Abstract: SA-PO0694
HLA-DQA1*05 May Not Affect Response to Intravenous Immunoglobulin in Donor-Specific Antibody-Driven Antibody-Mediated Rejection (AMR) Prevention After Kidney Transplant in Pediatric Patients
Session Information
- Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Kane, Abigail Sara, Children's Hospital Los Angeles Department of Pathology and Laboratory Medicine, Los Angeles, California, United States
- Foy, Alexandria C, Children's Hospital Los Angeles Division of Nephrology, Los Angeles, California, United States
- Vu, My Hai, Southern California Clinical and Translational Science Institute, Los Angeles, California, United States
- Baxter-Lowe, Lee Ann, Children's Hospital Los Angeles Department of Pathology and Laboratory Medicine, Los Angeles, California, United States
- Lestz, Rachel M., Children's Hospital Los Angeles Division of Nephrology, Los Angeles, California, United States
Background
HLA DQA1*05 mismatch between kidney transplant (tx) donor and recipient has been associated with increased risk of developing HLA donor-specific antibodies (DSA). DSA is associated with decreased graft survival and antibody mediated rejection. With growing interest in this deleterious mismatch, impact on long-term graft survival remains unclear. The purpose of this study was to determine whether intravenous immunoglobulin (IVIG) efficacy is different between patients with HLA-DQA1*05 DSA and those with other HLA DSA.
Methods
Kidney transplant recipients 2 to 19 years of age transplanted between January 2020 and July 2024 were included. Multiorgan tx and those with prior tx were excluded. High resolution HLA typing was performed by next generation sequencing. Antibody testing was done using Luminex microarrays per routine protocol at 30, 60 and 90 days, 6, 9 and 12 months, and every 6 months thereafter. Clinical data was obtained by retrospective chart review through April 2025. Mann-Whitney U test and Fisher’s exact test were used for statistical analysis of non-parametric and categorical data, respectively
Results
96 patients were included in analysis, 58% of which were male. Mean age at transplant was 12.9 years. 88% received kidney transplant from a deceased donor. Demographic and clinical variables, including DQA1*05 mismatch, type of induction and reduced maintenance immunosuppression with viremias or non-adherence were not significantly associated with increased frequency of DSA. Sixteen patients with clinically significant DSA but no evidence of AMR on biopsy were treated with IVIG. Of these, 94% had a reduction in DSA. The presence of DQA1*05 DSA did not significantly influence response to treatment with IVIG (p=0.7) and was not associated with a greater time to resolution of DSA (p=0.3).
Conclusion
IVIG decreases circulating DSA and could delay or prevent the development of AMR, prolonging graft survival. While DQA1*05 mismatch has been associated with increased immunogenicity in other cohorts, DQA1*05 DSA are not particularly resistant to treatment with IVIG. This study is limited by a relatively small sample size and short follow-up time.
Funding
- Private Foundation Support