Renal allograft outcomes following early corticosteroid withdrawal in Hispanic transplant recipients

Afaneh, Cheguevara; Cheng, Elaine; Aull, Meredith J.; Watkins, Anthony C.; Kim, Jim; Leeser, David B.; Kapur, Sandip

doi:10.1111/ctr.12218

Cited by 2 publications

(1 citation statement)

References 23 publications

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“…[1][2][3][4] In the past two decades, steroids withdrawal/avoidance has been used in the immediate or late post-transplant period to reduce complications associated to their use. [5][6][7][8][9][10][11][12][13][14][15][16] Despite some meta-analyses demonstrated a greater risk of AR with this intervention, nevertheless the majority shown mild or no-impact on renal function/allograft survival. [17][18][19][20] One of the clinical concern related to minimization/avoidance of immunosuppression is the development of donor-specific antibodies (DSA), during the post-transplant evolution.…”

Section: Introductionmentioning

confidence: 99%

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort

Andrade‐Sierra

Cueto-Manzano

Rojas–Campos

et al. 2021

Int J Immunopathol Pharmacol

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Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%; P < 0.05) and class II (17% vs 4%, P = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93–34.5, P = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I ( P = 0.07), and 86% with DSA II ( P = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2–44), P = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.

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Section: Introductionmentioning

confidence: 99%

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort

Andrade‐Sierra

Cueto-Manzano

Rojas–Campos

et al. 2021

Int J Immunopathol Pharmacol

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Immunosuppressive Minimization Strategies in Kidney Transplantation

Andrade‐Sierra¹,

Vazquez-Galvan²,

HernestoHernandez-Reyes³

et al. 2018

Organ Donation and Transplantation - Current Status and Future Challenges

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The long-term graft survival in renal transplantation results is still controversial, the toxicity and adverse reactions of the immunosuppressive drugs are implicated, as well as cellular and humoral antigen-specific immune mechanisms; therefore, different strategies for adapting immunosuppression are used to reduce the complications associated with the use of these drugs. Calcineurin inhibitors (CNI) require an adequate dose-dependent concentration leading to the appearance of drug-related adverse reactions. The variability in the required dose of CNI leads to minimization strategies that do not result in a higher acute rejection (AR) incidence when compared to other immunosuppressive agents. Early steroid withdrawal is another strategy, although with an increase in AR, but without an impact on the function and survival of the renal graft. The reduction of mycophenolate mofetil to 1.5 g/day seems to be a therapeutic option, decreasing the infectious, hematological and gastrointestinal adverse reactions. Finally, alemtuzumab, bortezomib, belatacept and cellular therapies are in the search for the new treatments, whose premise is the induction of donor-specific nonresponse in the context of operational tolerance or mixed chimerism. The use of adapted and adequate immunosuppression has led to variable results and some are very encouraging; however, they must be validated with experimental studies.

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Renal allograft outcomes following early corticosteroid withdrawal in Hispanic transplant recipients

Abstract: Our single-center experience indicates that ECW can be performed in Hispanic renal transplant recipients, with patient and allograft outcomes comparable with those observed in WR.

Cited by 2 publications

References 23 publications

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort

Immunosuppressive Minimization Strategies in Kidney Transplantation

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