The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients.

Autor:	Massart A; Renal Unit, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium Medical Genetics Department, ULB, Brussels, Belgium., Pallier A; Joint Research Unit 1064, French Institute of Health and Medical Research, Nantes, France., Pascual J; Nephrology, Hospital del Mar, Barcelona, Spain., Viklicky O; Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic., Budde K; Nephrology, Charité Campus Mitte, Berlin, Germany., Spasovski G; University Department of Nephrology, Skopje, Macedonia., Klinger M; Nephrology and Transplantation Medicine, Wrocław, Poland., Sever MS; Internal Medicine, Nephrology, Istanbul School of Medicine, Istanbul, Turkey., Sørensen SS; Nephrology P, Rigshospitalet, Copenhagen, Denmark., Hadaya K; Nephrology and Transplantation, Geneva University Hospitals, Geneva, Switzerland., Oberbauer R; Department of Medicine III-Nephrology, Hypertension and Renal Transplantation, Krankenhaus Elisabethinen Linz, Linz, Austria., Dudley C; Richard Bright Renal Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK., De Fijter JW; Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands., Yussim A; Department of Transplantation, Rabin Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israël., Hazzan M; Nephrology Department, CHU Lille, Lille, France., Wekerle T; Section of Transplantation Immunology, Department of Surgery, Medical University of Vienna, Vienna, Austria., Berglund D; Department of Immunology, Genetics and Pathology, Section of Clinical Immunology, Uppsala University, Sweden., De Biase C; UOS Trapianti Rene Pancreas, Centro Trapianti di Parma, Az. Ospedaliero-Universitaria di Parma, Parma, Italy., Pérez-Sáez MJ; Nephrology, Hospital del Mar, Barcelona, Spain., Mühlfeld A; Department of Nephrology, University Hospital Aachen, Aachen, Germany., Orlando G; Wake Forest School of Medicine, Department of Surgery, Section of Transplantation, Winston-Salem, NC, USA., Clemente K; U.O.C. Trapianti D'Organo, L'Aquila, Italy., Lai Q; U.O.C. Trapianti D'Organo, L'Aquila, Italy., Pisani F; U.O.C. Trapianti D'Organo, L'Aquila, Italy., Kandus A; Department of Nephrology, Renal Transplantation Centre Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia., Baas M; Kidney Diseases, Radboudumc Nijmegen, Nijmegen, The Netherlands., Bemelman F; Renal Transplant Unit, Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands., Ponikvar JB; Department of Nephrology, Renal Transplantation Centre Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia., Mazouz H; Service de Néphrologie, Unité de Transplantation Rénale et Pancréatique, CHU Sud, Amiens, France., Stratta P; Department of Translational Medicine, Amedeo Avogadro University, AOU Maggiore della Carità di Novara, Novara, Italy., Subra JF; Service de Néphrologie-Dialyse-Transplantation, CHU Angers, Angers, France., Villemain F; Service de Néphrologie-Dialyse-Transplantation, CHU Angers, Angers, France., Hoitsma A; Kidney Diseases, Radboudumc Nijmegen, Nijmegen, The Netherlands., Braun L; Hôpital de jour de Néphrologie, service de Néphrologie et Transplantation Rénale, Nouvel hôpital Civil, CHU de Strasbourg, Strasbourg, France., Cantarell MC; Nephrology, Hospital Universitari Val d'Hebron, Barcelona, Spain., Colak H; Nephrology, Tepecik Training and Research Hospital, Izmir, Turkey., Courtney A; Regional Nephrology Unit, Belfast City Hospital, Belfast, UK., Frasca GM; Nefrologia, Dialisi e Trapianto di rene, AO Torrette Umberto I, Ancona, Italy., Howse M; Nephrology/Transplantation, Royal Liverpool University Hospital, Liverpool, UK., Naesens M; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium., Reischig T; Nephrology Ward, Department of Internal Medicine, University Hospital Pilsen, Pilsen, Czech Republic., Serón D; Nephrology, Hospital Universitari Val d'Hebron, Barcelona, Spain., Seyahi N; Nephrology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey., Tugmen C; General Surgery, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey., Alonso Hernandez A; Servicio de Nefrología, Hospital Universitario, A Coruña, Spain., Beňa L; Transplant Centre, University Hospital Louis Pasteur Kosice, Kosice, Slovakia., Biancone L; Department of Medical Sciences, University of Turin, Turin, Italy., Cuna V; Department of Specialized, Experimental and Diagnostic Medicine, Section of Nephrology, Nephrology Dialysis and Renal Transplant Unit, St Orsola University Hospital, University of Bologna, Bologna, Italy., Díaz-Corte C; Nephrology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain., Dufay A; Service Néphrologie, Hôpital Victor Provo, Roubaix, France., Gaasbeek A; Nierziekten, LUMC, Leiden, The Netherlands., Garnier A; Néphrologie - Médecine Interne - Hypertension Pédiatrique, Hôpital des Enfants, Toulouse, France., Gatault P; Service Néphrologie - Immunoclinique, CHRU, Hôpital Bretonneau, Tours, France., Gentil Govantes MA; Unidad de Gestión Clínica de Urología y Nefrología, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Glowacki F; Nephrology Department, University Hospital of Lille, Lille, France., Gross O; Department of Nephrology and Rheumatology, University Medicine Göttingen, Göttingen, Germany., Hurault de Ligny B; Service de Néphrologie, CHRU Avenue Georges Clémenceau, Caen, France., Huynh-Do U; Division of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, University Hospital Bern, Bern, Switzerland., Janbon B; Transplantation rénale, CHU Grenoble, Grenoble, France., Jiménez Del Cerro LA; Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, Spain., Keller F; Internal Medicine 1, Nephrology, University Hospital Ulm, Ulm, Germany., La Manna G; Department of Specialized, Experimental and Diagnostic Medicine, Section of Nephrology, Nephrology Dialysis and Renal Transplant Unit, St Orsola University Hospital, University of Bologna, Bologna, Italy., Lauzurica R; Nephrology, Hospital Germans Trias i Pujol, Badalona (Barcelona), Spain., Le Monies De Sagazan H; Service Néphrologie, Hôpital Victor Provo, Roubaix, France., Thaiss F; University Hospital Hamburg Eppendorf (UKE), Hamburg, Germany., Legendre C; Université Paris Descartes et Hôpital Necker, Paris, France., Martin S; Service d'hémodialyse et de Néphrologie, Hôpital Robert Boulin, Libourne, France., Moal MC; Service de Néphrologie, CHRU de Brest, Brest, France., Noël C; Nephrology Department, University Hospital of Lille, Lille, France., Pillebout E; Nephrology Unit, Hôpital Saint Louis, Paris, France., Piredda GB; Kidney Diseases, Kidney Transplant Az. Osp. G. Brotzu, Cagliari, Italy., Puga AR; Servicio de Nefrología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain., Sulowicz W; Department of Nephrology, University Hospital Krakow, Krakow, Poland., Tuglular S; Nephrology, Marmara School of Medicine Hastanesi, Istanbul, Turkey., Prokopova M; Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic., Chesneau M; Institute of Transplantation Urology and Nephrology, Nantes University Hospital, Nantes, France., Le Moine A; Renal Unit, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium., Guérif P; Institute of Transplantation Urology and Nephrology, Nantes University Hospital, Nantes, France., Soulillou JP; Joint Research Unit 1064, French Institute of Health and Medical Research, Nantes, France Institute of Transplantation Urology and Nephrology, Nantes University Hospital, Nantes, France Faculty of Medicine, Nantes University, Nantes, France., Abramowicz M; Medical Genetics Department and IRIBHM (Institut de Recherche Interdisciplinaire en Biologie Humaine et Moleculaire), ULB, Brussels, Belgium., Giral M; Joint Research Unit 1064, French Institute of Health and Medical Research, Nantes, France Institute of Transplantation Urology and Nephrology, Nantes University Hospital, Nantes, France Faculty of Medicine, Nantes University, Nantes, France., Racapé J; Research Center of Epidemiology, Biostatistics and Clinical Research, School of Public Health, ULB, Brussels, Belgium., Maggiore U; UOS Trapianti Rene Pancreas, Centro Trapianti di Parma, Az. Ospedaliero-Universitaria di Parma, Parma, Italy., Brouard S; Joint Research Unit 1064, French Institute of Health and Medical Research, Nantes, France Institute of Transplantation Urology and Nephrology, Nantes University Hospital, Nantes, France Faculty of Medicine, Nantes University, Nantes, France., Abramowicz D; Nephrology-Renal Transplantation Department, Universitair Ziekenhuis Antwerp, Antwerp, Belgium Université Libre de Bruxelles (ULB), Brussels, Belgium.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2016 Jun; Vol. 31 (6), pp. 1002-13. Date of Electronic Publication: 2016 Jan 12.
DOI:	10.1093/ndt/gfv437
Abstrakt:	Background: Kidney recipients maintaining a prolonged allograft survival in the absence of immunosuppressive drugs and without evidence of rejection are supposed to be exceptional. The ERA-EDTA-DESCARTES working group together with Nantes University launched a European-wide survey to identify new patients, describe them and estimate their frequency for the first time. Methods: Seventeen coordinators distributed a questionnaire in 256 transplant centres and 28 countries in order to report as many 'operationally tolerant' patients (TOL; defined as having a serum creatinine <1.7 mg/dL and proteinuria <1 g/day or g/g creatinine despite at least 1 year without any immunosuppressive drug) and 'almost tolerant' patients (minimally immunosuppressed patients (MIS) receiving low-dose steroids) as possible. We reported their number and the total number of kidney transplants performed at each centre to calculate their frequency. Results: One hundred and forty-seven questionnaires were returned and we identified 66 TOL (61 with complete data) and 34 MIS patients. Of the 61 TOL patients, 26 were previously described by the Nantes group and 35 new patients are presented here. Most of them were noncompliant patients. At data collection, 31/35 patients were alive and 22/31 still operationally tolerant. For the remaining 9/31, 2 were restarted on immunosuppressive drugs and 7 had rising creatinine of whom 3 resumed dialysis. Considering all patients, 10-year death-censored graft survival post-immunosuppression weaning reached 85% in TOL patients and 100% in MIS patients. With 218 913 kidney recipients surveyed, cumulative incidences of operational tolerance and almost tolerance were estimated at 3 and 1.5 per 10 000 kidney recipients, respectively. Conclusions: In kidney transplantation, operational tolerance and almost tolerance are infrequent findings associated with excellent long-term death-censored graft survival. (© The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
Databáze:	MEDLINE
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