Tapering immunosuppression in recipients of living donor kidney transplants

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
Willem WeimarBarbara J van der Mast

Abstract

We have previously suggested that the in vitro donor-specific cytotoxic T-lymphocyte precursor (CTLp) assay can guide us to identify patients in which the immunosuppressive load can be tapered. In a clinical trial we had observed that a low (<10/10(6) PBMC) frequency of these CTLp was predictive for an uneventful rejection-free clinical course in patients that were converted from calcineurin inhibitors to mycophenolate mofetil or azathiopine. In the present prospective study in 81 stable kidney transplant recipients, already converted from calcineurin inhibitors, we measured CTLp frequencies and reduced the immunosuppressive load on a routine basis when CTLp were <10/10(6) PBMC. Donor-specific cytotoxicity could not be measured in 50/81 patients, while their reactivity against third-party lymphocytes was not impaired. These 50 patients were tapered in their immunosuppression. Only in one patient, who had stopped all his medication, was a rejection episode diagnosed. We conclude that in patients with a low donor-specific CTLp frequency it is safe to reduce the immunosuppression.

Citations

Jun 29, 2005·Transplant Immunology·Benjamin A Bradley
Oct 6, 2009·Transplant Immunology·Dinh Quang TruongRaymond Reding
Nov 26, 2008·Clinics in Laboratory Medicine·Valeriya Zarkhin, Minnie M Sarwal
Sep 4, 2008·Transplant International : Official Journal of the European Society for Organ Transplantation·Joanna Ashton-ChessSophie Brouard
Nov 20, 2008·Pediatric Transplantation·Udeme D EkongMaurice R G O'Gorman
Aug 8, 2006·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·I Esmé DijkeCarla C Baan
Apr 28, 2017·Clinical and Experimental Immunology·A MassartD Abramowicz
Feb 18, 2010·Expert Review of Clinical Immunology·Paolo Cravedi, Roslyn B Mannon
Jun 14, 2006·Transplantation·Kenneth A Newell, Christian P Larsen
May 16, 2009·Current Opinion in Organ Transplantation·Miranda Dierselhuis, Els Goulmy
Aug 25, 2006·Journal of the American Society of Nephrology : JASN·Nader NajafianKenneth A Newell

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