Journal Article

Tapering immunosuppression in recipients of living donor kidney transplants

Willem Weimar, Jacqueline Rischen-Vos, Petronella de Kuiper, Peter J. H. Smak Gregoor, Jan N. M. IJzermans, Nicole M. van Besouw, Carla C. Baan and Barbara J. van der Mast

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 19, issue suppl_4, pages iv61-iv63
Published in print July 2004 | ISSN: 0931-0509
Published online July 2004 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfh1044
Tapering immunosuppression in recipients of living donor kidney transplants

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We have previously suggested that the in vitro donor-specific cytotoxic T-lymphocyte precursor (CTLp) assay can guide us to identify patients in which the immunosuppressive load can be tapered. In a clinical trial we had observed that a low (<10/106 PBMC) frequency of these CTLp was predictive for an uneventful rejection-free clinical course in patients that were converted from calcineurin inhibitors to mycophenolate mofetil or azathiopine. In the present prospective study in 81 stable kidney transplant recipients, already converted from calcineurin inhibitors, we measured CTLp frequencies and reduced the immunosuppressive load on a routine basis when CTLp were <10/106 PBMC. Donor-specific cytotoxicity could not be measured in 50/81 patients, while their reactivity against third-party lymphocytes was not impaired. These 50 patients were tapered in their immunosuppression. Only in one patient, who had stopped all his medication, was a rejection episode diagnosed. We conclude that in patients with a low donor-specific CTLp frequency it is safe to reduce the immunosuppression.

Keywords: cytotoxic T lymphocytes; immunosuppression; kidney transplantation

Journal Article.  0 words. 

Subjects: Nephrology

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