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Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study

Cited by 3 publications

References 28 publications

A systematic review of social determinants of health in pediatric organ transplant outcomes

A systematic review of social determinants of health in pediatric organ transplant outcomes

Efficacy and safety of single‐dose anti‐thymocyte globulin versus basiliximab induction therapy in pediatric kidney transplant recipients: A retrospective comparative cohort study

Rejection markers in kidney transplantation: do new technologies help children?

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