Epithelial to Mesenchymal Transition Markers in Kidney Transplant Recipients: The CERTITEM Trial.

Hertig, Alexandre; Kamar, Nassim; Albano, L.; Anglicheau, Dany; Dürrbach, Antoine; Vuiblet, Vincent; Merville, Pierre; Moulin, B.; Hazzan, Marc; Lang, Philippe; Touchard, Guy; Ligny, Hurault B. De; Quéré, Stéphane; Giambattista, F. Di; Rondeau, Éric

doi:10.1097/00007890-201407151-00253

Cited by 3 publications

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“…The risk of drug discontinuation was also greater in the mTOR inhibitor group. It is important to stress that some studies suggest that early conversion to mTOR inhibitors may be associated with an increased risk of developing donor‐specific antibodies and acute and chronic ABMR . The role of the drug itself is not clear, but underdosage linked to the search for a better tolerance of the drug may lead to overall underimmunosuppression.…”

Section: Secondary Cni Conversionmentioning

confidence: 99%

Immunological risks of minimization strategies

2015

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SummaryDuring the past 10 years, minimization strategies have been legitimately initiated to decrease the many toxicities of calcineurin inhibitors, especially nephrotoxicity which was considered to be responsible for the majority of graft losses. Even though CNI-induced nephrotoxicity is undeniable, we have learned in the past 10 years that DSAs detected with solid-phase assays are excellent prognostic biomarkers in kidney transplantation (and in other organ transplantations as well) and that chronic antibody-mediated rejection has become the leading cause of graft loss. In this review, we will focus on the immunological risks linked to various strategies aiming at decreasing CNI doses either at time of transplantation or later in the course of follow-up. Some of these interventions are associated with an increase in acute cellular rejection rates but also with an improvement in renal function. The effects on antibody-mediated rejection and occurrence of de novo donor-specific antibodies are still under-reported. We are currently missing longterm data to appreciate the influence of these minimization strategies on graft and patient survival. This then leads to a cautious attitude regarding reducing immunosuppression.

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Section: Secondary Cni Conversionmentioning

confidence: 99%

Immunological risks of minimization strategies

2015

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Target of rapamycin inhibitors (TOR-I; sirolimus and everolimus) for primary immunosuppression in kidney transplant recipients

Hahn

Hodson

Hamiwka

et al. 2019

Cochrane Database of Systematic Reviews

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Calcineurin inhibitor withdrawal or tapering for kidney transplant recipients

Karpe

Talaulikar

Walters

2017

Cochrane Database of Systematic Reviews

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CNI avoidance increased acute rejection and CNI withdrawal increases acute rejection but reduced graft loss at least over the short-term. Low dose CNI with induction regimens reduced acute rejection and graft loss with no major adverse events, also in the short-term. The use of mTOR-I reduced CMV infections but increased the risk of acute rejection. These conclusions must be tempered by the lack of long-term data in most of the studies, particularly with regards to chronic antibody-mediated rejection, and the suboptimal methodological quality of the included studies.

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Epithelial to Mesenchymal Transition Markers in Kidney Transplant Recipients: The CERTITEM Trial.

Cited by 3 publications

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Immunological risks of minimization strategies

Immunological risks of minimization strategies

Target of rapamycin inhibitors (TOR-I; sirolimus and everolimus) for primary immunosuppression in kidney transplant recipients

Calcineurin inhibitor withdrawal or tapering for kidney transplant recipients

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