The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients
2 Medical Genetics Department [Brussels, Belgium]
3 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
4 Hospital del Mar - Nephrology [Barcelona, Spain]
5 Transplant Center - Department of Nephrology [Prague, Czech Republic]
6 Department of Nephrology [Berlin, Germany]
7 Department of Nephrology [Skopje, Macedonia]
8 Nephrology and Transplantation Medicine [Wrocław, Poland]
9 Internal Medicine, Nephrology [Istanbul, Turkey]
10 Nephrology P [Copenhagen, Denmark]
11 Nephrology and Transplantation [Geneva, Switzerland]
12 Department of Medicine III–Nephrology, Hypertension and Renal Transplantation
13 Richard Bright Renal Centre [Bristol, UK]
14 Department of Nephrology [Leiden, The Netherlands]
15 Rabin Medical Center - Department of Transplantation [Tel Aviv, Israël]
16 Service de Néphrologie et Transplantation rénale [CHRU-lille]
17 Section of Transplantation Immunology - Department of Surgery [Vienna, Austria]
18 Department of Immunology, Genetics and Pathology - Section of Clinical Immunology [Uppsala, Sweden]
19 Centro Trapianti di Parma - UOS Trapianti Rene Pancreas [Parma, Italy]
20 Department of Nephrology [Aachen, Germany]
21 Department of Surgery - Section of Transplantation [Winston-Salem, NC, USA]
22 U.O.C. Trapianti D’Organo [L’Aquila, Italy]
23 Renal Transplantation Centre Ljubljana - Department of Nephrology [Ljubljana, Slovenia]
24 Kidney Diseases [Nijmegen, The Netherlands]
25 Department of Nephrology - Renal Transplant Unit [Amsterdam, The Netherlands]
26 Service de Néphrologie - Unité de Transplantation Rénale et Pancréatique [CHU Sud, Amiens]
27 Department of Translational Medicine [Novara, Italy]
28 Service de Néphrologie-Dialyse-Transplantation [Angers]
29 Service de néphrologie et hémodialyse [CHU Strasbourg]
30 Vall d’Hebron Hospital - Pediatric Nephrology [Barcelona, Spain]
31 Department of Nephrology [Izmir, Turkey]
32 Regional Nephrology Unit [Belfast, UK]
33 Nefrologia, Dialisi e Trapianto di rene [Ancona, Italy]
34 Nephrology/Transplantation [Liverpool, UK]
35 Department of Nephrology and Renal Transplantation [Leuven, Belgium]
36 Department of Internal Medicine - Nephrology Ward [Pilsen, Czech Republic]
37 Istanbul University
38 Tepecik Training and Research Hospital [Izmir, Turkey]
39 Servicio de Nefrología
40 Transplant Centre
41 UNITO - Università degli studi di Torino = University of Turin
42 St. Orsola University Hospital
43 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna [Bologne]
44 HUCA - Hospital Universitario Central de Asturias
45 Centre Hospitalier de Roubaix
46 LUMC - Leiden University Medical Center [Leiden]
47 Service Néphrologie, médecine interne et hypertension pédiatrique [CHU Toulouse]
48 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
49 HUVR - Hospital Universitario Virgen del Rocío [Sevilla]
50 University Medicine Göttingen
51 Service de Néphrologie-Dialyse-Transplantation rénale [CHU Caen]
52 UNIBE - Universität Bern = University of Bern = Université de Berne
53 Transplantation rénale [CHU Grenoble]
54 General University Hospital of Alicante
55 Universitätsklinikum Ulm - University Hospital of Ulm
56 Hospital Universitario Germans Trias I Pujol
57 University Hospital Hamburg-Eppendorf
58 UPD5 - Université Paris Descartes - Paris 5
59 Hôpital Necker - Enfants Malades [AP-HP]
60 Service d'hémodialyse et de Néphrologie [Libourne]
61 CHRU - Service de néphrologie, dialyse et transplantation rénale
62 AP-HP - Hopital Saint-Louis [AP-HP]
63 Kidney Transplant Az. Osp. G. Brotzu
64 Hospital Universitario Insular de Gran Canaria [Las Palmas de Gran Canaria, Spain]
65 University Hospital in Krakow
66 Marmara School of Medicine Hastanesi
67 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
68 ULB - Université libre de Bruxelles = Free University of Brussels
69 Institut de Recherche Interdisciplinaire en Biologie Humaine et Moleculaire
70 Research Center of Epidemiology, Biostatistics and Clinical Research,
71 Nephrology-Renal Transplantation Department
- Fonction : Auteur correspondant
- PersonId : 1049050
Connectez-vous pour contacter l'auteur
- Fonction : Auteur
- PersonId : 914747
- Fonction : Auteur
- PersonId : 795354
- ORCID : 0000-0002-9863-8840
- Fonction : Auteur
- PersonId : 901335
- Fonction : Auteur
- PersonId : 793625
- ORCID : 0000-0002-5625-0792
- Fonction : Auteur
- PersonId : 764878
- ORCID : 0000-0003-1664-2879
- IdRef : 16936383X
- Fonction : Auteur
- PersonId : 762195
- ORCID : 0000-0001-5443-9172
- IdRef : 080281249
- Fonction : Auteur
- PersonId : 916428
- Fonction : Auteur
- PersonId : 1379678
- IdRef : 189698349
- Fonction : Auteur
- PersonId : 1158696
- Fonction : Auteur
- PersonId : 1048250
- ORCID : 0000-0001-7468-5135
- IdRef : 06386536X
- Fonction : Auteur
- PersonId : 1326564
- ORCID : 0000-0001-7641-1592
- IdRef : 121549828
- Fonction : Auteur
- PersonId : 975730
- ORCID : 0000-0002-6398-1315
- IdRef : 073751480
Résumé
BACKGROUND: Kidney recipients maintaining a prolonged allograft survival in the absence of immunosuppressive drugs and without evidence of rejection are supposed to be exceptional. The ERA-EDTA-DESCARTES working group together with Nantes University launched a European-wide survey to identify new patients, describe them and estimate their frequency for the first time. METHODS: Seventeen coordinators distributed a questionnaire in 256 transplant centres and 28 countries in order to report as many 'operationally tolerant' patients (TOL; defined as having a serum creatinine <1.7 mg/dL and proteinuria <1 g/day or g/g creatinine despite at least 1 year without any immunosuppressive drug) and 'almost tolerant' patients (minimally immunosuppressed patients (MIS) receiving low-dose steroids) as possible. We reported their number and the total number of kidney transplants performed at each centre to calculate their frequency. RESULTS: One hundred and forty-seven questionnaires were returned and we identified 66 TOL (61 with complete data) and 34 MIS patients. Of the 61 TOL patients, 26 were previously described by the Nantes group and 35 new patients are presented here. Most of them were noncompliant patients. At data collection, 31/35 patients were alive and 22/31 still operationally tolerant. For the remaining 9/31, 2 were restarted on immunosuppressive drugs and 7 had rising creatinine of whom 3 resumed dialysis. Considering all patients, 10-year death-censored graft survival post-immunosuppression weaning reached 85% in TOL patients and 100% in MIS patients. With 218 913 kidney recipients surveyed, cumulative incidences of operational tolerance and almost tolerance were estimated at 3 and 1.5 per 10 000 kidney recipients, respectively. CONCLUSIONS: In kidney transplantation, operational tolerance and almost tolerance are infrequent findings associated with excellent long-term death-censored graft survival.