Posttransplant Soluble XXXX Kinetics in Pediatric Recipients of First Kidney Allograft.

@entity1 @entity1531 @entity102 @entity8410
BACKGROUND: Development of de novo donor-specific antibodies (dnDSA) is associated with late or @entity102 ( @entity102 ) and poor graft outcome in low-risk kidney transplant recipients. High-level soluble @entity8410 (sBAFF) was observed in kidney recipients at higher risk of developing dnDSA. METHODS: We longitudinally analyzed sBAFF levels in 81 consecutive primary pediatric kidney recipients monitored for de novo human leukocyte antigen (HLA) antibody (Ab) occurrence to gain insight into the events conditioning B-cell activation posttransplant and to analyze the usefulness of paired DSA-sBAFF monitoring in this clinical setting. RESULTS: At a median follow-up of 65 months, 23 @entity1 (28%) developed dnDSA, with 13 of 23 developing @entity102 . Irrespective of HLA Ab status, sBAFF levels progressively increased in all @entity1 in the first posttransplant year, thereafter reaching a plateau. sBAFF levels were influenced by the degree of @entity1531 match and donor age. Despite higher levels of sBAFF in HLA Ab-positive @entity1 (median and 95% confidence interval sBAFF in DSA+non-DSA @entity1 : 568, 534-608 pg/mL vs. 502, 422-548 pg/mL in Ab-negative @entity1 ; P<0.05), we found that sBAFF monitoring could not predict DSA development by a time to event longitudinal analysis. Moreover, sBAFF kinetics up to @entity102 onset could not anticipate @entity102 development in the DSA cohort. CONCLUSION: Our findings provide evidence of early posttransplant B-cell activation even in unsensitized recipients of first kidney allograft. The significance of this activation, likely induced by exposition to the allograft, is yet unclear.
