Pediatric nephrologist Olga Charnaya discusses her latest research regarding pediatric kidney transplantation.
Hello, my name is Doctor Olga Chanaa and I'm a assistant professor of pediatrics in the division of pediatric nephrology. Here at the Johns Hopkins Children's Center. Today, I'd like to talk to you about my research in pediatric kidney transplantation. As we know the biggest challenge in transplantation is overcoming the immunological barrier or the recipient immune system recognizing the transplant as foreign material. This is done by the immune uh recipient immune system through presentation of peptides and antigen through the major histocompatibility complexes or the human leukocyte antigen system or HL A system. The HL A system is really an individual fingerprint of every person's immune system. In the past, immunological matching and transplant has really been prioritized to optimize outcomes. But we found that it was really disadvantaged, racial and ethnic minorities. And so the uno's allocation system has de prioritized immunological matching um to really ensure equitable access to transplant and to the to this life saving therapy. While we have equitable access, we do have more patients developing antibodies to their specific donor. And this is specifically and especially problematic in Children who require multiple transplants in their lifetime. And the more mismatch between the donor immune system and the recipient immune system. In the first transplant, the more likely the patients develop antibodies and the more difficult uh and unlikely becomes to find a suitable donor for their 2nd and 3rd transplant. My research is focusing on uh using novel HL a tissue typing ma uh technologies to identify specific high risk mismatches so that we can make changes in the allocation system to optimize outcomes without jeopardizing equity. Specifically, I'm building the first multi center pediatric cohort that will have full high resolution tissue typing of both recipients and donors as well as very granular clinical data points that we can use for a really deep dive analysis to identify risk factors. This is a benefit over other national registries which really don't have this granular clinical data. We'll be able to look at levels of immunosuppression. We'll look at markers of non adherence and special and uh viral exposures, all of which can impact the clinical course of pediatric kidney transplant recipients. Using this novel cohort will be identifying specific high risk mismatches uh in the HL A uh system that predispose to poor outcomes. Once we've identified those high risk mismatches, we'll be modeling changes to us organ allocation policy to instead of just try to find the best match to really only avoid the high risk mismatches. The goal is to be able to improve the immunological outcomes for Children without jeopardizing equity and ensuring pediatric priority on the kid deceased donor kidney transplant list. I'd like to really recognize that this research wouldn't be possible without the collaborative effort of multiple kidney transplant centers across the United States. And especially the support that I've received here at the Johns Hopkins Children's Center to develop my research and the education training and support that I've gotten from the Johns Hopkins School of Public Health.
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