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The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients
A. Massart, A. Pallier, J. Pascual, O. Viklicky, K. Budde, G. Spasovski, M. Klinger, MS. Sever, SS. Sørensen, K. Hadaya, R. Oberbauer, C. Dudley, JW. De Fijter, A. Yussim, M. Hazzan, T. Wekerle, D. Berglund, C. De Biase, MJ. Pérez-Sáez, A....
Language English Country England, Great Britain
Document type Journal Article, Multicenter Study
NLK
Free Medical Journals
from 1996 to 1 year ago
Open Access Digital Library
from 1996-01-01
PubMed
26763669
DOI
10.1093/ndt/gfv437
Knihovny.cz E-resources
- MeSH
- Adult MeSH
- Transplantation, Homologous MeSH
- Immune Tolerance immunology MeSH
- Immunosuppression Therapy methods MeSH
- Incidence MeSH
- Humans MeSH
- Survival Rate trends MeSH
- Graft Survival immunology MeSH
- Transplant Recipients * MeSH
- Surveys and Questionnaires MeSH
- Graft Rejection epidemiology immunology prevention & control MeSH
- Kidney Transplantation * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe epidemiology MeSH
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.
Department of Medical Sciences University of Turin Turin Italy
Department of Nephrology and Renal Transplantation University Hospitals Leuven Leuven Belgium
Department of Nephrology and Rheumatology University Medicine Göttingen Göttingen Germany
Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Nephrology University Hospital Aachen Aachen Germany
Department of Nephrology University Hospital Krakow Krakow Poland
General Surgery Tepecik Training and Research Hospital Yenisehir Izmir Turkey
Institute of Transplantation Urology and Nephrology Nantes University Hospital Nantes France
Internal Medicine 1 Nephrology University Hospital Ulm Ulm Germany
Internal Medicine Nephrology Istanbul School of Medicine Istanbul Turkey
Joint Research Unit 1064 French Institute of Health and Medical Research Nantes France
Kidney Diseases Kidney Transplant Az Osp G Brotzu Cagliari Italy
Kidney Diseases Radboudumc Nijmegen Nijmegen The Netherlands
Medical Genetics Department and IRIBHM ULB Brussels Belgium
Nefrologia Dialisi e Trapianto di rene AO Torrette Umberto 1 Ancona Italy
Néphrologie Médecine Interne Hypertension Pédiatrique Hôpital des Enfants Toulouse France
Nephrology and Transplantation Geneva University Hospitals Geneva Switzerland
Nephrology and Transplantation Medicine Wrocław Poland
Nephrology Charité Campus Mitte Berlin Germany
Nephrology Department CHU Lille Lille France
Nephrology Department University Hospital of Lille Lille France
Nephrology Hospital del Mar Barcelona Spain
Nephrology Hospital Germans Trias i Pujol Badalona Spain
Nephrology Hospital Universitari Val d'Hebron Barcelona Spain
Nephrology Hospital Universitario Central de Asturias Oviedo Spain
Nephrology Istanbul University Cerrahpasa Medical Faculty Istanbul Turkey
Nephrology Marmara School of Medicine Hastanesi Istanbul Turkey
Nephrology P Rigshospitalet Copenhagen Denmark
Nephrology Tepecik Training and Research Hospital Izmir Turkey
Nephrology Transplantation Royal Liverpool University Hospital Liverpool UK
Nephrology Unit Hôpital Saint Louis Paris France
Nephrology Ward Department of Internal Medicine University Hospital Pilsen Pilsen Czech Republic
Nierziekten LUMC Leiden The Netherlands
Regional Nephrology Unit Belfast City Hospital Belfast UK
Renal Transplant Unit Department of Nephrology Academic Medical Center Amsterdam The Netherlands
Renal Unit CUB Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
Richard Bright Renal Centre Southmead Hospital North Bristol NHS Trust Bristol UK
Service d'hémodialyse et de Néphrologie Hôpital Robert Boulin Libourne France
Service de Néphrologie CHRU Avenue Georges Clémenceau Caen France
Service de Néphrologie CHRU de Brest Brest France
Service de Néphrologie Dialyse Transplantation CHU Angers Angers France
Service de Néphrologie Unité de Transplantation Rénale et Pancréatique CHU Sud Amiens France
Service Néphrologie Hôpital Victor Provo Roubaix France
Service Néphrologie Immunoclinique CHRU Hôpital Bretonneau Tours France
Servicio de Nefrología Hospital General Universitario de Alicante Alicante Spain
Servicio de Nefrología Hospital Universitario A Coruña Spain
Transplant Centre University Hospital Louis Pasteur Kosice Kosice Slovakia
Transplantation rénale CHU Grenoble Grenoble France
U O C Trapianti D'Organo L'Aquila Italy
Université Paris Descartes et Hôpital Necker Paris France
University Department of Nephrology Skopje Macedonia
University Hospital Hamburg Eppendorf Hamburg Germany
Wake Forest School of Medicine Department of Surgery Section of Transplantation Winston Salem NC USA
References provided by Crossref.org
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- $a The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients / $c A. Massart, A. Pallier, J. Pascual, O. Viklicky, K. Budde, G. Spasovski, M. Klinger, MS. Sever, SS. Sørensen, K. Hadaya, R. Oberbauer, C. Dudley, JW. De Fijter, A. Yussim, M. Hazzan, T. Wekerle, D. Berglund, C. De Biase, MJ. Pérez-Sáez, A. Mühlfeld, G. Orlando, K. Clemente, Q. Lai, F. Pisani, A. Kandus, M. Baas, F. Bemelman, JB. Ponikvar, H. Mazouz, P. Stratta, JF. Subra, F. Villemain, A. Hoitsma, L. Braun, MC. Cantarell, H. Colak, A. Courtney, GM. Frasca, M. Howse, M. Naesens, T. Reischig, D. Serón, N. Seyahi, C. Tugmen, A. Alonso Hernandez, L. Beňa, L. Biancone, V. Cuna, C. Díaz-Corte, A. Dufay, A. Gaasbeek, A. Garnier, P. Gatault, MA. Gentil Govantes, F. Glowacki, O. Gross, B. Hurault de Ligny, U. Huynh-Do, B. Janbon, LA. Jiménez Del Cerro, F. Keller, G. La Manna, R. Lauzurica, H. Le Monies De Sagazan, F. Thaiss, C. Legendre, S. Martin, MC. Moal, C. Noël, E. Pillebout, GB. Piredda, AR. Puga, W. Sulowicz, S. Tuglular, M. Prokopova, M. Chesneau, A. Le Moine, P. Guérif, JP. Soulillou, M. Abramowicz, M. Giral, J. Racapé, U. Maggiore, S. Brouard, D. Abramowicz,
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