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

Annick Massart, Annaïck Pallier, Julio Pascual, Ondrej Viklicky, Klemens Budde, Goce Spasovski, Marian Klinger, Mehmet Sukru Sever, Søren Schwartz Sørensen, Karine Hadaya, Rainer Oberbauer, Christopher Dudley, Johan W De Fijter, Alexander Yussim, Marc Hazzan, Thomas Wekerle, David Berglund, Consuelo De Biase, María José Pérez-Sáez, Anja MühlfeldGiuseppe Orlando, Katia Clemente, Quirino Lai, Francesco Pisani, Aljosa Kandus, Marije Baas, Frederike Bemelman, Jadranka Buturovic Ponikvar, Hakim Mazouz, Piero Stratta, Jean-François Subra, Florence Villemain, Andries J Hoitsma, Laura Braun, Maria Carmen Cantarell, Hulya Colak, Aisling Courtney, Giovanni Maria Frasca, Matthew Howse, Maarten Naesens, Tomas Reischig, Daniel Serón, Nurhan Seyahi, Cem Tugmen, Angel Alonso Hernandez, Luboslav Beňa, Luigi Biancone, Vania Cuna, Carmen Díaz-Corte, Alexandre Dufay, André Gaasbeek, Arnaud Garnier, Philippe Gatault, Miguel Angel Gentil Govantes, François Glowacki, Oliver Gross, Bruno Hurault de Ligny, Uyen Huynh-Do, Bénédicte Janbon, Luis Antonio Jiménez Del Cerro, Frieder Keller, Gaetano La Manna, Ricardo Lauzurica, Hervé Le Monies De Sagazan, Friedrich Thaiss, Christophe Legendre, Séverine Martin, Marie-Christine Moal, Christian Noël, Evangeline Pillebout, Gian Benedetto Piredda, Ana Ramírez Puga, Wladyslaw Sulowicz, Serhan Tuglular, Michaela Prokopova, Mélanie Chesneau, Alain Le Moine, Pierrick Guérif, Jean-Paul Soulillou, Marc Abramowicz, Magali Giral, Judith Racapé, Umberto Maggiore, Sophie Brouard, Daniel Abramowicz

31 Citationer (Scopus)

Abstract

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.

OriginalsprogEngelsk
TidsskriftNephrology, Dialysis, Transplantation
Vol/bind31
Udgave nummer6
Sider (fra-til)1002-13
Antal sider12
ISSN0931-0509
DOI
StatusUdgivet - 24 jun. 2016

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