De Novo Allergy and Immune-Mediated Disorders Following Solid-Organ Transplantation-Prevalence, Natural History, and Risk Factors.

Abstract

OBJECTIVES:

To describe the prevalence, natural course, outcome, and risk factors of post-transplant de novo allergy and autoimmunity.

STUDY DESIGN:

A cross-sectional, cohort study of all children (<18 years) who underwent a solid-organ transplantation, between 2000 and 2012, in a single transplant center, with a follow-up period of 6 months or more post-transplant and without history of allergy or immune-mediated disorder pretransplant.

RESULTS:

A total of 626 eligible patients were screened, and 273 patients (160 males; 59%) met the inclusion criteria; this included 111 liver, 103 heart, 52 kidney, and 7 multivisceral recipients. Patients were followed for a median period of 3.6 years. A total of 92 (34%) patients (42 males, 46%) developed allergy or autoimmune disease after transplantation, with a high prevalence among liver (41%), heart (40%), and multivisceral (57%) transplant recipients compared with kidney recipients (4%; P < .001). Post-transplant allergies included eczema (n = 44), food allergy (22), eosinophilic gastrointestinal disease (11), and asthma (28). Autoimmunity occurred in 18 (6.6%) patients, presenting mainly as autoimmune cytopenia (n = 10). In a multivariate analysis, female sex, young age at transplantation, family history of allergy, Epstein-Barr virus infection, and elevated eosinophil count >6 months post-transplantation were associated with an increased risk for allergy or autoimmunity. Two patients (0.7%) died from autoimmune hemolytic anemia and hemophagocytic lymphohistiocytosis, and 52 episodes of post-transplant allergy, autoimmunity, and immune-mediated disorders (37%) did not improve over time.

CONCLUSIONS:

Allergy and autoimmunity are common in pediatric liver, heart, and multivisceral transplant recipients and pose a significant health burden. Further studies are required to clarify the mechanisms behind this post-transplant immune dysregulation.

• Authors: Nufar Marcus, Achiya Z Amir, Eyal Grunebaum, Anne Dipchand, Diane Hebert, Vicky L Ng, Thomas Walters, Yaron Avitzur
• Journal: The Journal of pediatrics (J Pediatr) Vol. 196 Pg. 154-160.e2 (05 2018) ISSN: 1097-6833 [Electronic] United States
• PMID: 29395171 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Autoimmune Diseases (etiology)
• Child
• Child, Preschool
• Cross-Sectional Studies
• Epstein-Barr Virus Infections (complications)
• Female
• Follow-Up Studies
• Food Hypersensitivity (complications)
• Humans
• Hypersensitivity (etiology)
• Immune System
• Immune System Diseases (etiology)
• Infant
• Male
• Organ Transplantation (adverse effects)
• Postoperative Complications
• Prevalence
• Retrospective Studies
• Risk Factors
• Treatment Outcome