76 research outputs found
Immunosuppression minimization in kidney transplantation
Kidney transplantation is considered the best
treatment for patients with end-stage renal failure, even in
extreme age-groups. Immunosuppression for “life” is,
however, mandatory. This chronic, somewhat unselected,
inhibition of the host immune system may induce
complications, such as cancer and infection, that could
counterbalance the benefits achieved by the transplant. In
addition, all currently used immunosuppressors have
several side-effects, impeding their long-term use.
Consequently, drug associations are frequently tested by
different centres according to their own practices, resulting
in different survival and tolerance profiles. Corticosteroids
and calcineurin inhibitors are the cornerstones of current
immunosuppressive regimens. However, they are also the
main culprits of adverse-events and side-effects
encountered after transplantation. Lowering the doses of
each drug, or even eliminating them from the
immunosuppressive menu, has been evaluated by many
groups over the last two decades. This review summarises a
huge number of studies dealing with corticosteroid and
calcineurin inhibitor minimization, including withdrawal
and avoidance trials. It is hard today to propose any
practical guidelines on such a controversial topic. Good
results are achieved by some groups and bad results by
others. The lack of long-term follow-up in randomized
studies contributes to this debate. Nevertheless, it seems
possible and safe to avoid corticosteroids and/or calcineurin
inhibitors in many patients. The application of protocol
biopsies as well as new immunological tests to determine
the degree of immunosuppression will certainly help
transplant physicians to provide more personalized
treatment strategies
Efficacy of Anti-IL-2 Receptor Antibodies Compared to no Induction and to Antilymphocyte Antibodies in Renal Transplantation
Two-year incidence of malignancy in sirolimus-treated renal transplant recipients: results from five multicenter studies*
Daclizumab prevents acute rejection and improves patient survival post transplantation: 1 year pooled analysis
Clonal expansion of lymphocytes bearing the gamma delta T-cell receptor in a patient with large granular lymphocyte disorder
Clonal expansion of lymphocytes bearing the gamma delta T-cell receptor in a patient with large granular lymphocyte disorder
Posttransplant Donor-Specific Anti-HLA Antibodies Negatively Impact Pancreas Transplantation Outcome
During a 9-year follow-up, 167 consecutive pancreas
transplant recipients (152 simultaneous pancreaskidney
[SPK]) were followed for the detection of posttransplant
anti-HLA antibodies. Forty patients (24%)
developed anti-HLA antibodies, 26 (65%) had donorspecific
antibodies (DSA; 61% anticlass 2) and 14 (35%)
non-DSA (78.6% anticlass 1). More rejection episodes
were observed in patients with positive anti-HLA antibodies
than in patients without antibodies (42.5% vs.
11%; p = 0.001), with the highest incidence observed
in DSA patients (53.8%). More severe rejections (according
to rescue therapy) were observed in DSA patients
compared to non-DSA (p < 0.05) or to negative
patients (p <0.001). Contrastingwith the kidney, pancreas
graft survival did not differ between patients with
or without anti-HLA antibodies. On the contrary, pancreas
and kidney survivals were significantly lower in
DSA positive patients (75% for both organs) as compared
to non-DSA positive patients (100% for pancreas
and 92% for kidney) or to HLA-negative patients (91%
for pancreas and 89% for kidney). Nontechnical pancreas
and kidney graft failureswere significantly higher
in positive than in negative anti-HLA patients (32.5%
vs. 11%; p < 0.01). Occurrence of posttransplant DSA
was an independent risk factor for both pancreas and
kidney survival (HR 3.2; p = 0.039) in diabetic transplant
recipients
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