The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients
(1, 2)
,
(3)
,
(4)
,
(5)
,
(6)
,
(7)
,
(8)
,
(9)
,
(10)
,
(11)
,
(12)
,
(13)
,
(14)
,
(15)
,
(16)
,
(17)
,
(18)
,
(19)
,
(4)
,
(20)
,
(21)
,
(22)
,
(22)
,
(22)
,
(23)
,
(24)
,
(25)
,
(23)
,
(26)
,
(27)
,
(28)
,
(28)
,
(24)
,
(29)
,
(30)
,
(31)
,
(32)
,
(33)
,
(34)
,
(35)
,
(36)
,
(30)
,
(37)
,
(38)
,
(39)
,
(40)
,
(41)
,
(42, 43)
,
(44)
,
(45)
,
(46)
,
(47)
,
(48)
,
(49)
,
(50)
,
(51)
,
(52)
,
(53)
,
(54)
,
(55)
,
(56)
,
(43)
,
(57)
,
(45)
,
(58)
,
(59, 60)
,
(61)
,
(62)
,
(50)
,
(63)
,
(64)
,
(65)
,
(66)
,
(67)
,
(5)
,
(68)
,
(69)
,
(68)
,
(3, 68)
,
(70)
,
(3, 68)
,
(71)
,
(19)
,
(3, 68)
,
(72)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
Annick Massart
Connectez-vous pour contacter l'auteur
- Function : Correspondent author
- PersonId : 1049050
Connectez-vous pour contacter l'auteur
Ondrej Viklicky
- Function : Author
- PersonId : 914747
Marc Hazzan
- Function : Author
- PersonId : 795354
- ORCID : 0000-0002-9863-8840
Hakim Mazouz
- Function : Author
- PersonId : 901335
Maarten Naesens
- Function : Author
- PersonId : 793625
- ORCID : 0000-0002-5625-0792
Philippe Gatault
- Function : Author
- PersonId : 764878
- ORCID : 0000-0003-1664-2879
- IdRef : 16936383X
François Glowacki
- Function : Author
- PersonId : 762195
- ORCID : 0000-0001-5443-9172
- IdRef : 080281249
Christian Noël
- Function : Author
- PersonId : 916428
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.
Embargoed file
Embargoed file
Ne sera jamais visible
Loading...