Sp873effects of Late Acute Rejection on Graft Survival and Outcome in Pediatric Renal Transplant Recipients

Baskın, Esra; Kantar, Aslı; Gülleroğlu, Kaan; Özmen, Esra; Özdemir, Handan; Kırnap, Mahir; Moray, Gökhan; Haberal, Mehmet

doi:10.1093/ndt/gfv203.11

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“…12 In children, Baskin et al found that AR after 6 months post-transplant was associated with worse graft survival than no AR or early AR and was associated with worse medication adherence, de novo donor-specific antibody production and antibody-mediated rejection. 13 Similar detrimental effects of late antibody-mediated AR on graft survival were found by Dorje et al when compared to non-antibody-mediated late AR, the former occurring more often in younger adults and in association to worse medication adherence. 14 To our knowledge, no large multi-center studies have looked at the impact of late first AR, nor examined the risk of late first AR by era.…”

supporting

confidence: 57%

“…The adverse impact of late AR after 1 year on graft survival is as detrimental as that of early AR 12 . In children, Baskin et al found that AR after 6 months post‐transplant was associated with worse graft survival than no AR or early AR and was associated with worse medication adherence, de novo donor‐specific antibody production and antibody‐mediated rejection 13 . Similar detrimental effects of late antibody‐mediated AR on graft survival were found by Dorje et al when compared to non‐antibody‐mediated late AR, the former occurring more often in younger adults and in association to worse medication adherence 14 .…”

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confidence: 99%

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

Barton

Halani

Galbiati

et al. 2020

Pediatric Transplantation

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Over the last 30 years of NAPRTCS registry data, we have been fortunate to witness the dramatic decline in the rates of early first AR (within 12 months post-transplant) in each more recent cohort. 1 These early AR improvements, coupled with nearly parallel cumulative incidence slopes of late first AR (beyond 12 months post-transplant), led to significant drops in the cumulative 48-month first AR rate. The reasons for these reductions are multi-factorial: more potent immunosuppression, improvements in surgical techniques, better donor selection, and immunological matching.However, the data from the most recent cohorts revealed a disturbing trend. Chua et al showed a higher cumulative incidence of late first AR (defined as first AR after 12 months post-transplant) that made the 48-month cumulative first AR rate higher in the 2012-2017 living donor cohort than the last two living donor cohorts of

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confidence: 57%