دورية أكاديمية
Standardized, risk-adapted induction therapy in kidney transplantation.
| العنوان: | Standardized, risk-adapted induction therapy in kidney transplantation. |
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| المؤلفون: | Eisinger F; Department of Diabetology, Endocrinology, Nephrology, University of Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Germany.; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany., Mühlbacher T; Department of Diabetology, Endocrinology, Nephrology, University of Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Germany., Na A; Department of Diabetology, Endocrinology, Nephrology, University of Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Germany., Althaus K; Center for Clinical Transfusion Medicine, University of Tübingen, Tübingen, Germany., Nadalin S; Department of General-, Visceral- and Transplant Surgery, University of Tübingen, Tübingen, Germany., Birkenfeld AL; Department of Diabetology, Endocrinology, Nephrology, University of Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Germany.; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany., Heyne N; Department of Diabetology, Endocrinology, Nephrology, University of Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Germany.; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany., Guthoff M; Department of Diabetology, Endocrinology, Nephrology, University of Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Germany. martina.guthoff@med.uni-tuebingen.de.; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany. martina.guthoff@med.uni-tuebingen.de.; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany. martina.guthoff@med.uni-tuebingen.de. |
| المصدر: | Journal of nephrology [J Nephrol] 2023 Sep; Vol. 36 (7), pp. 2133-2138. Date of Electronic Publication: 2023 Sep 09. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer Country of Publication: Italy NLM ID: 9012268 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1724-6059 (Electronic) Linking ISSN: 11218428 NLM ISO Abbreviation: J Nephrol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2014- : Heidelberg : Springer Original Publication: Rome : Acta Medica, |
| مواضيع طبية MeSH: | Kidney Transplantation*/adverse effects, Humans ; Alemtuzumab/adverse effects ; Antibodies, Monoclonal, Humanized/adverse effects ; Prospective Studies ; Induction Chemotherapy/adverse effects ; Immunosuppressive Agents/therapeutic use ; Graft Rejection ; Graft Survival |
| مستخلص: | Background: The choice of induction therapy in kidney transplantation is often non-standardized and centre-specific. Clinicians can choose between depleting and non-depleting antibodies, which differ in their immunosuppressive capacity and the concomitant risk of infection. We herein present a standardized risk-stratified algorithm for induction therapy that might help to balance the risk of rejection and/or serious infection. Methods: Prior to kidney transplantation, patients were stratified into low-risk, intermediate-risk or high-risk according to our protocol based on immunologic risk factors. Depending on their individual immunologic risk, patients received basiliximab (low risk), antithymocyte globulin (intermediate risk) or low-dose alemtuzumab (high risk) for induction therapy. We analysed the results after 3 years of implementation of our risk-stratified induction therapy protocol at our kidney transplant centre. Results: Between 01/2017 and 05/2020, 126 patients were stratified in accordance with our protocol (low risk/intermediate risk/high risk: 69 vs. 42 vs. 15 patients). The median follow-up time was 1.9 [1.0-2.5] years. No significant difference was observed in rejection rate and allograft survival (low risk/intermediate risk/high risk: 90.07% vs. 80.81% vs. 100% after 3 years (p > 0.05)) among the groups. The median eGFR at follow-up was (low risk/intermediate risk/high risk) 47 [33-58] vs 58 [46-76] vs 44 [22-55] ml/min/1.73 m 2 . Although the rate of viral and bacterial infections did not differ significantly, we observed a higher rate of opportunistic fungal infections with alemtuzumab induction. Conclusions: Our strategy offers facilitated and individualized choice of induction therapy in kidney transplantation. We propose further evaluation of our algorithm in prospective trials. (© 2023. The Author(s).) |
| References: | Kidney Disease: Improving Global Outcomes Transplant Work G (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9(Suppl 3):S1-155. https://doi.org/10.1111/j.1600-6143.2009.02834.x. (PMID: 10.1111/j.1600-6143.2009.02834.x) Hill P, Cross NB, Barnett AN, Palmer SC, Webster AC (2017) Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients. Cochrane Database Syst Rev 1(1):CD004759. https://doi.org/10.1002/14651858.CD004759.pub2. (PMID: 10.1002/14651858.CD004759.pub228073178) Brennan DC, Schnitzler MA (2008) Long-term results of rabbit antithymocyte globulin and basiliximab induction. N Engl J Med 359(16):1736–1738. https://doi.org/10.1056/NEJMc0805714. (PMID: 10.1056/NEJMc080571418923181) Guthoff M, Berger K, Althaus K, Muhlbacher T, Bakchoul T, Steurer W et al (2020) Low-dose alemtuzumab induction in a tailored immunosuppression protocol for sensitized kidney transplant recipients. BMC Nephrol 21(1):178. https://doi.org/10.1186/s12882-020-01767-z. (PMID: 10.1186/s12882-020-01767-z324040667218828) Boucquemont J, Foucher Y, Masset C, Legendre C, Scemla A, Buron F et al (2020) Induction therapy in kidney transplant recipients: description of the practices according to the calendar period from the French multicentric DIVAT cohort. PLoS ONE 15(10):e0240929. https://doi.org/10.1371/journal.pone.0240929. (PMID: 10.1371/journal.pone.0240929330910577580969) Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M et al (2021) OPTN/SRTR 2019 annual data report: kidney. Am J Transplant 21(Suppl 2):21–137. https://doi.org/10.1111/ajt.16502. (PMID: 10.1111/ajt.1650233595191) Wang JH, Skeans MA, Israni AK (2016) Current status of kidney transplant outcomes: dying to survive. Adv Chronic Kidney Dis 23(5):281–286. https://doi.org/10.1053/j.ackd.2016.07.001. (PMID: 10.1053/j.ackd.2016.07.00127742381) Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D (2006) Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 355(19):1967–1977. https://doi.org/10.1056/NEJMoa060068. (PMID: 10.1056/NEJMoa06006817093248) Schadde E, D’Alessandro AM, Knechtle SJ, Odorico J, Becker Y, Pirsch J et al (2008) Alemtuzumab induction and triple maintenance immunotherapy in kidney transplantation from donors after cardiac death. Transpl Int 21(7):625–636. https://doi.org/10.1111/j.1432-2277.2008.00642.x. (PMID: 10.1111/j.1432-2277.2008.00642.x18397178) |
| فهرسة مساهمة: | Keywords: Immunological risk; Induction therapy; Kidney transplantation; Standard operating procedure |
| المشرفين على المادة: | 3A189DH42V (Alemtuzumab) 0 (Antibodies, Monoclonal, Humanized) 0 (Immunosuppressive Agents) |
| تواريخ الأحداث: | Date Created: 20230909 Date Completed: 20231004 Latest Revision: 20231220 |
| رمز التحديث: | 20231220 |
| مُعرف محوري في PubMed: | PMC10543942 |
| DOI: | 10.1007/s40620-023-01746-1 |
| PMID: | 37688753 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1724-6059 |
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| DOI: | 10.1007/s40620-023-01746-1 |