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Kidney Week

Abstract: PO2352

Variability in Surveillance Monitoring and Management of Donor-Specific Antibodies Among Pediatric Transplant Programs Participating in the Improving Renal Outcomes Collaborative (IROC)

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Harshman, Lyndsay, The University of Iowa Stead Family Department of Pediatrics, Iowa City, Iowa, United States
  • Patel, Hiren P., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Barletta, Gina-Marie, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Hooper, David K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Garro, Rouba, Emory University, Atlanta, Georgia, United States
Background

There have been few advancements in long-term outcome of pediatric kidney transplant (KT) recipients who develop rejection. Many centers perform surveillance monitoring for donor specific antibodies (DSA) to diagnose and treat subclinical rejection. Despite the existence of guidelines, there is variability in monitoring and management of DSA post-pediatric KT.

Methods

An IRB approved survey was distributed using REDCap among pediatric KT programs participating in IROC to evaluate practice patterns in monitoring and management of DSA post KT.

Results

Twenty-nine of 33 (88%) IROC centers completed the survey. Twenty-five of 29 (86%) centers perform surveillance DSA monitoring. Of those 25 centers, 20 (69%) check DSA twice or more in year one post KT. Nineteen (65%) check once in the second year and annually thereafter. Ten (35%) centers check DSA only by indication after year two post KT. Twenty-eight (97%) utilize MFI trend in interpreting DSA results and 10 (34%) centers use C1q complement fixing antibody assay to guide management.

Management of patients with +DSA, stable creatinine and no evidence of antibody mediated rejection (AMR) on biopsy varies across centers from monitoring alone (10/29, 34%) to intensifying baseline immunosuppression (19/29, 66%). Very few centers reported giving IVIG alone (3/29, 10%) or IVIG and rituximab (3/29, 10%). Only 34% of centers (10/29) perform kidney biopsy if DSA develops with stable creatinine.

When rituximab is used for treatment of DSA+ AMR, 11/29 (41%) centers use one dose and 13/29 (45%) use 2 doses with variable frequency. Of centers that use IVIG as monotherapy for treatment of DSA+ AMR, 12/20 (60%) use 1 g/kg/dose and 6/20 (30%) use 2 g/kg/dose. The frequency of IVIG dosing is monthly in 16/20 (80%). The number of IVIG doses is variable ranging from 1 to 6.

Conclusion

There is significant variability in surveillance monitoring and management of DSA post-KT across pediatric centers. Large, multicenter studies should be considered to evaluate the ideal post-KT surveillance DSA monitoring strategy and to determine the effect of different treatment approaches on long-term outcomes in pediatric KT recipients.