Format

Send to

Choose Destination
J Pediatr. 2018 May;196:154-160.e2. doi: 10.1016/j.jpeds.2017.11.026. Epub 2018 Feb 1.

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

Author information

1
Division of Immunology and Allergy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kipper Institute for Allergy and Immunology, Schneider Children's Medical Center of Israel, University of Tel-Aviv, Tel-Aviv, Israel.
2
Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; The Pediatric Gastroenterology, Hepatology & Nutrition Clinic, Tel-Aviv Medical Center, University of Tel-Aviv, Tel-Aviv, Israel.
3
Division of Immunology and Allergy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
4
Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
5
Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
6
Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
7
Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: yaron.avitzur@sickkids.ca.

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.

KEYWORDS:

allergy; autoimmunity; children; heart; immune disorder; intestine; kidney; liver; multivisceral; solid organ; transplantation

PMID:
29395171
DOI:
10.1016/j.jpeds.2017.11.026
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center