Impact of reduced exposure to calcineurin inhibitors on the development of de novo DSA: a cohort of non-immunized first kidney graft recipients between 2007 and 2014

Abstract : BACKGROUND: In low-immunological risk kidney transplant recipients (KTRs), reduced exposure to calcineurin inhibitor (CNI) appears particularly attractive for avoiding adverse events, but may increase the risk of developing de novo Donor Specific Antibodies (dnDSA). METHODS: CNI exposure was retrospectively analyzed in 247 non-HLA immunized first KTRs by taking into account trough levels (C0) collected during follow-up. Reduced exposure to CNI was defined as follows: C0 less than the lower limit of the international targets for ≥50% of follow-up. RESULTS: During a mean follow-up of 5.0 ± 2.0 years, 39 patients (15.8%) developed dnDSA (MFI ≥1000). Patients with DSA were significantly younger (46.6 ± 13.8 vs. 51.7 ± 14.0 years, p = 0.039), received more frequently poorly-matched grafts (59% with 6-8 A-B-DR-DQ HLA mismatches vs. 34.6%, p = 0.016) and had more frequently a reduced exposure to CNI (92.3% vs. 62.0%, p = 0.0002). Reduced exposure to CNI was associated with an increased risk of dnDSA (multivariable HR = 9.77, p = 0.002). Reduced exposure to CNI had no effect on patient survival, graft loss from any cause including death, or post-transplant cancer. CONCLUSIONS: Even in a low-immunological risk population, reduced exposure to CNI is associated with increased risk of dnDSA. Benefits and risks of under-immunosuppression must be carefully evaluated before deciding on CNI minimization.
Document type :
Journal articles
Complete list of metadatas

Cited literature [49 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-02080341
Contributor : Myriam Bodescot <>
Submitted on : Tuesday, March 26, 2019 - 4:24:16 PM
Last modification on : Friday, March 29, 2019 - 4:02:20 PM
Long-term archiving on : Thursday, June 27, 2019 - 5:59:28 PM

File

12882_2018_Article_1014.pdf
Publication funded by an institution

Identifiers

Collections

Citation

Sophie Girerd, Johan Schikowski, Nicolas Girerd, Kevin Duarte, Helen Busby, et al.. Impact of reduced exposure to calcineurin inhibitors on the development of de novo DSA: a cohort of non-immunized first kidney graft recipients between 2007 and 2014. BMC Nephrology, BioMed Central, 2018, 19 (1), pp.232. ⟨10.1186/s12882-018-1014-2⟩. ⟨inserm-02080341⟩

Share

Metrics

Record views

43

Files downloads

81