Allograft outcomes of treated children with kidney transplant who developed plasma cell-rich acute rejection (PCAR): A single center's experience

Issa Alhamoud, Rong Huang, Chantale Lacelle, Daniel Burguete, Allen R Hendricks, Jose R Torrealba, Mouin G Seikaly

Research output: Contribution to journalArticle

Abstract

Introduction: PCAR is a rare form of ACR that may compromise renal allografts. This review evaluates the outcomes of a protocol used to treat PCAR (Study group), and compares these outcomes with a matched cohort with ACR (Control group). Methods: A retrospective analysis of 138 of pRTRs who underwent renal allograft biopsies between January 2008 and November 2016. Results: Seven biopsies revealed in situ hybridization of EBER-negative PCAR (5%). Three Study group pRTRs lost their grafts within 3 months after rejection (43%). None of the Control group pRTRs lost their graft during this period. At the time of rejection, eGFR was different between the Control and Study groups (27.0 ± 19.9 mL/min per m2 vs 40.0 ± 10.6 mL/min/1.73 m2, respectively; P < 0.05). Among Study group pRTRs with functioning allografts (n = 4), treatment resulted in an increase in eGFR from nadir levels (27.0 ± 19.9 vs 55.6 ± 18.3 mL/min/1.73 m2, P < 0.05). In the Study group, complications included neutropenia, BK and EBV viremia, and infusion-related hypotension and hypertension. Summary: (a) Graft loss in Study group while remaining high (43%) was lower than that reported in the published pediatric literature. (b) Our protocol was associated with improvement in eGFR in all surviving pRTRs within the Study group. (c) No life-threatening complications or malignancy were reported during the observation period.

Original languageEnglish (US)
Article numbere13500
JournalPediatric Transplantation
Volume23
Issue number6
DOIs
StatePublished - Jan 1 2019

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Plasma Cells
Allografts
Transplants
Kidney
Control Groups
Biopsy
Viremia
Neutropenia
Human Herpesvirus 4
Hypotension
In Situ Hybridization
Observation
Pediatrics
Hypertension
Neoplasms
Therapeutics

Keywords

  • pediatric renal transplant recipients
  • plasma cell rich acute rejection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

@article{057cabdd99d140869b00295b35f4791f,
title = "Allograft outcomes of treated children with kidney transplant who developed plasma cell-rich acute rejection (PCAR): A single center's experience",
abstract = "Introduction: PCAR is a rare form of ACR that may compromise renal allografts. This review evaluates the outcomes of a protocol used to treat PCAR (Study group), and compares these outcomes with a matched cohort with ACR (Control group). Methods: A retrospective analysis of 138 of pRTRs who underwent renal allograft biopsies between January 2008 and November 2016. Results: Seven biopsies revealed in situ hybridization of EBER-negative PCAR (5{\%}). Three Study group pRTRs lost their grafts within 3 months after rejection (43{\%}). None of the Control group pRTRs lost their graft during this period. At the time of rejection, eGFR was different between the Control and Study groups (27.0 ± 19.9 mL/min per m2 vs 40.0 ± 10.6 mL/min/1.73 m2, respectively; P < 0.05). Among Study group pRTRs with functioning allografts (n = 4), treatment resulted in an increase in eGFR from nadir levels (27.0 ± 19.9 vs 55.6 ± 18.3 mL/min/1.73 m2, P < 0.05). In the Study group, complications included neutropenia, BK and EBV viremia, and infusion-related hypotension and hypertension. Summary: (a) Graft loss in Study group while remaining high (43{\%}) was lower than that reported in the published pediatric literature. (b) Our protocol was associated with improvement in eGFR in all surviving pRTRs within the Study group. (c) No life-threatening complications or malignancy were reported during the observation period.",
keywords = "pediatric renal transplant recipients, plasma cell rich acute rejection",
author = "Issa Alhamoud and Rong Huang and Chantale Lacelle and Daniel Burguete and Hendricks, {Allen R} and Torrealba, {Jose R} and Seikaly, {Mouin G}",
year = "2019",
month = "1",
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doi = "10.1111/petr.13500",
language = "English (US)",
volume = "23",
journal = "Pediatric Transplantation",
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T1 - Allograft outcomes of treated children with kidney transplant who developed plasma cell-rich acute rejection (PCAR)

T2 - A single center's experience

AU - Alhamoud, Issa

AU - Huang, Rong

AU - Lacelle, Chantale

AU - Burguete, Daniel

AU - Hendricks, Allen R

AU - Torrealba, Jose R

AU - Seikaly, Mouin G

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: PCAR is a rare form of ACR that may compromise renal allografts. This review evaluates the outcomes of a protocol used to treat PCAR (Study group), and compares these outcomes with a matched cohort with ACR (Control group). Methods: A retrospective analysis of 138 of pRTRs who underwent renal allograft biopsies between January 2008 and November 2016. Results: Seven biopsies revealed in situ hybridization of EBER-negative PCAR (5%). Three Study group pRTRs lost their grafts within 3 months after rejection (43%). None of the Control group pRTRs lost their graft during this period. At the time of rejection, eGFR was different between the Control and Study groups (27.0 ± 19.9 mL/min per m2 vs 40.0 ± 10.6 mL/min/1.73 m2, respectively; P < 0.05). Among Study group pRTRs with functioning allografts (n = 4), treatment resulted in an increase in eGFR from nadir levels (27.0 ± 19.9 vs 55.6 ± 18.3 mL/min/1.73 m2, P < 0.05). In the Study group, complications included neutropenia, BK and EBV viremia, and infusion-related hypotension and hypertension. Summary: (a) Graft loss in Study group while remaining high (43%) was lower than that reported in the published pediatric literature. (b) Our protocol was associated with improvement in eGFR in all surviving pRTRs within the Study group. (c) No life-threatening complications or malignancy were reported during the observation period.

AB - Introduction: PCAR is a rare form of ACR that may compromise renal allografts. This review evaluates the outcomes of a protocol used to treat PCAR (Study group), and compares these outcomes with a matched cohort with ACR (Control group). Methods: A retrospective analysis of 138 of pRTRs who underwent renal allograft biopsies between January 2008 and November 2016. Results: Seven biopsies revealed in situ hybridization of EBER-negative PCAR (5%). Three Study group pRTRs lost their grafts within 3 months after rejection (43%). None of the Control group pRTRs lost their graft during this period. At the time of rejection, eGFR was different between the Control and Study groups (27.0 ± 19.9 mL/min per m2 vs 40.0 ± 10.6 mL/min/1.73 m2, respectively; P < 0.05). Among Study group pRTRs with functioning allografts (n = 4), treatment resulted in an increase in eGFR from nadir levels (27.0 ± 19.9 vs 55.6 ± 18.3 mL/min/1.73 m2, P < 0.05). In the Study group, complications included neutropenia, BK and EBV viremia, and infusion-related hypotension and hypertension. Summary: (a) Graft loss in Study group while remaining high (43%) was lower than that reported in the published pediatric literature. (b) Our protocol was associated with improvement in eGFR in all surviving pRTRs within the Study group. (c) No life-threatening complications or malignancy were reported during the observation period.

KW - pediatric renal transplant recipients

KW - plasma cell rich acute rejection

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