Tacrolimus-de-novo-donor-specific-hla-antibody-allograft-rejection-pediatric-kt
The recommended course of treatment for children with stage 5 chronic kidney disease is kidney transplantation (KTx). Short-term transplant results have greatly improved because to powerful immunosuppressants including tacrolimus (Tac), a calcineurin inhibitor (CNI), and mycophenolate mofetil (MMF), as well as anti-infective prophylaxis. Though rare, long-term transplant survival does exist.
De novo donor-specific antibodies (dnDSA) directed against human leukocyte antigens (HLA), in particular, play a significant role in this setting as alloantigen-dependent components. Pediatric kidney transplant patients' tacrolimus (Tac) intraindividual variability (TacIPV) is only imperfectly understood.
This article investigated the impact of TacIPV on de novo donor-specific HLA antibodies (dnDSA) development and allograft rejection in Caucasian pediatric recipients of a living or deceased donor kidney with low immunological risk.
It was found that high TacIPV is associated with an increased risk of dnDSA development and rejection episodes > year 1 posttransplant even in patients with low immunological risk profile. Therefore, in patients with high TacIPV, potential causes should be addressed, and if not resolved, changes in immunosuppressive therapy should be considered.