Posttransplant Soluble B-Cell Activating Factor Kinetics in Pediatric Recipients of First Kidney Allograft. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Comoli, Patrizia; Quartuccio, Giuseppe; Cioni, Michela; Parodi, Angelica; Nocera, Arcangelo; Basso, Sabrina; Fontana, Iris; Magnasco, Alberto; Sioli, Viviana; Guido, Ilaria; Klersy, Catherine; Zecca, Marco; Cardillo, Massimo; Ghiggeri, Gian Marco; Ginevri, Fabrizio
• Is Part Of: Transplantation. Volume 99:Issue 1(2015)
• Publication Date: 2015-01
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000276
• Languages: English
• ISSNs: 0041-1337

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>Development of de novo donor-specific antibodies (dnDSA) is associated with late or chronic antibody-mediated rejection (CAMR) and poor graft outcome in low-risk kidney transplant recipients. High-level soluble B-cell activating factor (sBAFF) was observed in kidney recipients at higher risk of developing dnDSA.</p> </sec> <sec> <title>Methods</title> <p>We longitudinally analyzed sBAFF levels in 81 consecutive primary pediatric kidney recipients monitored for de novo human leukocyte antigen (HLA) antibody (Ab) occurrence to gain insight into the events conditioning B-cell activation posttransplant and to analyze the usefulness of paired DSA-sBAFF monitoring in this clinical setting.</p> </sec> <sec> <title>Results</title> <p>At a median follow-up of 65 months, 23 patients (28%) developed dnDSA, with 13 of 23 developing CAMR. Irrespective of HLA Ab status, sBAFF levels progressively increased in all patients in the first posttransplant year, thereafter reaching a plateau. sBAFF levels were influenced by the degree of HLA class I antigen match and donor age. Despite higher levels of sBAFF in HLA Ab-positive patients (median and 95% confidence interval sBAFF in DSA+non-DSA patients: 568, 534–608 pg/mL vs. 502, 422–548 pg/mL in Ab-negative patients; <italic>P</italic><0.05), we found that sBAFF monitoring could not predict DSA development by a time to event longitudinal analysis. Moreover, sBAFF kinetics up to CAMR onset could not anticipate CAMR development in the DSA cohort.</p> </sec> <sec> <title>Conclusion</title> <p>Our findings provide evidence of early posttransplant B-cell activation even in unsensitized recipients of first kidney allograft. The significance of this activation, likely induced by exposition to the allograft, is yet unclear.</p> </sec> </abstract>