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

• Published in: The Journal of pediatrics Vol. 196; pp. 154 - 160.e2
• Main Authors: Marcus, Nufar, Amir, Achiya Z., Grunebaum, Eyal, Dipchand, Anne, Hebert, Diane, Ng, Vicky L., Walters, Thomas, Avitzur, Yaron
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2018
• Subjects: allergy; autoimmunity; children; heart; immune disorder; intestine; kidney; liver; multivisceral; solid organ; transplantation; PTAA; intestine; liver; HLH; allergy; IBD; heart; kidney; multivisceral; autoimmunity; children; solid organ; transplantation; EBV; PTLD; SOT; immune disorder; EGID; CNI
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2017.11.026

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