SUN-317 INCIDENCE OF ACUTE REJECTION AND EARLY GRAFT LOSS AFTER KIDNEY TRANSPLANTATION IN A COHORT OF CHILDREN: A RETROSPECTIVE SINGLE CENTER STUDY

Abstract

Acute rejection and delayed graft function are a common complication post kidney transplant that lead to significant number of graft failure. Our objective is to highlight the incident of acute rejection & delayed graft function after Kidney transplant in children, and its impact on allograft function. Abbreviations: congenital anomalies of the kidney and urinary tract (CAKUT); Donor Specific Antibody (DSA); donor/recipient (D/R); Antiyhymocyte Globulin (ATG); focal segmental glomerulosclerosis (FSGS); Intravenous immunoglobulin (IVIG); Kidney Transplantation (KTx); Polymerase chain reaction (PCR); complement dependent cytotoxicity (CDC); Human leukocyte antigen (HLA); A review of children underwent Kidney transplant between 2012 and 2019. Baseline demographics, Immunosuppression agents, episodes of acute rejection, delayed graft function and graft loss were collected. All children received induction therapy as Antiyhymocyte Globulin (ATG) to all high risk patient include all deceased kidney transplant and basiliximab induction for low risk patients. Tacrolimus and mycophenolate mofetil is a maintenance immunosuppression that given for all patient post kidney transplant. Table 1Age at Transplantation (years)Mean 10 yearsGenderMale 20 (60%)Weight (mean in Kilograms)21 kgNumber of Deceased donor23 (69.6%)Number of life related donor5 (15%)Number of unrelated life donor5 (15%)Mean Human leukocyte antigen (HLA) mismatches4.5/6Number of patients with zero Human leukocyte antigen (HLA) Matching7 (21.1%)Positive complement dependent Cytotoxicity (CDC) cross match12% (4patients)Anti-thymocyte globulin as induction87% (29 from 33 patients)Risk of acute Rejection9% (3 patients)Risk of Delayed graft function15% (5 patients)Donor Specific antibody was positive24% ( 8 patients)Mean cold time7 hoursCauses of End stage kidney disease(CAKUT) Congenital anomalies of the kidney and urinary tract12(36%)(FSGS) Focal Segmental Glomerulosclerosis7 (21.1%)Congenital nephrotic syndrome3 (9%)Wilms’ tumor1 (3%)Nephronophthisis1 (3%)UNKNOWN6 (18%) Open table in a new tab A total of 33 children were transplanted. Three episode of acute rejection (9%), two of them were acute cellular rejection that treated successfully with pulse of steroid and one episode were acute antibody rejection was treated with Intravenous immunoglobulin (IVIG) and multiple session of plasmapheresis. Five episode of delayed graft function (15%), one episode with graft failure related to thrombosis, Current immunosuppressant provide effective protection from renal allograft rejection, however there use may complicated by serious side effect.