Increase of circulating IgA levels after pediatric liver transplantation. A retrospective cohort study

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.