Early Steroid Withdrawal in Recipients of a Kidney Transplant From a Living Donor: Experience of a Single Mexican Center

Andrade‐Sierra, Jorge; Rojas–Campos, Enrique; Cardona-Muñoz, Ernesto Germán; Evangelista-Carrillo, Luis Alberto; Gómez-Navarro, Benjamín; González-Espinoza, Eduardo; Lugo-López, Orlando; Cerrillos‐Gutiérrez, José Ignacio; Medina-Pérez, Miguel; Jalomo-Martínez, Basilio; Nieves-Hernández, J.J.; Sandoval, Mario; Abundis-Jiménez, J.R.; Ramírez-Robles, Juan Narciso; Villanueva-Pérez, Martha Arisbeth; Monteón-Ramos, Francisco; Cueto-Manzano, Alfonso M.

doi:10.1016/j.transproceed.2015.12.013

Cited by 11 publications

(14 citation statements)

References 59 publications

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“…Maintenance therapy with medium/low prednisone is used to relieve IgAN progression in combination with angiotensin-converting enzyme inhibitors (ACEIs) to reduce proteinuria. Early steroid withdrawal is a safe intervention in living donor transplantation,[34, 35] but steroid withdrawal should be handled with caution when choosing maintenance immunosuppressive treatments for patients with a high risk of recurrence. Based on our experience of treatment of native IgAN and related references,[36, 37] a maintenance therapy of oral prednisone at a dose of 0.6 mg/kg (qod) for Chinese patients after a IgAN in renal allografts diagnosis may be worthwhile.…”

Section: Discussionmentioning

confidence: 99%

Graft failure of IgA nephropathy in renal allografts following living donor transplantation: predictive factor analysis of 102 biopsies

et al. 2019

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BackgroundTo investigate predictive factors related to graft failure of IgA nephropathy(IgAN) in renal allografts following living donor transplantation.MethodsWe identified a series of 102 biopsies diagnosed as IgAN in renal allografts following living donor transplantation from July 2004 to January 2017 at our center, and assess the predict value of the Lee’s classification and the 2009 Oxford classification in IgAN in renal allografts, clinical, ultrasonic and pathological characteristics at biopsy and the outcomes were retrospectively analyzed.ResultsThe 5-year graft cumulative survival rate after transplantation was 91.4%. The 4-year graft cumulative survival rate after biopsy diagnosis of IgAN in renal allografts was 59.6%. The mean time ± SD to disease was 4.7 ± 3.5 years. The color doppler ultrasound and blood flow imagine showed the echo enhancement, the reduced blood flow distribution, the reduced peak systolic velocity of main renal artery, and the increased resistance index of arcuate renal artery were valuable in evaluating the graft dysfunction. The Cox multivariate analysis revealed that the 24-h urinary protein level (HR 1.6 for 1-g increase, 95%CI 1.2–2.0), estimated glomerular filtration rate (eGFR) (HR 1.0 for 1-mL/min/1.73 m^2 decline, 95%CI 1.0–1.1), and mesangial C1q deposition (HR 3.0, 95%CI 1.2–7.4) at biopsy were independent predictive factors of graft failure of IgAN in renal allografts.ConclusionsIgAN in renal allografts occurred frequently within 5 years after transplantation. The risk of graft failure should be taken seriously in patients who exhibit heavy proteinuria and/or a declined eGFR as the initial symptoms; a high lesion grade (grade IV-V of Lee’s classification) and/or mesangial C1q deposition may also indicated a poor outcome.

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Section: Discussionmentioning

confidence: 99%

Graft failure of IgA nephropathy in renal allografts following living donor transplantation: predictive factor analysis of 102 biopsies

et al. 2019

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“…Unlike in deceased donors, in living transplantation, early steroid withdrawal has been shown to be a safe intervention in the management of low immunological risk [ 14 , 15 ]. However, some studies have suggested that the risk of recurrence has increased as a result [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Etiological analysis of graft dysfunction following living kidney transplantation: a report of 366 biopsies

et al. 2018

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Aim: The aim of this study is to investigate the clinical features of graft dysfunction following living kidney transplantation and to assess its causes.Methods: We retrospectively analyzed a series of 366 living kidney transplantation indication biopsies with a clear etiology and diagnosis from July 2003 to June 2016 at our center. The classifications and diagnoses were performed based on clinical and pathological characteristics. All biopsies were evaluated according to the Banff 2007 schema.Results: Acute rejection (AR) occurred in 85 cases (22.0%), chronic rejection (CR) in 62 cases (16.1%), borderline rejection (BR) in 12 cases (3.1%), calcineurin inhibitor (CNI) toxicity damage in 41 cases (10.6%), BK virus-associated nephropathy (BKVAN) in 43 cases (11.1%), de novo or recurrent renal diseases in 134 cases (34.7%), and other causes in nine cases (2.3%); additionally, 20 cases had two simultaneous causes. The 80 cases with IgA nephropathy (IgAN) had the highest incidence (59.7%) of de novo or recurrent renal diseases. After a mean ± SD follow up of 3.7 ± 2.3 years, the 5-year graft cumulative survival rates of AR, CR, CNI toxicity, BKVAN, and de novo or recurrent renal diseases were 60.1%, 31.2%, 66.6%, 66.9%, and 67.1%, respectively.Conclusions: A biopsy is helpful for the diagnosis of graft dysfunction. De novo or recurrent renal disease, represented by IgAN, is a major cause of graft dysfunction following living kidney transplantation.

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“…CsA. Studies that involve corticosteroid withdrawal associated with TAC in the immunosuppression regimen, document the development of borderline changes in AR, especially in the early stage of transplantation, without impact on function or survival of the graft [23,62].…”

Section: Strategies For Removing Steroids From Immunosuppression In Kmentioning

confidence: 99%

“…Experience with this intervention in our transplant center has shown satisfactory short-term (12 months) results with similar AR rates in immunosuppression with and without steroids, with lower glucose levels, lipids, and better blood pressure parameters, which leads to less use of antihypertensive and lipid-lowering drugs in the group without steroids [17,23]. Nonetheless, despite the acceptable results found with these strategies the community dedicated to transplantation is concerned about what happens with these long-term immunosuppression strategies, especially since presently one of the main causes of graft loss is the chronic antibody-mediated rejection mainly associated to sub-immunosuppression.…”

Section: Strategies For Removing Steroids From Immunosuppression In Kmentioning

confidence: 99%

“…Undoubtedly, the measurement of antibody subclasses in patients subjected to a sub-immunosuppression state with minimization schemes or suspension of immunosuppression should be considered in order to discern whether the presence of these antibodies, according to the ability to fix complement, can generate chronic damage and lower the survival of the grafts. Finally, the benefits obtained from the nonsteroid schemes in the posttransplant stages in the lipid, metabolic, and blood pressure profiles, in our previously reported experience, should be considered for its possible risk of activating the immune system [17,23].…”

Section: Antihuman Leukocyte Antigen Antibodies In Kidney Recipients mentioning

confidence: 99%

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Immunosuppressive Minimization Strategies in Kidney Transplantation

Andrade‐Sierra¹,

Vazquez-Galvan²,

HernestoHernandez-Reyes³

et al. 2018

Organ Donation and Transplantation - Current Status and Future Challenges

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The long-term graft survival in renal transplantation results is still controversial, the toxicity and adverse reactions of the immunosuppressive drugs are implicated, as well as cellular and humoral antigen-specific immune mechanisms; therefore, different strategies for adapting immunosuppression are used to reduce the complications associated with the use of these drugs. Calcineurin inhibitors (CNI) require an adequate dose-dependent concentration leading to the appearance of drug-related adverse reactions. The variability in the required dose of CNI leads to minimization strategies that do not result in a higher acute rejection (AR) incidence when compared to other immunosuppressive agents. Early steroid withdrawal is another strategy, although with an increase in AR, but without an impact on the function and survival of the renal graft. The reduction of mycophenolate mofetil to 1.5 g/day seems to be a therapeutic option, decreasing the infectious, hematological and gastrointestinal adverse reactions. Finally, alemtuzumab, bortezomib, belatacept and cellular therapies are in the search for the new treatments, whose premise is the induction of donor-specific nonresponse in the context of operational tolerance or mixed chimerism. The use of adapted and adequate immunosuppression has led to variable results and some are very encouraging; however, they must be validated with experimental studies.

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Early Steroid Withdrawal in Recipients of a Kidney Transplant From a Living Donor: Experience of a Single Mexican Center

Cited by 11 publications

References 59 publications

Graft failure of IgA nephropathy in renal allografts following living donor transplantation: predictive factor analysis of 102 biopsies

Graft failure of IgA nephropathy in renal allografts following living donor transplantation: predictive factor analysis of 102 biopsies

Etiological analysis of graft dysfunction following living kidney transplantation: a report of 366 biopsies

Immunosuppressive Minimization Strategies in Kidney Transplantation

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