Intermediate steroid withdrawal after renal transplantation and anti-HLA antibodies (HLA-Abs) development.
INTRODUCTION: Steroid withdrawal in renal transplantation is desirable to avoid their adverse effects. However, by decreasing the immunosuppression, could lead to an increased risk for the development of HLA-Abs. OBJECTIVE: Evaluate the relationship between steroid withdrawal and development of HLA-...
| Published in: | Nefrología Vol. 37; no. 4; pp. 415 - 423 |
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| Main Authors: | , , , , , , , , , |
| Format: | Article |
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Revista Nefrologia
jul/ago2017
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| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=lth&AN=124340630&site=ehost-live header: @attributes: shortDbName: lth uiTerm: 124340630 longDbName: MedicLatina uiTag: AN controlInfo: bkinfo: jinfo: jid: 02116995 50C3 jtl: Nefrología issn: 02116995 maglogo: N pubinfo: dt: jul/ago2017 vid: 37 iid: 4 pid: 39358 pub: Revista Nefrologia artinfo: ui: 124340630 10.1016/j.nefro.2017.02.002 ppf: 415 ppct: 8 formats: fmt: @attributes: type: P size: 545KB tig: atl: Intermediate steroid withdrawal after renal transplantation and anti-HLA antibodies (HLA-Abs) development. aug: au: Monfá, Elena San Segundo, David Ruiz San Millán, Juan Carlos Sanabria, Judith Albines, Zoila Rodrigo, Emilio Romón, Iñigo Asensio, Esther Arias, Manuel López-Hoyos, Marcos affil: Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain Pharmacology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain su: Kidney transplantation Physiological effects of steroids HLA histocompatibility antigens Anti-antibodies Tacrolimus Mycophenolic acid Therapeutics sug: subj: Kidney transplantation Physiological effects of steroids HLA histocompatibility antigens Anti-antibodies Tacrolimus Mycophenolic acid Therapeutics keyword: Anti-HLA-antibodies Anticuerpos anti-HLA Corticoides Immunosuppression Inmunosupresión Retirada Steroids Trasplante renal Withdrawal Anticuerpos anti-HLA Corticoides Inmunosupresión Retirada Trasplante renal ab: INTRODUCTION: Steroid withdrawal in renal transplantation is desirable to avoid their adverse effects. However, by decreasing the immunosuppression, could lead to an increased risk for the development of HLA-Abs. OBJECTIVE: Evaluate the relationship between steroid withdrawal and development of HLA-Abs in renal transplantation. METHODS: We analyzed sera by Luminex from 182 kidney transplants performed from 1998 to 2011, before and two years after transplantation. All the patients had a pretransplant PRA (panel reactive of antibodies) <20% by complement-dependent cytotoxicity (CDC) and maintenance immunosuppression with tacrolimus and mycophenolate mofetil (MMF). We compared a group of steroid withdrawal at 7 months (group-I; n=130) and another control with non-withdrawal (group-II; n=52). RESULTS: 22 patients (16.9%) in group-I and 11 patients in group-II (21.1%) had HLA-Abs after two years (pNS). Despite excluding patients with PRA >20%, we detected HLA-Abs pretransplant by Luminex in 11.5% of patients in both groups, of which, 66.6%, versus 53% (p 0.058), developed new specificities, with a similar percentage of donor specific antibodies (DSA) in both groups (33.33% vs 36.36%), pNS. In the subgroup without pretransplant HLA-Abs (group-I; n=115, group-II; n=45), 6.08% developed de novo HLA-Abs, being DSA 3.4% (Group-I) versus 7.69% in group II with 3.84% DSA (pNS). CONCLUSIONS: Steroid withdrawal at 7 months of renal transplantation does not entail a higher risk in terms of HLA-Abs development in patients without pretransplant HLA-Abs and treatment with tacrolimus and MMF, although larger studies are needed to confirm these findings. Introducción: La retirada de esteroides en el trasplante renal es deseable por sus efectos adversos, sin embargo, al disminuir la inmunosupresión podría conllevar un riesgo superior para el desarrollo de Ac-anti-HLA. Objetivo: Evaluar la relación entre la retirada de esteroides y el desarrollo de Ac-anti-HLA en el trasplante renal. Métodos: Se evaluaron los sueros por Luminex de 182 trasplantados renales desde 1998 a 2011, antes y a los 2 años del trasplante. Todos tenían un panel reactivo frente a anticuerpos (PRA) < 20% pretrasplante por citotoxicidad dependiente de complemento y mantuvieron la inmunosupresión con tacrolimús y micofenolato mofetilo (MMF). Comparamos un grupo de retirada de esteroides a los 7 meses (grupo i; n = 130) y otro de no retirada (grupo ii; n = 52). Resultados: 22 pacientes (16,9%) en el grupo i y 11 pacientes en el grupo ii (21,1%) presentaban Ac-anti-HLA a los 2 años (pNS). A pesar de excluir a los pacientes con PRA > 20%, detectamos Ac-anti-HLA pretrasplante por Luminex en el 11,5% de los pacientes en ambos grupos, de los cuale, desarrollaron nuevas especificidades el 66,6% del grupo i y el 53% en el grupo ii (p 0,058), con un similar porcentaje de anticuerpos donante específicos (DSA) (33,3% vs. 36,36%), pNS. En el subgrupo sin Ac-anti-HLA pretrasplante (grupo i; n = 115; grupo ii; n = 45), el 6,08% desarrollaron Ac-anti-HLA de novo, siendo DSA el 3,4% (grupo-I) vs. 7,69% con DSA en el 3,84% (grupo-II), pNS. Conclusiones: La retirada de esteroides a los 7 meses del trasplante renal no conlleva un riesgo superior en términos de desarrollo de Ac-anti-HLA en aquellos pacientes sin anticuerpos pretrasplante y en tratamiento con tacrolimús y MMF, aunque se requieren estudios más amplios para confirmar estos hallazgos. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: Y custom: Copyright of Nefrología is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. item: Nefrología holder: Revista Nefrologia dt: @attributes: year: 2017 holdings: @attributes: islocal: N |
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