Immunosuppression Therapy in Kidney Transplantation

Aiyegbusi, Oshorenua; McGregor, E.; McManus, Siobhan K.; Stevens, Kate

doi:10.1016/j.ucl.2021.12.010

Cited by 8 publications

(5 citation statements)

References 90 publications

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“…Calcineurin inhibitors (CNIs) have significantly improved short-term outcomes for patient and graft survival in kidney transplantation, however long-term use can cause irreversible nephrotoxicity and graft loss. 1 Additional adverse effects such as neurotoxicity, alopecia, and new-onset diabetes after transplant may impair tolerability and quality of life, 2 which may require immunosuppression modification. Belatacept (BELA) has emerged as an effective immunosuppression agent with a favorable side effect profile.…”

Section: Introductionmentioning

confidence: 99%

Overall Infectious Complications Related to Belatacept Conversion in Comparison to Tacrolimus in Kidney Transplant Recipients

et al. 2022

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Introduction: Belatacept has demonstrated effectiveness for preventing rejection in kidney transplant and has a favorable side effect profile. Studies assessing long-term infectious complications with belatacept compared to tacrolimus are limited. Project Aims: The purpose of this program evaluation was to determine the proportion of patients who developed an infection when converted to belatacept compared to those on tacrolimus. Design: In this retrospective evaluation, kidney transplant recipients receiving belatacept were matched 1:1 to those receiving tacrolimus, based on transplant date, age, induction immunosuppression, and cytomegalovirus risk. Data collection was initiated in tacrolimus patients on the date of belatacept conversion in the belatacept-matched patients. Data were extracted until study conclusion, death, or discontinuation of belatacept. Patients were stratified into 3 groups based on time of conversion posttransplant, which included early, late, and very late conversion. The primary outcome was the proportion of patients with an infection in belatacept compared to tacrolimus. Outcome data were calculated using chi-square, Fisher's exact test, student's t-test or Mann-Whitney U test where appropriate. Results: A total of 328 matched patients were included in the analysis. More patients on belatacept developed an infection compared to tacrolimus (42.7% vs 29.9%, P = 0.02), which was primarily driven by pneumonia (6.1% vs 0.5%; P = 0.01). Higher incidences of infections were identified in those converted within 6 months from transplant. Conclusions: Belatacept was associated with a higher proportion of patients with infections compared to tacrolimus, particularly in those converted within 6 months from time of transplant.

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Section: Introductionmentioning

confidence: 99%

Overall Infectious Complications Related to Belatacept Conversion in Comparison to Tacrolimus in Kidney Transplant Recipients

et al. 2022

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“…Early diagnosis and treatment of suspected relapse may account for these results. Furthermore, the increased use of tacrolimus instead of cyclosporine as maintenance therapy [25], which reduces the incidence of acute rejection by providing stronger immunosuppression, also reduced the risk of relapse. Indeed, only one patient in this series, i.e., the one with the longest transplant vintage, was treated with cyclosporine.…”

Section: Discussionmentioning

confidence: 99%

Kidney transplantation in patients with ANCA-associated vasculitis is associated with a high incidence of post-transplant cancer

Perna,

Campise,

Alfieri

et al. 2024

J Nephrol

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Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare disease with limited data on outcomes after transplantation. Methods In this single-center retrospective cohort study, we describe the outcomes of kidney transplant patients with AAV transplanted at our institute from February 2006 to January 2022. Results We identified 9 patients among 1026 with a pre-transplant diagnosis of AAV; all patients had received previous treatment with cyclophosphamide. Maintenance immunosuppression after transplantation was tacrolimus-based in 89% of the patients. At the end of a mean follow-up of 132 ± 61.1 months after transplantation, only one case of extrarenal vasculitis relapse was observed. The relapse rate was 0.01 per patient per year, which is comparable to that reported in the literature. However, seven patients were diagnosed with cancer after a mean follow-up of 81.4 months after transplantation; six had skin cancer and three had renal cell carcinoma (RCC) of the native kidneys (cumulative incidence of 78%). One patient died from metastatic squamous cell carcinoma. Conclusion In this study, we found a noticeable decrease in disease relapse (1 relapse in the present cohort vs 7 relapses in 19 patients in the previous cohort) in kidney transplant patients with AAV compared with previous data from our group (December 1987–January 2006). Conversely, we found a high incidence of post-transplant cancer. This result could be attributed to reduced immunosurveillance due to immunosuppression therapy before and after transplantation. Therefore, constant cancer early diagnosis and prevention is mandatory during the post-transplant follow-up of AAV patients. Graphical abstract

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“…All drugs currently used for maintenance therapy in kidney transplantation have direct or indirect effects on lymphocyte proliferation. Therefore, potential interference from these therapies cannot be excluded, as well as eventual changes to the dose or therapeutic regimen during the analyzed period 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Contudo, é preciso considerar as terapias imunossupressoras dos pacientes transplantados como fatores de confusão. Todas as drogas atualmente usadas para a terapia de manutenção no transplante renal apresentam efeitos diretos ou indiretos sobre a proliferação linfocitária, de modo que não se pode afastar potenciais interferências dessas terapias e eventuais modificações de dose ou esquema terapêutico durante o período analisado 14 .…”

Section: Discussionunclassified

Analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory biomarkers in chronic kidney disease: impact of parathyroidectomy

Teng,

Duque,

Crispilho

et al. 2024

Braz. J. Nephrol.

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Introduction: Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients. Methods: A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed. Results: There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count. Conclusion: N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice.

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Immunosuppression Therapy in Kidney Transplantation

Cited by 8 publications

References 90 publications

Overall Infectious Complications Related to Belatacept Conversion in Comparison to Tacrolimus in Kidney Transplant Recipients

Overall Infectious Complications Related to Belatacept Conversion in Comparison to Tacrolimus in Kidney Transplant Recipients

Kidney transplantation in patients with ANCA-associated vasculitis is associated with a high incidence of post-transplant cancer

Analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory biomarkers in chronic kidney disease: impact of parathyroidectomy

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