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Article Dans Une Revue Nephrology Dialysis Transplantation Année : 2016

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 Sukru Sever (9) , Søren Schwartz Sørensen (10) , Karine Hadaya (11) , Rainer Oberbauer (12) , Christopher Dudley (13) , Johan W 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 Carmen Cantarell (30) , Hulya Colak (31) , Aisling Courtney (32) , Giovanni Maria 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 Angel Gentil 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 La Manna (43) , Ricardo Lauzurica (57) , Hervé Le Monies de Sagazan (45) , Friedrich Thaiss (58) , Christophe Legendre (59, 60) , Séverine Martin (61) , Marie-Christine Moal (62) , Christian Noël (50) , Evangeline Pillebout (63) , Gian Benedetto Piredda (64) , Ana Ramírez 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)
1 ULB - Renal Unit [Brussels, Belgium]
2 Medical Genetics Department [Brussels, Belgium]
3 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
4 Hospital del Mar - Nephrology [Barcelona, Spain]
5 Transplant Center - Department of Nephrology [Prague, Czech Republic]
6 Department of Nephrology [Berlin, Germany]
7 Department of Nephrology [Skopje, Macedonia]
8 Nephrology and Transplantation Medicine [Wrocław, Poland]
9 Internal Medicine, Nephrology [Istanbul, Turkey]
10 Nephrology P [Copenhagen, Denmark]
11 Nephrology and Transplantation [Geneva, Switzerland]
12 Department of Medicine III–Nephrology, Hypertension and Renal Transplantation
13 Richard Bright Renal Centre [Bristol, UK]
14 Department of Nephrology [Leiden, The Netherlands]
15 Rabin Medical Center - Department of Transplantation [Tel Aviv, Israël]
16 Département de Néphrologie [CHRU Lille]
17 Section of Transplantation Immunology - Department of Surgery [Vienna, Austria]
18 Department of Immunology, Genetics and Pathology - Section of Clinical Immunology [Uppsala, Sweden]
19 Centro Trapianti di Parma - UOS Trapianti Rene Pancreas [Parma, Italy]
20 Department of Nephrology [Aachen, Germany]
21 Department of Surgery - Section of Transplantation [Winston-Salem, NC, USA]
22 U.O.C. Trapianti D’Organo [L’Aquila, Italy]
23 Renal Transplantation Centre Ljubljana - Department of Nephrology [Ljubljana, Slovenia]
24 Kidney Diseases [Nijmegen, The Netherlands]
25 Department of Nephrology - Renal Transplant Unit [Amsterdam, The Netherlands]
26 Service de Néphrologie - Unité de Transplantation Rénale et Pancréatique [CHU Sud, Amiens]
27 Department of Translational Medicine [Novara, Italy]
28 Service de Néphrologie-Dialyse-Transplantation [Angers]
29 Hôpital de jour de Néphrologie - service de Néphrologie et Transplantation Rénale [CHU Strasbourg]
30 Vall d’Hebron Hospital - Pediatric Nephrology [Barcelona, Spain]
31 Department of Nephrology [Izmir, Turkey]
32 Regional Nephrology Unit [Belfast, UK]
33 Nefrologia, Dialisi e Trapianto di rene [Ancona, Italy]
34 Nephrology/Transplantation [Liverpool, UK]
35 Department of Nephrology and Renal Transplantation [Leuven, Belgium]
36 Department of Internal Medicine - Nephrology Ward [Pilsen, Czech Republic]
37 Istanbul University
38 Tepecik Training and Research Hospital [Izmir, Turkey]
39 Servicio de Nefrología
40 Transplant Centre
41 UNITO - Università degli studi di Torino = University of Turin
42 St. Orsola University Hospital
43 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
44 HUCA - Hospital Universitario Central de Asturias
45 Service Néphrologie [Roubaix]
46 Leids Universitair Medisch Centrum [Leiden, The Netherlands]
47 Service Néphrologie, médecine interne et hypertension pédiatrique [CHU Toulouse]
48 Service Néphrologie - Immunoclinique [CHRU Tours]
49 Hospital Universitario Virgen del Rocío [Sevilla]
50 Service de Néphrologie et Transplantation rénale [CHRU-lille]
51 University Medicine Göttingen
52 Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen]
53 UNIBE - Universität Bern / University of Bern
54 Transplantation rénale [CHU Grenoble]
55 Hospital General Universitario de Alicante
56 Universitätsklinikum Ulm - University Hospital of Ulm
57 Hospital Universitario Germans Trias I Pujol
58 University Hospital Hamburg-Eppendorf
59 UPD5 - Université Paris Descartes - Paris 5
60 Hôpital Necker - Enfants Malades [AP-HP]
61 Service d'hémodialyse et de Néphrologie [Libourne]
62 CHRU - Service de néphrologie, dialyse et transplantation rénale
63 Département de Néphrologie et transplantation [Hôpital Saint Louis - APHP]
64 Kidney Transplant Az. Osp. G. Brotzu
65 Hospital Universitario Insular de Gran Canaria
66 University Hospital in Krakow
67 Marmara School of Medicine Hastanesi
68 Institute of Transplantation Urology and Nephrology [CHU Nantes]
69 ULB - Université libre de Bruxelles
70 Institut de Recherche Interdisciplinaire en Biologie Humaine et Moleculaire
71 Research Center of Epidemiology, Biostatistics and Clinical Research,
72 Nephrology-Renal Transplantation Department
Marc Hazzan
Luboslav Beňa
  • Fonction : Auteur

Résumé

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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inserm-02153251 , version 1 (12-06-2019)

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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, 2016, 31 (6), pp.1002-1013. ⟨10.1093/ndt/gfv437⟩. ⟨inserm-02153251⟩
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