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

Annick Massart 1, 2, * Annaïck Pallier 3 Julio Pascual 4 Ondrej Viklicky 5 Klemens Budde 6 Goce Spasovski 7 Marian Klinger 8 Mehmet Sever 9 Søren Schwartz Sørensen 10 Karine Hadaya 11 Rainer Oberbauer 12 Christopher Dudley 13 Johan de Fijter 14 Alexander Yussim 15 Marc Hazzan 16 Thomas Wekerle 17 David Berglund 18 Consuelo de Biase 19 María José Pérez-Sáez 4 Anja Mühlfeld 20 Giuseppe Orlando 21 Katia Clemente 22 Quirino Lai 22 Francesco Pisani 22 Aljosa Kandus 23 Marije Baas 24 Frederike Bemelman 25 Jadranka Buturovic Ponikvar 23 Hakim Mazouz 26 Piero Stratta 27 Jean-François Subra 28 Florence Villemain 28 Andries Hoitsma 24 Laura Braun 29 Maria Cantarell 30 Hulya Colak 31 Aisling Courtney 32 Giovanni Frasca 33 Matthew Howse 34 Maarten Naesens 35 Tomas Reischig 36 Daniel Serón 30 Nurhan Seyahi 37 Cem Tugmen 38 Angel Alonso Hernandez 39 Luboslav Beňa 40 Luigi Biancone 41 Vania Cuna 42, 43 Carmen Díaz-Corte 44 Alexandre Dufay 45 André Gaasbeek 46 Arnaud Garnier 47 Philippe Gatault 48 Miguel Govantes 49 François Glowacki 50 Oliver Gross 51 Bruno Hurault de Ligny 52 Uyen Huynh-Do 53 Bénédicte Janbon 54 Luis Antonio Jiménez del Cerro 55 Frieder Keller 56 Gaetano Manna 43 Ricardo Lauzurica 57 Hervé de Sagazan 45 Friedrich Thaiss 58 Christophe Legendre 59, 60 Séverine Martin 61 Marie-Christine Moal 62 Christian Noël 50 Evangeline Pillebout 63 Gian Piredda 64 Ana Puga 65 Wladyslaw Sulowicz 66 Serhan Tuglular 67 Michaela Prokopova 5 Mélanie Chesneau 68 Alain Le Moine 69 Pierrick Guérif 68 Jean-Paul Soulillou 3, 68 Marc Abramowicz 70 Magali Giral 3, 68 Judith Racapé 71 Umberto Maggiore 19 Sophie Brouard 3, 68 Daniel Abramowicz 72
* Corresponding author
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.
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Annick Massart, Annaïck Pallier, Julio Pascual, Ondrej Viklicky, Klemens Budde, et al.. The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients. Nephrology Dialysis Transplantation, Oxford University Press (OUP), 2016, 31 (6), pp.1002-1013. ⟨10.1093/ndt/gfv437⟩. ⟨inserm-02153251⟩

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