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2 results on '"immunological low-risk"'

1. Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients.

Author

Michielsen, Laura A, Zuilen, Arjan D van, Verhaar, Marianne C, Wisse, Bram W, Kamburova, Elena G, Joosten, Irma, Allebes, Wil A, van der Meer, Arnold, Baas, Marije C, Spierings, Eric, Hack, Cornelis E, Reekum, Franka E van, Bots, Michiel L, Drop, Adriaan C A D, Plaisier, Loes, Seelen, Marc A J, Sanders, Jan-Stephan F, Hepkema, Bouke G, Lambeck, Annechien J, and Bungener, Laura B

Subjects
*KIDNEY transplantation
Abstract

Background Few studies have evaluated the effect of different immunosuppressive strategies on long-term kidney transplant outcomes. Moreover, as they were usually based on historical data, it was not possible to account for the presence of pretransplant donor-specific human-leukocyte antigen antibodies (DSA), a currently recognized risk marker for impaired graft survival. The aim of this study was to evaluate to what extent frequently used initial immunosuppressive therapies increase graft survival in immunological low-risk patients. Methods We performed an analysis on the PROCARE cohort, a Dutch multicentre study including all transplantations performed in the Netherlands between 1995 and 2005 with available pretransplant serum (n  = 4724). All sera were assessed for the presence of DSA by a luminex single-antigen bead assay. Patients with a previous kidney transplantation, pretransplant DSA or receiving induction therapy were excluded from the analysis. Results Three regimes were used in over 200 patients: cyclosporine (CsA)/prednisolone (Pred) (n  = 542), CsA/mycophenolate mofetil (MMF)/Pred (n  = 857) and tacrolimus (TAC)/MMF/Pred (n  = 811). Covariate-adjusted analysis revealed no significant differences in 10-year death-censored graft survival between patients on TAC/MMF/Pred therapy (79%) compared with patients on CsA/MMF/Pred (82%, P = 0.88) or CsA/Pred (79%, P = 0.21). However, 1-year rejection-free survival censored for death and failure unrelated to rejection was significantly higher for TAC/MMF/Pred (81%) when compared with CsA/MMF/Pred (67%, P <   0.0001) and CsA/Pred (64%, P <   0.0001). Conclusion These results suggest that in immunological low-risk patients excellent long-term kidney graft survival can be achieved irrespective of the type of initial immunosuppressive therapy (CsA or TAC; with or without MMF), despite differences in 1-year rejection-free survival. [ABSTRACT FROM AUTHOR]

Published
2019
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2. Effect of initial immunosuppression on long-term kidney transplant outcome in immunological low-risk patients

Author

Elizabeth M. van Duijnhoven, Arnold van der Meer, Sebastiaan Heidt, Irma Joosten, Lotte Wieten, Marianne C. Verhaar, Marije C. Baas, Mariëlle A C J Gelens, Johan W. de Fijter, Neelke C. van der Weerd, Shaikh A. Nurmohamed, Laura A. Michielsen, Elena G. Kamburova, Marcel G.J. Tilanus, Caroline Roozendaal, N M Lardy, Maarten H. L. Christiaans, Michiel G. H. Betjes, Wil A. Allebes, Paul J M van der Boog, Marc A. Seelen, Karlijn A M I van der Pant, Frans H.J. Claas, Frederike J. Bemelman, Loes Plaisier, Michiel L. Bots, Eric Spierings, Bram W. Wisse, Annechien J. A. Lambeck, Andries J. Hoitsma, Laura Bungener, Frans J. van Ittersum, Christien Voorter, Franka E. van Reekum, Adriaan C.A.D. Drop, Henderikus G. Otten, Luuk B. Hilbrands, Arjan D. van Zuilen, Bouke G. Hepkema, Cornelis E. Hack, Ineke J. M. ten Berge, Jan-Stephan F. Sanders, Dave L. Roelen, Wendy Swelsen, Nephrology, AII - Inflammatory diseases, APH - Aging & Later Life, Oral and Maxillofacial Surgery, Erasmus MC other, Internal Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Diabetes & metabolism, Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Interne Geneeskunde, MUMC+: DA TI Staf (9), MUMC+: DA Transplantatie Immunologie (5), MUMC+: DA TI Laboratorium (9), MUMC+: MA Nefrologie (9), and RS: NUTRIM - R3 - Respiratory & Age-related Health

Subjects
Graft Rejection, Male, Nephrology, medicine.medical_treatment, TACROLIMUS, 030232 urology & nephrology, graft survival, 030230 surgery, Kidney, Gastroenterology, DISEASE, Cohort Studies, 0302 clinical medicine, HLA Antigens, INFECTION, Medicine, FAILURE, Kidney transplantation, Netherlands, immunosuppression, RENAL-TRANSPLANTATION, Immunosuppression, Middle Aged, medicine.anatomical_structure, REJECTION, Cohort, Prednisolone, Female, MINIMIZATION, Inflammatory diseases Radboud Institute for Molecular Life Sciences [Radboudumc 5], Immunosuppressive Agents, medicine.drug, Adult, medicine.medical_specialty, NEPHROPATHY, kidney transplantation, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Disease-Free Survival, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Internal medicine, Journal Article, Humans, Immunosuppression Therapy, GRAFT-SURVIVAL, Transplantation, business.industry, Mycophenolic Acid, anti-HLA antibodies, medicine.disease, Tacrolimus, CYCLOSPORINE, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, immunological low-risk
Abstract

Background Few studies have evaluated the effect of different immunosuppressive strategies on long-term kidney transplant outcomes. Moreover, as they were usually based on historical data, it was not possible to account for the presence of pretransplant donor-specific human-leukocyte antigen antibodies (DSA), a currently recognized risk marker for impaired graft survival. The aim of this study was to evaluate to what extent frequently used initial immunosuppressive therapies increase graft survival in immunological low-risk patients. Methods We performed an analysis on the PROCARE cohort, a Dutch multicentre study including all transplantations performed in the Netherlands between 1995 and 2005 with available pretransplant serum (n = 4724). All sera were assessed for the presence of DSA by a luminex single-antigen bead assay. Patients with a previous kidney transplantation, pretransplant DSA or receiving induction therapy were excluded from the analysis. Results Three regimes were used in over 200 patients: cyclosporine (CsA)/prednisolone (Pred) (n = 542), CsA/mycophenolate mofetil (MMF)/Pred (n = 857) and tacrolimus (TAC)/MMF/Pred (n = 811). Covariate-adjusted analysis revealed no significant differences in 10-year death-censored graft survival between patients on TAC/MMF/Pred therapy (79%) compared with patients on CsA/MMF/Pred (82%, P = 0.88) or CsA/Pred (79%, P = 0.21). However, 1-year rejection-free survival censored for death and failure unrelated to rejection was significantly higher for TAC/MMF/Pred (81%) when compared with CsA/MMF/Pred (67%, P Conclusion These results suggest that in immunological low-risk patients excellent long-term kidney graft survival can be achieved irrespective of the type of initial immunosuppressive therapy (CsA or TAC; with or without MMF), despite differences in 1-year rejection-free survival.

Published
2019

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