The Risk of Postkidney Transplant Outcomes by Induction Choice Differs by Recipient Age

Ahn, JiYoon B.; Bae, Sunjae; Chu, Nadia M.; Wang, Lingyu; Kim, Jong Yeon; Hess, Gregory P.; Lentine, Krista L.; Segev, Dorry L.; McAdams‐DeMarco, Mara

doi:10.1097/txd.0000000000001105

Cited by 5 publications

(2 citation statements)

References 41 publications

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“…An observational study among kidney transplant recipients aged ≥60 years found that the risks of acute rejection at 1‐year post transplant and mortality were significantly higher with IL‐2 receptor antagonists when compared with rATG 54 . The effectiveness of rATG on acute rejection in elderly recipients was also shown in another study 55 . As a result, choice of induction agents should be considered by the balance between the immunological risks of patients and side effects of drugs regardless of patients' age.…”

Section: Elderly Kidney Transplant Recipientsmentioning

confidence: 98%

“…54 The effectiveness of rATG on acute rejection in elderly recipients was also shown in another study. 55 As a result, choice of induction agents should be considered by the balance between the immunological risks of patients and side effects of drugs regardless of patients' age. For maintenance immunosuppression, early steroid-tapering regimens can be considered in patients with lower immunological risks in order to reduce the corticosteroids-related toxicities.…”

Section: Elderly Kidney Transplant Recipientsmentioning

confidence: 99%

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Personalized immunosuppression after kidney transplantation

Cheung

Tang

2022

Nephrology

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With advances in immunosuppressive therapy, there have been significant improvements in acute rejection rates and short-term allograft survival in kidney transplant recipients.However, this success has not been translated into long-term benefits by the same magnitude. Optimization of immunosuppression is important to improve the clinical outcome of transplant recipients. It is important to note that each patient has unique attributes and immunosuppression management should not be a one-size-fits-all approach. Elderly transplant patients are less likely to develop acute rejection but more likely to die from infectious and cardiovascular causes than younger patients. For those with posttransplant cancers and BK polyomavirus-associated nephropathy, reduction of immunosuppression can increase the risk of rejection. Therapeutic drug monitoring (TDM) is routinely used for dosage adjustment of several immunosuppressive drugs. It has been hoped that pharmacogenetics can be used to complement TDM in optimizing drug exposure. Among the various drug-genotype pairs being investigated, tacrolimus and CYP3A5 gives the most promising results. Different studies have consistently shown that CYP3A5 expressers require a higher tacrolimus dose and take longer time to achieve target blood tacrolimus levels than nonexpressers. However, for pharmacogenetics to be widely used clinically, further trials are necessary to demonstrate the clinical benefits of genotypeguided dosing such as reduction of rejection and drug-related toxicities. The development of different biomarkers in recent years may help to achieve true personalized therapy in transplant patients.

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Section: Elderly Kidney Transplant Recipientsmentioning

confidence: 98%

Section: Elderly Kidney Transplant Recipientsmentioning

confidence: 99%

Personalized immunosuppression after kidney transplantation

Cheung

Tang

2022

Nephrology

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Kidney transplants from elderly donors: what we have learned 20 years after the Crystal City consensus criteria meeting

Mella,

Calvetti,

Barreca

et al. 2024

J Nephrol

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Based on the current projection of the general population and the combined increase in end-stage kidney disease with age, the number of elderly donors and recipients is increasing, raising crucial questions about how to minimize the discard rate of organs from elderly donors and improve graft and patient outcomes. In 2002, extended criteria donors were the focus of a meeting in Crystal City (VA, USA), with a goal of maximizing the use of organs from deceased donors. Since then, extended criteria donors have progressively contributed to a large number of transplanted grafts worldwide, posing specific issues for allocation systems, recipient management, and therapeutic approaches. This review analyzes what we have learned in the last 20 years about extended criteria donor utilization, the promising innovations in immunosuppressive management, and the molecular pathways involved in the aging process, which constitute potential targets for novel therapies. Graphical abstract

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