Abstracts

2013 Blood Purification  
It continues to be a challenge to identify and monitor for medication nonadherence (MNA). There is no accepted, reliable and patient-specific method for assessing MNA in pediatric renal transplant recipients. Immunosuppressive MNA and the presence of donor specific anti-HLA antibodies (DSA) are each independently associated with allograft loss. We sought to determine whether DSA could be used as a marker for MNA. Methods: We studied 125 pediatric patients who were transplanted between 9/2006
more » ... 12/2011. Patients were followed un til they turned 21 years old or until allograft loss, defined as return to dialysis. DSA were performed at 6 months, 1 yr, and 2 yrs after transplant and for clinical indication. DSA were measured using the single antigen Luminex assay, with positive DSA defined as MFI >1000. MNA was based on statistical drug monitoring (% coefficient of variation) and patient self report, using a standardized interviewing technique that assessed MNA over a 4 week period. Results: 92 (74%) patients were adherent and 33 (26%) were not. Nonadherent patients were at significantly higher risk of developing DSA compared to adherent patients (p = 0.001); 24 (22%) of the adherent patients had DSA, while 22 (67%) of the nonadherent patients had DSA. There were 7 total graft loss; all were nonadherent. DSA were noted in 6 out of these 7 patients. DSA tended to be from HLA class II (p < 0.001). Of the 46 patients with DSA, 33 (72%) had DSA from HLA class II only, 3 (7%) from HLA class I only, and 10 (21%) from both classes. Of the 22 patients with DSA and MNA, 13 (59%) had DSA from HLA class II only, 1 (5%) from HLA class I only, and 8 (36%) from both classes. Of the 6 patients that were nonadherent with DSA and graft loss, 4 had DSA from HLA class II only, none from HLA class I only, and 4 from both classes. Conclusions: MNA patients had a significantly higher risk of developing DSA compared to adherent patients. Regardless of MNA status, the predominant DSA were against class II antigens. The predominance of Class II antibodies likely contribute to rejection and graft loss in patients with MNA, confirming previous studies. This study suggests that the presence of DSA may potentially be a marker for MNA. Future studies are needed to determine whether serial monitoring of DSA as a marker of MNA can lead to earlier detection of rejection, allowing for earlier intervention and enhanced graft survival.
doi:10.1159/000345306 fatcat:pcagbizxybhzjdaj76src2nagy