Marcus N, et al. - The prevalence, natural course, outcome, and risk factors of post-transplant de novo allergy and autoimmunity were described in this study. In pediatric liver, heart, and multivisceral transplant recipients, allergy and autoimmunity were common and posed a significant health burden.

Methods

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

Results

• The researchers screened 626 eligible patients.
• A total of 273 patients (160 males; 59%) met the inclusion criteria (111 liver, 103 heart, 52 kidney, and 7 multivisceral recipients).
• In this study, patients were followed for a median period of 3.6 years.
• After transplantation, 92 (34%) patients (42 males, 46%) developed allergy or autoimmune disease, with a high prevalence among liver (41%), heart (40%), and multivisceral (57%) transplant recipients compared with kidney recipients (4%; P < .001).
• Eczema (n = 44), food allergy (22), eosinophilic gastrointestinal disease (11), and asthma (28) were identified as post-transplant allergies.
• In 18 (6.6%) patients, autoimmunity occurred, presenting mainly as autoimmune cytopenia (n = 10).
• In a multivariate analysis, factors associated with an increased risk for allergy or autoimmunity were female sex, young age at transplantation, family history of allergy, Epstein-Barr virus infection, and elevated eosinophil count >6 months post-transplantation.
• Death of 2 patients (0.7%) was reported from autoimmune hemolytic anemia and hemophagocytic lymphohistiocytosis.
• Fifty-two episodes of post-transplant allergy, autoimmunity, and immune-mediated disorders (37%) did not improve over time.