Chronic kidney disease

Chronic kidney disease is a major health concern in this country afflicting more than eight million Americans. When kidney function declines to a certain level, patients have end-stage renal disease and require either dialysis or transplantation to sustain their life. Currently, more than 340,000 people are on dialysis; with 106,000 new patients added in 2006. Over 140,000 people are living with a functioning kidney transplant.
The prevalence of these two populations of end-stage renal disease has tripled in the last 20 years. Medicare expenditure for end-stage renal disease is expected to exceed $28 billion in 2010. In 2006, 10,659 patients received a deceased donor kidney transplant and 6,432 patients received a live donor kidney transplant. However, more than 74,000 people are currently on the national waiting list for a deceased donor kidney transplant. Despite the increasing numbers of kidney transplants performed each year, the waiting list continues to grow. Twelve people die each day awaiting a kidney transplant.

Anti-human leukocyte antibodies

Children who developed anti-human leukocyte antibodies against their donor’s kidney; known as de novo donor-specific antibodies (dnDSA); after kidney transplant more likely to experience carotid intima-media thickening (CIMT) than those without these antibodies; according to preliminary research presented May 7, 2019, during the 10th Congress of the International Pediatric Transplant Association.

dnDSA plays a key role in the survival of a transplanted organ. While human leukocyte antibodies protect the body from infection, dnDSA is a major cause of allograft loss. CIMT measures the thickness of the intima and media layers of the carotid artery and can serve as an early marker of cardiac disease. Emerging evidence links dnDSA with increasing risk of accelerated systemic hardening of the arteries (arteriosclerosis); major cardiac events in adult organ transplant recipients.

The kidney transplants

However, this phenomenon has not been studied extensively in children who receive kidney transplants. To investigate the issue, Children’s researchers enrolled 38 children who had received kidney transplants and matched them by race with 20 healthy children. They measured their CIMT, blood pressure and lipids 18 months and 30 months after their kidney transplants. They monitored dnDSA at 18 months and 30 months after a kidney transplant.
The transplant recipients’ median age was 11.3 years, 50 % African American, and 21% developed dnDSA. “In this prospective controlled cohort study, they compared outcomes among patients who developed dnDSA with transplant recipients who did not develop dnDSA and with race-matched healthy kids. Children with dnDSA after transplant had 5.5% thicker CIMT than those who did not have dnDSA. Being African American was also independently associated with a 9.2% increase in CIMT among transplant recipients.” Additional studies will need to be conducted in larger numbers of pediatric kidney transplant recipients to verify this preliminary association.