ESPN 51th Annual Meeting

ESPN 2018


 
EPITOPIC INCOMPATIBILITY IN PEDIATRIC RENAL TRANSPLANTATION (R-Tx)
ANDREEA LIANA RACHISAN 1 VALERIE DUBOIS 2 BRUNO RANCHIN 3 ANNE LAURE SELLIER LECLERC 3 AURELIA BERTHOLET THOMAS 3 PIERRE COCHAT 3 JUSTINE BACCHETTA 3

1- DEPARTMENT OF PEDIATRICS II, UNIVERSITY OF MEDICINE & PHARMACY “IULIU HATIEGANU“, CLUJ-NAPOCA, ROMANIA
2- HISTOCOMPATIBILITY LABORATORY, EFS LYON, FRANCE
3- DEPARTMENT OF PEDIATRIC NEPHROLOGY, REFERENCE CENTER FOR RARE RENAL DISEASES, HOSPICES CIVILS DE LYON, LYON, FRANCE
 
Introduction:

 Epitopic incompatibility appears to be a better predictor of the de novo appearance of donor-specific antibodies (dnDSA) post-Tx than HLA antigen matching in adults. We evaluated the HLA Matchmaker® software (version 2.1) in our pediatric cohort to predict the appearance of dnDSA post-Tx. 

Material and methods:

 We included 70 pediatric patients (26 girls, 10 living donors, mean age 11.2±3.9 years) after a first R-Tx (January 2010 - August 2016), without prior immunization, having complete HLA typing (A, B, C, DRB1 and DQB1) and dnDSA follow-up for at least one year.

Results:

The mean of HLA and epitope incompatibilities were 4.7±1.3 and 15.5±6.1, respectively, with a correlation coefficient r2 between these two variables of  0.34 (p<0.001). The epitopic load was 12.8±5.0 in living donors vs 15.9±6.2 in deceased donors (p=NS), 12.6±6.1 in pre-emptive R-Tx (n = 14) vs 16.3±5.9 for non-preemptive R-Tx (p=0.04). Seven patients (10%) developed dnDSA during the 3.5±1.2 years post-Tx. The epitope load was 13.7±5.5 for those who developed dnDSA vs 15.7±6.1 for the others (p=NS). 

 

Conclusions:

 In our single-center series of pediatric R-Tx with good HLA matching and lower epitopic load than previously published series, eplet incompatibilities do not predict the development of dnDSA. The question of the HLA matching requirement and the daily interest of the HLA Matchmaker® software to help select the grafts remains open.