Anti-TNFα therapy for chronic inflammatory disease in kidney transplant recipients

Abstract

Anti-tumor necrosis factor-α (TNFα) therapy has improved the prognosis of many chronic inflammatory diseases. It appears to be well-tolerated by liver-transplant patients. However, their use and their safety in kidney-transplant patients have yet to be determined.In this retrospective study, we identified 16 adult kidney-transplant patients aged 46.5 years (34–51.8) who received anti-TNFα therapy from 7 kidney transplantation centers. The indications for this treatment included: chronic inflammatory bowel disease (n = 8), inflammatory arthritis (n = 5), AA amyloidosis (n = 1), psoriasis (n = 1), and microscopic polyangiitis (n = 1).Anti-TNFα therapies resulted in a clinical response in 13/16 patients (81%). Estimated glomerular filtration rates (MDRD-4) were similar on day 0 and at 24 months (M24) after anti-TNFα treatment had been initiated (41 [12–55] and 40 [21–53] mL/min/1.73 m2, respectively). Two allograft losses were observed. The 1st case was due to antibody-mediated rejection (M18), while the 2nd was the result of AA amyloidosis recurrence (M20). There were several complications: 8 patients (50%) developed 23 serious infections (18 bacterial, 4 viral, and 1 fungal) and 4 developed cancer. Five patients died (infection n = 2, cardiac AA amyloidosis n = 1, intraalveolar hemorrhage following microscopic polyangiitis n = 1, and acute respiratory distress syndrome n = 1). On univariate analysis, recipient age associated with death (P = 0.009) and infection development (P = 0.06).Using anti-TNFα therapies, remission can be achieved in chronic inflammatory diseases in kidney-transplant patients. However, concommitant anti-TNFα and immunosuppresive therapies must be used with caution due to the high risk of infection, particularly after the age of 50.

Gastrointestinal complications after kidney transplantation

“…In a cohort of 940 kidney transplant recipients, Dobies et al[ 25 ] found an IBD in 7 patients (0.7%). An additional case of de novo CD was recently reported by Motté et al[ 19 ], making for a total of 46 de novo histologically proven IBD cases (23 UC cases and 21 CD cases, plus 2 cases not otherwise specified) reported to date in kidney transplant recipients[ 5 , 15 , 19 , 20 , 22 - 34 ], including three paediatric patients[ 18 , 32 ]. In contrast, MMF-related colitis has a higher incidence, since it is present in up to 47% of patients undergoing colonoscopy for chronic diarrhoea[ 5 , 13 , 25 , 35 ].…”

“…Post-transplant de novo IBDs present more frequently in males, with a mean age of 35 years[ 5 , 15 , 18 , 21 , 22 , 26 - 35 ]. The main presenting symptoms are diarrhoea, abdominal pain and bright red haematochezia[ 5 , 15 , 18 , 21 , 22 , 26 - 34 ], and the mean time after transplantation to IBD presentation is 4.6 years[ 5 , 15 , 19 , 20 , 22 - 31 ]. Only in one patient did IBD present early, within one year after transplantation[ 18 ].…”

Glomerular filtration rate in patients with moderate‐to‐severe psoriasis

“…6 Cyclosporine could be nephrotoxic, whereas methotrexate and biologics are not considered to affect kidney function, 7 although studies investigating their effect on glomerular filtration rate (GFR) are scarce. 8 The objective of this retrospective study was to estimate GFR in patients with psoriasis and GFR reduction during systemic treatment. Consecutive patients with chronic plaque psoriasis (n = 311) candidate to systemic treatment who attended the Section of Dermatology and Venereology of the University Hospital of Verona, Italy, between June and December 2017 were included.…”

“…Differences between groups are not significant at any time point. Diabetes N (%) 4 (10) 3 (8) Dyslipidaemia N (%) 6 (15) 4 (12)…”

Benchmarking Stem Cells and Transplantation in Psoriasis

“…A retrospective study of 16 adults with kidney transplants that underwent anti-rejection therapy plus TNF-blockers described the efficacy of this combination in curing concurrent chronic inflammatory diseases, as psoriasis. However, A high risk of subsequent infections and careful use in patients older than 50 years of age were underlined [40].…”