Increase of circulating IgA levels after pediatric liver transplantation. A retrospective cohort study - 29/11/23

Doi : 10.1016/j.liver.2023.100194

Guillermo Costaguta ^a,^{^{1
Address: 1340 Chem. Regent, H3P 2K7. Montreal, QC, Canada.},}^{^{2
All authors made substantial contribution to the conception of the work, acquisition, analysis, and interpretation of the data, and drafting of the work. They revised it critically and gave the final approval for the last version of the manuscript. They are also accountable for all aspects of the work.},}^⁎ , Stéphanie Dion ^a,^b,^{^{2
All authors made substantial contribution to the conception of the work, acquisition, analysis, and interpretation of the data, and drafting of the work. They revised it critically and gave the final approval for the last version of the manuscript. They are also accountable for all aspects of the work.}}, Marie-Ève Chartier ^a,^c,^{^{2
All authors made substantial contribution to the conception of the work, acquisition, analysis, and interpretation of the data, and drafting of the work. They revised it critically and gave the final approval for the last version of the manuscript. They are also accountable for all aspects of the work.}}, Massimiliano Paganelli ^a,^c,^{^{2
All authors made substantial contribution to the conception of the work, acquisition, analysis, and interpretation of the data, and drafting of the work. They revised it critically and gave the final approval for the last version of the manuscript. They are also accountable for all aspects of the work.}}, Fernando Álvarez ^a,^c,^{^{2
All authors made substantial contribution to the conception of the work, acquisition, analysis, and interpretation of the data, and drafting of the work. They revised it critically and gave the final approval for the last version of the manuscript. They are also accountable for all aspects of the work.}}
^a Pediatric Gastroenterology, Hepatology and Nutrition department. CHU Sainte-Justine, University of Montreal, 3175 Chem. de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5, Canada
^b Nurse coordinator of the liver transplant department at CHU Sainte-Justine, University of Montreal, 3175 Ch. de la Côte-Sainte-Catherine, H3T 1C5, Montreal, QC, Canada
^c Pediatric Department of the Montreal University. 2900 Blvd. Edouard Montpetit (H3T 1J4), Montreal, QC, Canada

^⁎Corresponding author at: Gastroenterology, hepatology, and nutrition, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, H3P 1C5, Montréal, QC, Canada.Gastroenterology, hepatology, and nutritionCHU Sainte-Justine3175 Chemin de la Côte-Sainte-CatherineMontréalQCH3P 1C5Canada

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Highlights

•	Some pediatric liver recipients develop abnormally high levels of circulating IgA.
•	This group of patients seem to have a higher incidence of allergic manifestations (skin or alimentary).
•	Patients with elevated circulating IgA have a faster decline in renal function, when compared to those with normal levels.

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Abstract

Introduction

Elevation of IgA levels has not been studied in the post-transplant setting. We present a series of pediatric liver recipients with elevated IgA during follow-up and relate them to changes in renal function.

Materials and methods

We conducted a retrospective study of patients that underwent a liver transplantation at our institution between 2002 and 2022 and excluded those with less than two years of follow-up.

Results

Eighty-five patients were identified, 56% with elevated IgA. They were younger at transplantation (p 0.006) and had persistent splenomegaly (p 0.02). They were also more likely to have allergies (p < 0.001). Furthermore, 93% of those with eczema (p < 0.001) and 90% of those with food allergy had elevated IgA (p < 0.001). Glomerular filtration rate decreased over time in both groups, although it wasn't significant. However, the rate was different between the two (p < 0.001), especially after the sixth year of follow-up (p 0.02). Furthermore, of the 14 patients with values below 90 mL/min/1.73 m², 12 belonged to the group with elevated IgA (p 0.02).

Conclusion

We believe that intestinal permeability secondary to portal hypertension combined with tacrolimus exposure may facilitate the development of immune reactions increasing IgA levels, causing its deposition in kidneys, and leading to renal injury over time.

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Keywords : IgA, Pediatric liver transplantation, Glomerular filtration rate, Allergy, Tacrolimus

Abbreviations : APC, IgA, IgM, IgG, CMV, CsA, EBV, GFR, ULN, TLR

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Allergic manifestations ()

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Article 100194- février 2024 Retour au numéro

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Increase of circulating IgA levels after pediatric liver transplantation. A retrospective cohort study - 29/11/23

Highlights

Abstract

Introduction

Materials and methods

Results

Conclusion

Plan

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