The Natural History of Clinical Operational Tolerance After Kidney Transplantation Through Twenty-Seven Cases

Autor: M. Ranbant, Andries J. Hoitsma, Evangeline Pillebout, Angelo Testa, J. P. Soulillou, C. Guillot-Guegen, Richard Danger, Claire Legendre, A. Devys, Annaïck Pallier, Le De Sagazan, F. Villemain, M.-C. Moal, C. Noël, L. Braun, Gwenaelle Roussey, Aline Garnier, Frederike J. Bemelman, S. Le Roux, Karine Renaudin, Anne Cesbron, Yohann Foucher, Jean Harb, Sophie Brouard, Giuseppe Orlando, C. Cantarell, Magali Giral, Jean-François Subra, H. Jambon, Joanna Ashton-Chess
Přispěvatelé: AII - Amsterdam institute for Infection and Immunity, Nephrology, Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Biologie Neurovasculaire et Mitochondriale Intégrée (BNMI), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université d'Angers (UA)
Rok vydání: 2012
Předmět:
Zdroj: American Journal of Transplantation, 12, 12, pp. 3296-3307
American Journal of Transplantation, 12, 3296-3307
American journal of transplantation, 12(12), 3296-3307. Wiley-Blackwell
American Journal of Transplantation
American Journal of Transplantation, 2012, 12 (12), pp.3296-3307. ⟨10.1111/j.1600-6143.2012.04249.x⟩
ISSN: 1600-6135
1600-6143
DOI: 10.1111/j.1600-6143.2012.04249.x⟩
Popis: Item does not contain fulltext We report here on a European cohort of 27 kidney transplant recipients displaying operational tolerance, compared to two cohorts of matched kidney transplant recipients under immunosuppression and patients who stopped immunosuppressive drugs and presented with rejection. We report that a lower proportion of operationally tolerant patients received induction therapy (52% without induction therapy vs. 78.3%[p = 0.0455] and 96.7%[p = 0.0001], respectively), a difference likely due to the higher proportion (18.5%) of HLA matched recipients in the tolerant cohort. These patients were also significantly older at the time of transplantation (p = 0.0211) and immunosuppression withdrawal (p = 0.0002) than recipients who rejected their graft after weaning. Finally, these patients were at lower risk of infectious disease. Among the 27 patients defined as operationally tolerant at the time of inclusion, 19 still display stable graft function (mean 9 +/- 4 years after transplantation) whereas 30% presented slow deterioration of graft function. Six of these patients tested positive for pre-graft anti-HLA antibodies. Biopsy histology studies revealed an active immunologically driven mechanism for half of them, associated with DSA in the absence of C4d. This study suggests that operational tolerance can persist as a robust phenomenon, although eventual graft loss does occur in some patients, particularly in the setting of donor-specific alloantibody.
Databáze: OpenAIRE
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