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

• Type of Material: Article
• Authors: Robert Ettenger, University of California Los Angeles; Hyunsook Chin, Rho Inc; Karen Kesler, Rho Inc; Nancy Bridges, National Institute of Health; Paul Grimm, Stanford University; Elaine F. Reed, University of California Los Angeles; Minnie Sarwal, University of California San Francisco; Richard Sibley, Stanford University; Eileen Tsai, University of California Los Angeles; Barry L Warshaw, Emory University; Allan D Kirk, Emory University
• Language: English
• Date: 2017-06-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.14169
• Title of Journal or Parent Work: American Journal of Transplantation
• ISSN: 1600-6135
• Volume: 17
• Issue: 6
• Start Page: 1549
• End Page: 1562
• Grant/Funding Information: This work was funded by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health: U01 AI077821.
• Keywords: T-CELLS; Surgery; BARR-VIRUS VIREMIA; Life Sciences & Biomedicine; GRAFT-REJECTION; ALLOGRAFT SURVIVAL; Transplantation; CHILDREN; RENAL-TRANSPLANTATION; RECIPIENTS; CYTOMEGALOVIRUS-INFECTION; DONOR-SPECIFIC ANTIBODIES; Science & Technology; SOLID-ORGAN TRANSPLANTATION
• Research Categories: Health Sciences, Pathology; Health Sciences, General

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.