Steroids do not prevent this antibody-mediated injury and rejectionHighlights• Pediatric kidney transplant recipients who have antibodies directed against their new organ are more likely to experience kidney injury and rejection than patients without these antibodies.• Steroids do not prevent this antibody-mediated injury and rejection.
Approximately 2,500 children received a kidney transplant last year in the United States.
Newswise — Washington, DC (February 28, 2013) — A transplanted kidney has a finite life expectancy because it often becomes the target of the recipient’s immune system, which may mount antibodies that attack the organ. Because there is a critical need to extend the life of transplanted organs—especially in children, who can face two to three kidney transplants in their lifetime—researchers recently examined the role of this antibody-mediated injury in rejection and the effectiveness of medications to prevent it. Their findings are reported in the Journal of the American Society of Nephrology (JASN).
Minnie Sarwal, MD, FRCP, PhD (California Pacific Medical Center) and her colleagues mapped the antibody immune response in 130 children who received kidney transplants through 12 different US transplant programs participating in a trial comparing complete steroid avoidance after transplantation and standard steroid therapy after transplantation. (Some patients received long-term steroids after transplantation as a treatment to potentially protect the new organ from antibody-mediated injury, while others received no steroids.) Patients were monitored for two years after transplantation.
“The development of antibodies were confirmed to injure the transplant, though the incidence of this antibody-mediated injury to the transplant was quite low at only about 6%,” said Dr. Sarwal. Patients with these antibodies were more likely to experience organ injury and rejection than patients without these antibodies.
Also, steroids did not seem to provide a benefit. “There was no difference in the immune response in children who did not receive steroids, though there was a huge benefit in their growth, in lower blood pressures, and lower cholesterol levels, supporting the importance of avoiding steroids in children after transplantation wherever possible,” she added.
The researchers recommend monitoring recipients for the presence of antibodies directed against transplanted organs at various stages and customizing immunosuppressive treatments to prevent rejection.
Study co-authors include Abanti Chaudhuri, MD, Mikki Ozawa, Matthew Everly, Robert Ettenger, MD, Vikas Dharnidharka, MD, Mark Benfield, MD, Robert Mathias, MD, Anthony Portale, MD, Ruth McDonald, MD, William Harmon, MD, David Kershaw, MD, V. Matti Vehaskari, MD, Elaine Kamil, MD, H. Jorge Baluarte, MD, Bradley Warady, MD,Li Li, Tara Sigdel, Szu-chuan Hsieh, Hong Dai, Maarten Naesens, Janie Waskerwitz, RN, Oscar Salvatierra Jr, MD, and Paul Terasaki, PhD.
Disclosures: The authors reported no financial disclosures.
The article, entitled “Humoral Immunity Associates with Outcomes in Pediatric Renal Transplantation,” will appear online at http://jasn.asnjournals.org/ on February 28, 2013, doi: 10.1681/ASN.2012070663. The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
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Journal of the American Society of Nephrology (doi: 10.1681/ASN.2012070663)