Introduction: Antibody mediated rejection (ABMR) is a major complication compromising allograft survival after kidney transplantation (KT). The main purpose of our study was to identify factors associated to ABMR in pediatric kidney recipients and to assess its impact on graft and patient’s survival.
Method: We conducted a descriptive retrospective study in the Pediatric and Internal Medicine “A” departments of Charles Nicolle’s university hospital of Tunis, including all kidney transplantations in recipients aged 20yearsold or less over a period of 34 years. A multivariate analysis was performed to assess potential associated factors to biopsy proven ABMR. A survival analysis was conducted in order to assess its impact on graft and patient’s survival.
Results: A total of 97 patients were recorded. Mean recipients’ age was 15.4 ±3.2 years old with a sex-ratio M/F of 1.4. Biopsy proven ABMR was identified in 22 (22,7%) patients. ABMR was classified as active in 50% (n=11), chronic active in 31.8% (n=7) and chronic in 4.5% (n=1) of cases. Negative C4d ABMR was identified in 2 patients (4,5%).
Factors associated to ABMR on multivariate analysis were: hyperuricemia (OR = 4), post- transplant anti HLA-DQ antibodies (OR = 44), recipient’s hypertension requiring the use of at least two antihypertensive drugs (OR = 10.3) and the use of Ciclosporin as a first line anticalcineurin drug (OR = 4). Cox regression identified ABMR as an independent factor compromising allograft survival (HR=5.5).
Conclusion: Allograft rejection remains a serious complication following KT. Multiple associated factors were identified in our study. Management of treatable factors and a closer monitoring of high-risk patients will improve KT outcomes in pediatric recipients.