ESPN 51th Annual Meeting

ESPN 2018


 
Antibody-mediated renal allograft rejection after the transition period from pediatric to adult care
SIFAKI LOUKIA 1 CACHAT FRANCOIS 1 VENETZ JEAN-PIERRE 1 PILON NATHALIE 1 PASCUAL MANUEL 1 CHEHADE HASSIB 1

1- LAUSANNE UNIVERSITY HOSPITAL
 
Introduction:

Non-adherence to immunosuppressive treatment after kidney transplantation can result in the production of de novo donor-specific HLA antibodies (DSA) and allograft loss. Moreover, because poor adherence to therapy is a well-known concern in adolescents and young adults, the gradual transition of care from the pediatric to the adult transplant clinic is critical.

Material and methods:

We have compared in a retrospective manner, the evolution of two groups of ten adolescents with kidney transplants, who received a cross-match negative renal graft, with conventional immunosuppression and who were transferred from pediatric to adult clinic care during the period 2007-2017. In the first group (n=4), the patients were transferred to the adult transplant clinic between 2007-2011, without any structured transitional period. In the second group (n=6), patients were transferred to adult care between 2012 and 2017, in the context of a structured multidisciplinary “transition care clinic”. 

 

Results:

From 2007 to 2017, a total of 21 children received a kidney transplant. Ten of them (47%) were transferred from pediatric to adult clinic care. The four adolescents in the first group, transferred without “any structured transitional period”, displayed poor adherence to immunosuppressive therapy, and they developed de novo DSA. Patient survival after transition in this group was 100%, however all of these patients lost their grafts due to chronic antibody-mediated rejection. The six adolescents transferred in the context of a formal “transition care clinic”, with a structured and progressive transition program, had a good outcome, without transplant loss or de novo DSA, with a median follow-up of 22 months. Patients and graft survival were 100% in this second group.

Conclusions:

The implementation of a structured multidisciplinary transition kidney transplant clinic improved adherence and appears to be a key factor to improve outcomes in that setting.