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

DOI
Publisher DOI
PubMed ID
26763669
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 TOL. 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.
Date Issued
2016-01-12
Publication Type
Article
Subject(s)
Subjects
frequency
•
graft survival
•
kidney transplantation
•
minimally immunosuppressed patients
•
operational tolerance
Language(s)
en
Author(s)
Massart, Annick
Pallier, Annaïck
Pascual, Julio
Viklicky, Ondrej
Budde, Klemens
Spasovski, Goce
Klinger, Marian
Sever, Mehmet Sukru
Sørensen, Søren Schwartz
Hadaya, Karine
Oberbauer, Rainer
Dudley, Christopher
De Fijter, Johan W
Yussim, Alexander
Hazzan, Marc
Wekerle, Thomas
Berglund, David
De Biase, Consuelo
Pérez-Sáez, María José
Mühlfeld, Anja
Orlando, Giuseppe
Clemente, Katia
Lai, Quirino
Pisani, Francesco
Kandus, Aljosa
Baas, Marije
Bemelman, Frederike
Ponikvar, Jadranka Buturovic
Mazouz, Hakim
Stratta, Piero
Subra, Jean-François
Villemain, Florence
Hoitsma, Andries
Braun, Laura
Cantarell, Maria Carmen
Colak, Hulya
Courtney, Aisling
Frasca, Giovanni Maria
Howse, Matthew
Naesens, Maarten
Reischig, Tomas
Serón, Daniel
Seyahi, Nurhan
Tugmen, Cem
Alonso Hernandez, Angel
Beňa, Luboslav
Biancone, Luigi
Cuna, Vania
Díaz-Corte, Carmen
Dufay, Alexandre
Gaasbeek, André
Garnier, Arnaud
Gatault, Philippe
Gentil Govantes, Miguel Angel
Glowacki, François
Gross, Oliver
Hurault de Ligny, Bruno
Janbon, Bénédicte
Jiménez Del Cerro, Luis Antonio
Keller, Frieder
La Manna, Gaetano
Lauzurica, Ricardo
Le Monies De Sagazan, Hervé
Thaiss, Friedrich
Legendre, Christophe
Martin, Séverine
Moal, Marie-Christine
Noël, Christian
Pillebout, Evangeline
Piredda, Gian Benedetto
Puga, Ana Ramírez
Sulowicz, Wladyslaw
Tuglular, Serhan
Prokopova, Michaela
Chesneau, Mélanie
Le Moine, Alain
Guérif, Pierrick
Soulillo, Jean-Paul
Abramowicz, Marc
Giral, Magali
Racapé, Judith
Maggiore, Umberto
Brouard, Sophie
Abramowicz, Daniel
Additional Credits
Journal
Nephrology, dialysis, transplantation
Publisher
Oxford University Press
ISSN
0931-0509
Access(Rights)
restricted
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