Relationship Among Viremia/Viral Infection, Alloimmunity, and Nutritional Parameters in the First Year After Pediatric Kidney Transplantation

Overview

Journal Am J Transplant

Publisher Elsevier

Specialty General Surgery

Date 2016 Dec 19

PMID 27989013

Citations 15

Authors

R Ettenger

H Chin

K Kesler

N Bridges

P Grimm

E F Reed

M Sarwal

R Sibley

E Tsai

B Warshaw

A D Kirk

Affiliations

Soon will be listed here.

Abstract

The Immune Development in Pediatric Transplantation (IMPACT) study was conducted to evaluate relationships among alloimmunity, protective immunity, immune development, physical parameters, and clinical outcome in children undergoing kidney transplantation. We prospectively evaluated biopsy-proven acute rejection (BPAR), de novo donor-specific antibody (dnDSA) formation, viremia, viral infection, T cell immunophenotyping, and body mass index (BMI)/weight Z scores in the first year posttransplantation in 106 pediatric kidney transplant recipients. Outcomes were excellent with no deaths and 98% graft survival. Rejection and dnDSAs occurred in 24% and 22%, respectively. Pretransplant cytomegalovirus (CMV) and Epstein-Barr virus (EBV) serologies and subsequent viremia were unrelated to BPAR or dnDSA. Viremia occurred in 73% of children (EBV, 34%; CMV, 23%; BMK viremia, 23%; and JC virus, 21%). Memory lymphocyte phenotype at baseline was not predictive of alloimmune complications. Patients who developed viral infection had lower weight (-2.1) (p = 0.028) and BMI (-1.2) (p = 0.048) Z scores at transplantation. The weight difference persisted to 12 months compared with patients without infection (p = 0.038). These data indicate that there is a high prevalence of viral disease after pediatric kidney transplantation, and underweight status at transplantation appears to be a risk factor for subsequent viral infection. The occurrence of viremia/viral infection is not associated with alloimmune events.

Citing Articles

New Immunosuppressants in Pediatric Kidney Transplantation: What's in the Pipeline for Kids?.

Tonshoff B, Patry C, Fichtner A, Hocker B, Bohmig G Pediatr Transplant. 2024; 29(1):e70008.

PMID: 39711054 PMC: 11664202. DOI: 10.1111/petr.70008.

High-affinity chimeric antigen receptor signaling induces an inflammatory program in human regulatory T cells.

Cochrane R, Robino R, Granger B, Allen E, Vaena S, Romeo M Mol Ther Methods Clin Dev. 2024; 32(4):101385.

PMID: 39687729 PMC: 11647616. DOI: 10.1016/j.omtm.2024.101385.

Development and validation of a simple clinical nomogram for predicting infectious diseases in pediatric kidney transplantation recipients: a retrospective study.

Li L, Fu M, Wang C, Pei Y, Chen L, Rong L PeerJ. 2024; 12:e18454.

PMID: 39583098 PMC: 11586046. DOI: 10.7717/peerj.18454.

Combinatorial genetic engineering strategy for immune protection of stem cell-derived beta cells by chimeric antigen receptor regulatory T cells.

Barra J, Robino R, Castro-Gutierrez R, Proia J, Russ H, Ferreira L Cell Rep. 2024; 43(11):114994.

PMID: 39561045 PMC: 11659569. DOI: 10.1016/j.celrep.2024.114994.

Incidence, risk factors, management strategies, and outcomes of antibody-mediated rejection in pediatric kidney transplant recipients-a multicenter analysis of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN).

Fichtner A, Gauche L, Susal C, Tran T, Waldherr R, Krupka K Pediatr Nephrol. 2024; 40(2):491-503.

PMID: 39283519 PMC: 11666708. DOI: 10.1007/s00467-024-06487-2.

References

Mengelle C, Kamar N, Mansuy J, Sandres-Saune K, Legrand-Abravanel F, Miedouge M . JC virus DNA in the peripheral blood of renal transplant patients: a 1-year prospective follow-up in France. J Med Virol. 2010; 83(1):132-6. DOI: 10.1002/jmv.21951. View

Jameson S, Masopust D . Diversity in T cell memory: an embarrassment of riches. Immunity. 2010; 31(6):859-71. PMC: 2957815. DOI: 10.1016/j.immuni.2009.11.007. View

Weikert B, Blumberg E . Viral infection after renal transplantation: surveillance and management. Clin J Am Soc Nephrol. 2008; 3 Suppl 2:S76-86. PMC: 3152274. DOI: 10.2215/CJN.02900707. View

Dowd J, Palermo T, Brite J, McDade T, Aiello A . Seroprevalence of Epstein-Barr virus infection in U.S. children ages 6-19, 2003-2010. PLoS One. 2013; 8(5):e64921. PMC: 3661547. DOI: 10.1371/journal.pone.0064921. View

Athavale D, Worthington J, Webb N, Roberts D, Martin S, Shenoy M . Pediatric kidney recipients may benefit from monitoring for donor-specific antibodies. Pediatr Transplant. 2014; 18(3):258-65. DOI: 10.1111/petr.12247. View

Smith J, Martz K, Blydt-Hansen T . Pediatric kidney transplant practice patterns and outcome benchmarks, 1987-2010: a report of the North American Pediatric Renal Trials and Collaborative Studies. Pediatr Transplant. 2013; 17(2):149-57. DOI: 10.1111/petr.12034. View

Muscheites J, Wigger M, Drueckler E, Klaassen I, John U, Wygoda S . Estimated one-yr glomerular filtration rate is an excellent predictor of long-term graft survival in pediatric first kidney transplants. Pediatr Transplant. 2008; 13(3):365-70. DOI: 10.1111/j.1399-3046.2008.00976.x. View

Kim J, Balasubramanian R, Michaelides G, Wittenhagen P, Sebire N, Mamode N . The clinical spectrum of de novo donor-specific antibodies in pediatric renal transplant recipients. Am J Transplant. 2014; 14(10):2350-8. DOI: 10.1111/ajt.12859. View

Matas A, Smith J, Skeans M, Thompson B, Gustafson S, Stewart D . OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant. 2015; 15 Suppl 2:1-34. DOI: 10.1111/ajt.13195. View

10.

Arthurs S, Eid A, Pedersen R, Kremers W, Cosio F, Patel R . Delayed-onset primary cytomegalovirus disease and the risk of allograft failure and mortality after kidney transplantation. Clin Infect Dis. 2008; 46(6):840-6. DOI: 10.1086/528718. View

11.

Smith C, Khanna R . Immune regulation of human herpesviruses and its implications for human transplantation. Am J Transplant. 2013; 13 Suppl 3:9-23. DOI: 10.1111/ajt.12005. View

12.

Blumberg J, Gritsch H, Reed E, Cecka J, Lipshutz G, Danovitch G . Kidney paired donation in the presence of donor-specific antibodies. Kidney Int. 2013; 84(5):1009-16. PMC: 3913053. DOI: 10.1038/ki.2013.206. View

13.

Bialasiewicz S, Hart G, Oliver K, Agnihotri S, Koralnik I, Viscidi R . A Difficult Decision: Atypical JC Polyomavirus Encephalopathy in a Kidney Transplant Recipient. Transplantation. 2016; 101(6):1461-1467. PMC: 5201453. DOI: 10.1097/TP.0000000000001275. View

14.

Eftimov T, Enchev Y, Tsekov I, Simeonov P, Kalvatchev Z, Encheva E . JC polyomavirus in the aetiology and pathophysiology of glial tumours. Neurosurg Rev. 2015; 39(1):47-53. DOI: 10.1007/s10143-015-0676-5. View

15.

Razonable R, Paya C . Infections and allograft rejection - intertwined complications of organ transplantation. Swiss Med Wkly. 2005; 135(39-40):571-3. DOI: 10.4414/smw.2005.10984. View

16.

Al Khasawneh E, Gupta S, Tuli S, Shahlaee A, Garrett T, Schechtman K . Stable pediatric kidney transplant recipients run higher urine indoleamine 2, 3 dioxygenase (IDO) levels than healthy children. Pediatr Transplant. 2014; 18(3):254-7. PMC: 3981946. DOI: 10.1111/petr.12232. View

17.

Ginevri F, Nocera A, Comoli P, Innocente A, Cioni M, Parodi A . Posttransplant de novo donor-specific hla antibodies identify pediatric kidney recipients at risk for late antibody-mediated rejection. Am J Transplant. 2012; 12(12):3355-62. DOI: 10.1111/j.1600-6143.2012.04251.x. View

18.

Abraham A, Mak R, Mitsnefes M, White C, Moxey-Mims M, Warady B . Protein energy wasting in children with chronic kidney disease. Pediatr Nephrol. 2014; 29(7):1231-8. PMC: 4414488. DOI: 10.1007/s00467-014-2768-9. View

19.

Khan H, Mubarak M, Aziz T, Ahmed E, Fazal Akhter S, Kazi J . Prevalence and risk factors for early chronic allograft nephropathy in a live related renal transplant program. J Nephropathol. 2014; 3(2):69-79. PMC: 3999587. DOI: 10.12860/jnp.2014.15. View

20.

Stern M, Hirsch H, Cusini A, Van Delden C, Manuel O, Meylan P . Cytomegalovirus serology and replication remain associated with solid organ graft rejection and graft loss in the era of prophylactic treatment. Transplantation. 2014; 98(9):1013-8. DOI: 10.1097/TP.0000000000000160. View