Risk Factors in Long Term Immunosuppressive Use and Advagraf. Daniel Serón Nephrology department Hospital Universitari Vall d Hebron
|
|
- Jeffrey Watts
- 5 years ago
- Views:
Transcription
1 Risk Factors in Long Term Immunosuppressive Use and Advagraf Daniel Serón Nephrology department Hospital Universitari Vall d Hebron
2 Progressive well defined diseases ABMR GN Polyoma Non-specific Findings Fibrosis Inflammation Non-specific Findings Fibrosis Inflammation 1 st year > 1 year
3 Time dependency of histological diagnosis Sellares J et al. Am J Transplant 2012; 12: 388
4 ABMR is the main cause of graft failure Late Early Before 6 m After 6m Torres IB et al. Unpubliished observation
5 Inflammation a driving force for fibrosis Prevention of early inflammation and progression of fibrosis Providing an adequate immunosuppression
6 Inflammation a driving force for fibrosis Prevention of early inflammation and progression of fibrosis Providing an adequate immunosuppression
7 Temporal evolution of histologic lesions 120 patients with DM1, receiving a kidney-pancreas transplant, 961 biopsies Subclinical inflammation IF/TA Glomerulosclerosis Nankivell B et al N Engl J Med 2003; 349: 2236
8 Fibrosis is measured with an ordinal scale 100% 50% 3 25% 10% 0% 2 1 0
9 Inflammation and progression of IF/TA in paired biopsies n=598 Bx, (no SCR 462, SCRB 102, SCRA 34) * p<0.05 ***p<0.001 Nankivell BJ et al, Transplantation 2004; 78:242
10 Classification of inflammation and fibrosis Normal (no inflammation no fibrosis) Inflammation (no fibrosis) Fibrosis (no inflammation) Inflammation and fibrosis
11 i-if/ta Surveillance biopsies < 6 m 1.75 Normal=186 i=74 IF/TA=110.5 i=if/ta= months Shishido et al, JASN 2003; 14: 1046 Cosio FG et al, Am J Transplant 2005; 5: 2464, Moreso F et al Am J Transplant 2006; 6:747 Gago M et al. Am J Transplant 2012; 12: 1199
12 Inflammation at 1m/4m and IF/TA and i-if/ta at 1 y Induction + TAC+MMF+P (500, 250,125,60,30) No inflammation 172, Borderline 50, acute rejection IF/TA 2 IF/TA i-if/ta i-if/ta Heilman RL et al. Am J Transplant 2010; 10: 563
13 Inflammation IF/TA and i-if/ta at 1year IF/TA Inflammation i-if/ta
14 Moreso F et al. Transplantation 2012; 93: 41 Inflammation at 4 m and risk of late AMR Surveillance Bx n = 517 7y Late AMR 44 IF/TA nos 42 Recurrence 11 De novo GN 7 Acute rejection 4 Polyoma 1 Acute score (p=0.003) Indication Bx n = 109
15 CHR, IF/TA and outcome Moreso F et al. Transplantation 2012; 93: 41
16 Surveillance Bx at 6m, de novo DSA and late AMR n=315 (DSA=47, no DSA=268) Time of DSA detection 4.6±3.0 0,7 0,6 0,5 0,4 0,3 i ptc 0,2 0,1 0 DSA No DSA Wiebe C et al. Am J Transplant 2012; 12: 1157
17 Graft survival and DSA Wiebe C et al. Am J Transplant 2012; 12: 1157
18 AR during 1st year in DSA neg pts and 1y % normal histology at 1 y protocol Bx n=797 pts ( ), DSA pre Tx neg % class II DSA at 1 y El Ters M et al. Am J Transplant 2013: 13: 2334
19 IF/TA Inflammation i-if/ta CHR+IF/TA
20 What does early inflammation mean? a.) Injury repair innate immunity a.) Alloimmune response aquired immune response against donor antigens
21 Anti-donor cellular reactivity & subclinical inflammation Bestard O et al. Kidney Int 2013; 84: 1126 N=60 pts Elispot and protocol biopsy at 6 months (SRL 22 and TAC 38)
22 Injury/repair after kidney transplantation Tissue Damage Complement Apoptosis Necrosis Inflammation MBL
23 Failure to repair injury and inflammation: Mannose binding lectin Ibernon M et al. Transpl Immunol 2014; 31: 152
24 Ibernon M et al. Transpl Immunol 2014; 31: 152
25 Ibernon M et al. Transpl Immunol 2014; 31: 152 Low MBL and increased inflammation and apoptosis Apoptotic cells Inflammation 3,5 3 p= ,5 2 1,5 1 v t i g 0,5 0 MBL T1 MBL T2+T3
26 Alloimmunity IF/TA Inflammation i-if/ta Injury/repair CHR
27 Inflammation a driving force for fibrosis Prevention of early inflammation and progression of fibrosis Providing an adequate immunosuppression
28 Treatment of SCR with steroid boluses (n=72; 36 pts per group) CsA+AZA+PN Inflammation > 50 (%) Biopsy group Randomization Control group Biopsy group Control group chronic score at 6m ns ci + ct score at 6m Rush D et al, J Am Soc Nephrol 1998; 9: 2129
29 Treatment of SCR in p<tients treated with TAC+MMF+P Prospective, multicentric study (12 centres) Randomization Biopsy group Control group Protocol Bx (n=121) Control (n=119) 6m IF/TA>2 (%) m IF/TA>2 (%) m CrCl (ml/min) Rush D et al Am J T ransplant2007; 7: 2538
30 TAC vs CsA: a case control study all treated with MMF and P n=98 borderline AR I AR II Moreso F et al Transplantation 2004; 78: 1064
31 Serón D et al. Transplantation 2007;83: Tac versus CsA: 4m immunophenotype Tacrolimus (n=44) vs ciclosporina (n=22) p<0.01 p<0.01 ns p<0.05
32 NUMBER OF INTERSTITIAL INFILTRATING CELLS ACCORDING TO TACROLIMUS TROUGH LEVELS AT BIOPSY (median TAC levels at Bx = 9.3 ng/ml) n=90 pts P = P=0.122 P=0.020 P=0.004 Torres IB unpublished observation
33 CNI+MMF vs CNI +SRL Prospective randomized study (jun 2000-oct 2004) Basiliximab + stop steroids at 2 days Lesión CsA + MMF 50 CSA + SRL 50 TAC + MMF 50 TAC + SRL 50 BPAR % (1a) SCR% (1a) IF/TA % (5a) Kumar A et al. Transpl Immunol 2008; 20:32
34 CNI +MMF vs CNI +EVR 6 m protocol Bx historical cohort (N=51), experimental cohort (N=28) SCR ml/min/1.73m CNI + MMF CNI + EVR IF/TA CNI + MMF CNI + EVR egfr 0 CNI + MMF CNI + EVR Kanzelmeyer NK et al. Clin Transplant 2013; 27:319
35 Serón D et al. Kidney Int 2002;61:727 CsA minimisation & progression of IF/TA N=155 patients & 310 biopsies 0 4m 1y No progression (n=104) Progression (n=51) Donor age (years) 35 ± ± 15 NS DGF (%) NS AR (%) NS Mean CsA levels (1 st biopsy) Mean CsA levels (2 nd biopsy) NS 165 ± ± P
36 Tac Exposure and Evolution of Histology in the First Year After Transplantation (n=61 pairs of biopsies) Naesens M et al. AJT 2007;7:
37 Cumulative survival Tacrolimus minimisation and withdrawal after 1 year is associated with poor graft survival Kidney graft survival (serum creatinine <260µmol/L); both comparisons Years post-transplantation Tacrolimus: Continuation (n=1,736) Dose reduction (n=352) Withdrawal (n=296) Opelz G et al. Transplantation 2008;86:371
38 Inflammation and CNI free regimens 1y subclinical inflammation:concept trial n=121 pts CsA+MMF+P: continuation vs conversion to SRL at 3 m SRL CsA p N SCI (%) <0.01 Thierry A et al. AJT 2011; 11: 2153
39 Cumulative incidence of DSA Cumulative incidence of AbMR Liefeldt L et al. Am J Transplant 2012;12: CNI-free regimens are associated with an increased risk of DSA and antibodymediated rejection n=127 patients (Zeus and Crad001); CsA (n=66), everolimus (n=61) EVR CsA EVR CsA Time after transplantation (months) Time after transplantation (months)
40 Inflammation a driving force for fibrosis Prevention of early inflammation and progression of fibrosis Providing an adequate immunosuppression
41
42 Adherence in children and graft survival > 6m Medicacation possesion ratio Tx CNI based IS 4009 Graft survival > 6m 3908 Upper quartile 36 m follow up quartiles 36m claims database 877 Crisholm-Burns MA et al. Am J Transplant 2009; 9: 2497
43 Cause of graft failure and non adherence Sellares J et al. Am J Transplant 2012; 12:
44 Non-adherence is associated with poor graft survival in kidney transplantation Kaplan-Meier graft survival. The non-adherent group consisted of 19 patients (3 graft failures) and the adherent group consisted of 94 patients (2 graft failures) Tielen M et al. Am J Transplant 2014;Article
45 Non adherence Fine et al. Am J Transplant 2009; 9: 35
46 Evaluation of non adherence
47 Morisky scale yes (0) and no (1) MMAS-4 Do you ever forget to take your medicine? Are you careless at times about taking your medicine? Sometimes when you feel worse when you take the medicine, do you stop taking it? When you feel better do you sometimes stop taking your medicine?
48 Factors associated with non-adherence N=312 pts: Morisky scale > m 6m 12m 24m % NA Couzi et al et al. Transplantation 2013; 95: 326
49 Non adherence 18 y 73 %males 87 % cadaveric 87 % first Tx N=63% SMAQ 27 % BAASIS 30.2 %
50 Prospective randomized study: adherence contract vs conventional follow up Adherence (pharmacy refill records) Probability (%) NOT to be hospitalized Chisholm-Burns MA et al. Am J Transplant 2013; 13: 2364.
51 High variability in tacrolimus exposure is associated with increased incidence of rejection CV% of tacrolimus levels 100 CV% >41% OR=9.7, P= No rejection (n=36) Rejection (n=10) Hsiau M et al. Transplantation2011;92:918
52 Varaibility of TAC and outcome outcome variable: late AR, TG, graft loss Sapir-Pichhadze T et al. Kidney Int 2013; 85: 1404
53 Variability of TAC levels and inflammation Variable Tac CV (<26,7) n = Tac CV (26,7-43,8) n = Tac CV >43,8 n=28 p-value E GFR 57± 16 57± 13 53±17 ns g-score 0.06± ± ±0.33 ns i-score 0.17 ± ± ± Total i score 0.22± ± ± CD ± ±8 25± IB Torres et al Manuscript in preparation
54 Factors associated with non-adherence Socio-economic factors financial difficulties / lack of transportation Health organization barriers limited amount of time/patient, staff rotation Disease related factors depression and anxiety Therapy related factors side effects of drugs, complex dose regimens Patient related factors communication barriers, healt attitudes health beliefs and literacy Moreso F et al. (in press)
55 Improvements in correct dosing after conversion from TAC to ADV (n=219 pts) p= Kuypers et al. Transplantation 2013; 95: 333
56 Non adherence is more commonin the evening dose Kuypers et al. Transplantation 2013; 95: 333
57 Conversion from TAC to ADV n=1832 pts Conv 1:1 and 1 to 1.1 in pts with through levels < 6 ng(ml Guirado L et al. Am J Transplant 2011; 11: 1965
58 Var AUC 0-24 after conversion from TAC BID to TAC QD AUC 5 times before and 5 times after conversion (n=40) P =0.012 TAC ADV Var coeficient %14,1 Stifft F et al. Transplantation 2014;97: 775
59 Summary + inflammation Treatment + IF-TA i-ifta Chronic humoral rejection
60 Under-immunosuppression as a cause of chronic rejection and graft loss
61 61
James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant
James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant Program Has no real or apparent conflicts of interest
More informationLiterature Review: Transplantation July 2010-June 2011
Literature Review: Transplantation July 2010-June 2011 James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Kidney Transplant Top 10 List: July Kidney
More informationDSA Positive and then To biopsy or not?
DSA Positive and then To biopsy or not? Banff SCT 2017 29 March 2017 Peter Nickerson, MD, FRCPC, FCAHS Flynn Family Chair in Renal Transplantation Professor of Internal Medicine and Immunology Relevant
More informationRecognition and Treatment of Chronic Allograft Dysfunction
Recognition and Treatment of Chronic Allograft Dysfunction Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs
More informationLiterature Review Transplantation
Literature Review 2010- Transplantation Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of
More informationConsidering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol
Considering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol Patient details Name DOB ESRD Other history Mr. B.I.B. 12 January 1975 (34yo) Membranous GN
More informationInduction of donor-specific hyporesponsiveness after renal. transplantation. Long term follow-up
Induction of donor-specific hyporesponsiveness after renal transplantation. Long term follow-up Marc Lúcia, Oriol Bestard, Marcel la Franquesa, Josep M Cruzado, Montse Gomà, Núria Bolaños, Gema Cerezo,
More informationThe new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials
The new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials Carmen Lefaucheur 1 2 Banff 2015: Integration of HLA-Ab for improving
More informationWhy Do We Need New Immunosuppressive Agents
Why Do We Need New Immunosuppressive Agents 1 Reducing acute rejection rates has not transplanted into better long-term graft survival Incidence of early acute rejection episodes by era Relative risk for
More informationDiagnosis and Management of Acute and Chronic Humoral Rejection. Lars Pape
Diagnosis and Management of Acute and Chronic Humoral Rejection Lars Pape Immunosuppression Acute rejection Chronic rejection Side effects Infections Nephrotoxicity Adult population Nearly all late rejection-related
More informationCKD in Other Organ Transplants
CKD in Other Organ Transplants Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of Colorado
More informationCurrent Trends in Kidney Transplantation: The Role of Nonadherence
Current Trends in Kidney Transplantation: The Role of Nonadherence Donald E. Hricik, MD Professor of Medicine Case Western Reserve University Chief of the Division of Nephrology and Hypertension Medical
More informationManagement of Rejection
Management of Rejection I have no disclosures Disclosures (relevant or otherwise) Deborah B Adey, MD Professor of Medicine University of California, San Francisco Kidney and Pancreas Transplant Center
More informationFuture Webinars. Handouts 18/09/ Program-Handouts.aspx
Transplant Webinar Series: Ep. 9 Bio for Post-Transplant Immune Injury Future Webinars Link to register: https://immucor.webinato.com/register All Content 215 Immucor, Inc. Handouts http://www.immucor.com/en-us/pages/educational-
More informationTransplant Webinar Series: Ep. 9 Biomarkers for Post-Transplant Immune Injury
Transplant Webinar Series: Ep. 9 Biomarkers for Post-Transplant Immune Injury Future Webinars Link to register: https://immucor.webinato.com/register All Content 2015 Immucor, Inc. Handouts http://www.immucor.com/en-us/pages/educational-
More informationImmunopathology of T cell mediated rejection
Immunopathology of T cell mediated rejection Ibrahim Batal MD Columbia University College of Physicians & Surgeons New York, NY, USA Overview Pathophysiology and grading of TCMR TCMR is still a significant
More informationShould red cells be matched for transfusions to patients listed for renal transplantation?
Should red cells be matched for transfusions to patients listed for renal transplantation? Dr M.Willicombe Imperial College Renal and Transplant Centre, Hammersmith Hospital Should red cells be matched
More informationThe Banff Classification for Diagnosis of Renal Allograft Rejection: Updates from the 2017 Banff Conference
The Banff Classification for Diagnosis of Renal Allograft Rejection: Updates from the 2017 Banff Conference Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA Statement of Disclosure Mark
More informationHLA and Non-HLA Antibodies in Transplantation and their Management
HLA and Non-HLA Antibodies in Transplantation and their Management Luca Dello Strologo October 29 th, 2016 Hystory I 1960 donor specific antibodies (DSA): first suggestion for a possible role in deteriorating
More informationPathological back-ground of renal transplant pathology and important mile-stones of the Banff classification
Banff 1 Banff Pathological back-ground of renal transplant pathology and important mile-stones of the Banff classification Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital Morozumi Kunio,
More informationSELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
More informationImpact of Subclinical Rejection on Transplantation
Trends in Transplantation 2007;1:56-60 Impact of Subclinical Rejection on Transplantation David N. Rush for the Winnipeg Transplant Group Transplant Manitoba Adult Kidney Program, University of Manitoba,
More informationControversies in Renal Transplantation. The Controversial Questions. Patrick M. Klem, PharmD, BCPS University of Colorado Hospital
Controversies in Renal Transplantation Patrick M. Klem, PharmD, BCPS University of Colorado Hospital The Controversial Questions Are newer immunosuppressants improving patient outcomes? Are corticosteroids
More informationKidney transplantation 2016: current status and potential challenges
Kidney transplantation 2016: current status and potential challenges 15/12/2016 BVN-SBN : State-of-the-Art on Kidney Transplantation Patrick Peeters Ghent University Hospital, Belgium Challenges in 2016
More informationStatement of Disclosure
Statement of Disclosure Mark Haas serves as a paid consultant on pathology adjudication committees for two industry-sponsored clinical trials: Shire ViroPharma Treatment of Acute ABMR AstraZeneca Treatment
More informationHow to improve long term outcome after liver transplantation?
How to improve long term outcome after liver transplantation? François Durand Hepatology & Liver Intensive Care University Paris Diderot INSERM U1149 Hôpital Beaujon, Clichy PHC 2018 www.aphc.info Long
More information2017 BANFF-SCT Joint Scientific Meeting. Personalized Medicine in Liver Transplantation
2017 BANFF-SCT Joint Scientific Meeting Personalized Medicine in Liver Transplantation Miquel Navasa Liver Transplant Unit. Hospital Clínic. Barcelona. Barcelona, March 2017 Disclosures Consultant for
More informationBiopsy Features of Kidney Allograft Rejection Banff B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Biopsy Features of Kidney Allograft Rejection Banff 2017 B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary Treatment of allograft dysfunction should rely on the biopsy findings
More informationKidney Allograft Fibrosis and Atrophy Early After Living Donor Transplantation
American Journal of Transplantation 2005; 5: 1130 1136 Blackwell Munksgaard Copyright C Blackwell Munksgaard 2005 doi: 10.1111/j.1600-6143.2005.00811.x Kidney Allograft Fibrosis and Atrophy Early After
More informationSteroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
More informationNew-onset diabetes after transplantation. Christophe Legendre Université Paris Descartes & Hôpital Necker, Paris.
New-onset diabetes after transplantation Christophe Legendre Université Paris Descartes & Hôpital Necker, Paris. Actualités Jean Hamburger Paris, 23-24 avril 2012 NODAT IFG IGT CJ Yates et al, Am J Transplant
More informationDesensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver
Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney
More informationRenal Pathology- Transplantation. Eva Honsova Institute for Clinical and Experimental Medicine Prague, Czech Republic
Renal Pathology- Transplantation Eva Honsova Institute for Clinical and Experimental Medicine Prague, Czech Republic eva.honsova@ikem.cz Kidney has a limited number of tissue reactions by which the kidney
More informationUpdate on Transplant Glomerulopathy
Update on Transplant Glomerulopathy Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Division of Nephrology, Department of Medicine University of Tennessee Health Science Center
More informationChronic Calcineurin Inhibitor Nephrotoxicity: Myth or Reality?
Chronic Calcineurin Inhibitor Nephrotoxicity: Myth or Reality? Aji Djamali, MD Associate Professor of Medicine and Surgery Division Chief Nephrology University of Wisconsin School of Medicine and Public
More informationPathology and Management of Chronic Allograft Dysfunction. Simin Goral, MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Pathology and Management of Chronic Allograft Dysfunction Simin Goral, MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Mission Impossible? PLAN To review the description of chronic
More informationSubclinical Rejection: The Sword of Damocles in Renal Transplantation?
Subclinical Rejection: The Sword of Damocles in Renal Transplantation? John Lyons, PharmD PGY-2 Solid Organ Transplant Pharmacy Resident University Health System, San Antonio, TX Division of Pharmacotherapy,
More informationLiver transplantation issues in 2018 Minimisation of immunosuppression in the long term : what is it for?
Liver transplantation issues in 2018 Minimisation of immunosuppression in the long term : what is it for? Chairs: Didier SAMUEL (France) Pierre-Alain CLAVIEN (Switzerland) Speakers: Dominique THABUT (France)
More informationChronic Active TCMR: clinical implications
Chronic Active TCMR: i, iatr, i-ifta, and the clinical implications Roslyn B. Mannon, M.D. Professor of Medicine, Division of Nephrology Professor of Surgery, Division of Transplantation Director of Research,
More informationSCORING OF i-ifta: POTENTIAL RULES & ROLE IN CHRONIC TCMR
SCORING OF i-ifta: POTENTIAL RULES & ROLE IN CHRONIC TCMR Parmjeet Randhawa, MD Professor of Pathology The Thomas E Starzl Transplantation Institute University of Pittsburgh . I HAVE NO CONFLICTS OR FINANCIAL
More informationLe Rejet Humoral Chronique en 2010: Histoire naturelle et problématiques
Le Rejet Humoral Chronique en 2010: Histoire naturelle et problématiques CAMR in 2010: natural history and perspectives Alexandre Loupy 1 Introduction 2 CAMR: the missing link 3 Natural history of CAMR
More informationHLA Part II: My Patient Has DSA, Now What?
2017 CST-Astellas Canadian Transplant Fellows Symposium HLA Part II: My Patient Has DSA, Now What? James Lan, MD, FRCPC, D(ABHI) Dr. Lan completed his nephrology training at the University of British Columbia.
More information2017 CST-Astellas Canadian Transplant Fellows Symposium. Management of Renal Dysfunction in Extra Renal Transplants
2017 CST-Astellas Canadian Transplant Fellows Symposium Management of Renal Dysfunction in Extra Renal Transplants Jeffrey Schiff, MD Dr. Jeffrey Schiff is an Assistant Professor of Medicine at the University
More informationAlemtuzumab-based induction treatment versus basiliximab based induction treatment in kidney transplantation (the 3C Study): a randomised trial
Alemtuzumab-based induction treatment versus basiliximab based induction treatment in kidney transplantation (the 3C Study): a randomised trial Journal club Feb 2014 Background and Rationale Despite substantial
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/29755 holds various files of this Leiden University dissertation. Author: Moes, Dirk Jan Alie Roelof Title: Optimizing immunosuppression with mtor inhibitors
More informationPleiotropic effects of mtor inhibitors : cardiovascular and cancer. Dr Paolo Malvezzi Clinique de Néphrologie CHU Grenoble
Pleiotropic effects of mtor inhibitors : cardiovascular and cancer Dr Paolo Malvezzi Clinique de Néphrologie CHU Grenoble Tehran August 2016 Why this topic? Since last year very little news in the immunosuppressive
More informationUtility of protocol kidney biopsies for de novo donor- specific antibodies
Received: 6 June 2017 Revised: 24 July 2017 Accepted: 29 July 2017 DOI: 10.1111/ajt.14466 BRIEF COMMUNICATION Utility of protocol kidney biopsies for de novo donor- specific antibodies Sandesh Parajuli
More informationOUT OF DATE. Choice of calcineurin inhibitors in adult renal transplantation: Effects on transplant outcomes
nep_734.fm Page 88 Friday, January 26, 2007 6:47 PM Blackwell Publishing AsiaMelbourne, AustraliaNEPNephrology1320-5358 2006 The Author; Journal compilation 2006 Asian Pacific Society of Nephrology? 200712S18897MiscellaneousCalcineurin
More informationDonor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients
Donor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients Stanley C. Jordan, MD Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical
More informationDix ans de transplantation rénale Fonds Boussard
Dix ans de transplantation rénale Fonds Boussard Groupe Spiesser A.T.N. Christophe Legendre, Hôpital Necker & Université Paris Descartes, Paris Fondation Day-Solvay Actualités Néphrologiques Jean Hamburger
More informationIntruduction PSI MODE OF ACTION AND PHARMACOKINETICS
Multidisciplinary Insights on Clinical Guidance for the Use of Proliferation Signal Inhibitors in Heart Transplantation Andreas Zuckermann, MD et al. Department of Cardio-Thoracic Surgery, Medical University
More informationKidneytransplant pathologyrelatedto immunosuppressiveagents
Kidneytransplant pathologyrelatedto immunosuppressiveagents Helmut Hopfer Pathologie Women, 53 years old. 16 months after kidney transplantation for diabetic nephropathy. Metabolicsyndromeandcoronaryheartdisease.
More informationReview of Rituximab and renal transplantation. Dr.E Nemati. Professor of Nephrology
Review of Rituximab and renal transplantation Dr.E Nemati Professor of Nephrology Introductio n Rituximab is a chimeric anti-cd20 monoclonal antibody. The CD20 antigen is a transmembrane nonglycosylated
More informationTransplantation: Year in Review
Transplantation: Year in Review Alexander Wiseman, MD Medical Director, Kidney and Pancreas Transplant Program Associate Professor, Division of Renal Diseases and Hypertension University of Colorado Outline:
More informationCase Report Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration Rate
Case Reports in Transplantation, Article ID 190516, 4 pages http://dx.doi.org/10.1155/2014/190516 Case Report Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration
More informationVictims of success: Do we still need clinical trials? Robert S. Gaston, MD CTI Clinical Trials and Consulting University of Alabama at Birmingham
Victims of success: Do we still need clinical trials? Robert S. Gaston, MD CTI Clinical Trials and Consulting University of Alabama at Birmingham Disclosure Employee: CTI Clinical Trials and Consulting
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Lefaucheur C, Loupy A, Vernerey D, et al. Antibody-mediated
More informationUpdate on Transplant Glomerulopathy
Update on Transplant Glomerulopathy Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Methodist University Hospital, Transplant Institute Division of Transplantation, Department
More informationEARLY VERSUS LATE STEROID WITHDRAWAL Julio Pascual, Barcelona, Spain Chairs: Ryszard Grenda, Warsaw, Poland
EARLY VERSUS LATE STEROID WITHDRAWAL Julio Pascual, Barcelona, Spain Chairs: Ryszard Grenda, Warsaw, Poland Julio Pascual, Barcelona, Spain Prof. Julio Pascal Hospital del Mar Nephrology Department Barcelona,
More informationABO-incompatible kidney transplantation in elderly patients over 60 years of age
Int Urol Nephrol (2012) 44:1563 1570 DOI 10.1007/s11255-012-0231-z NEPHROLOGY - ORIGINAL PAPER ABO-incompatible kidney transplantation in elderly patients over 60 years of age Junji Uchida Tomoaki Iwai
More informationThe causes, significance and consequences of inflammatory fibrosis in kidney transplantation: The Banff i- IFTA lesion
Received: 31 May 2017 Revised: 25 October 2017 Accepted: 28 October 2017 DOI: 10.1111/ajt.14609 ORIGINAL ARTICLE The causes, significance and consequences of inflammatory fibrosis in kidney transplantation:
More informationChronic Renal Allograft Dysfunction An unsolved problem
hronic Renal Allograft Dysfunction An unsolved problem Johan (Hans) W. de Fijter, D, PhD Professor of edicine and Nephrology Director of the Kidney and the Pancreas Transplant Program eiden niversity edical
More informationWhat is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham
What is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham SYMPHONY Study Ekberg et al. NEJM 2008 Excluded: DCD kidneys; CIT>30hours;
More informationPrecision Medicine and not Individualized Therapy is Required for Successful Novel Drug Development
Precision Medicine and not Individualized Therapy is Required for Successful Novel Drug Development 1 Disclosures F Vincenti University of California San Francisco, San Francisco, United States I have
More informationA Balancing Act: June 12, :00 PM 2:15 PM Sheraton Boston Hotel Republic Ballroom. Immunosuppression in Transplant Medicine.
June 12, 2016 1:00 PM 2:15 PM Sheraton Boston Hotel Republic Ballroom A Balancing Act: Immunosuppression in Transplant Medicine Supported by an educational grant from Novartis Pharmaceuticals Corporation
More informationBK virus infection in renal transplant recipients: single centre experience. Dr Wong Lok Yan Ivy
BK virus infection in renal transplant recipients: single centre experience Dr Wong Lok Yan Ivy Background BK virus nephropathy (BKVN) has emerged as an important cause of renal graft dysfunction in recent
More informationBetter than Google- Click on Immunosuppression Renal Transplant. David Landsberg Oct
Better than Google- Click on Immunosuppression Renal Transplant David Landsberg Oct 3 2008 OUTLINE History of Immunosuppression Trends in Immunosupression FK vs CYA Steroid Minimization CNI Avoidance Sirolimus
More informationDoes the formulation of tacrolimus matter?
Does the formulation of tacrolimus matter? This promotional meeting has been fully funded and organised by Astellas Pharma Ltd and Astellas products will be discussed. PI can be found at the end of this
More informationTreatment of Late and Mixed Rejection
Kidney 1: Significance of i-ifta, revisiting TCMR & mixed rejection Treatment of Late and Mixed Rejection Brian J. Nankivell Westmead Hospital, Sydney No conflicts of interest Some off label discussions
More informationProgressive histological damage in renal allografts is associated with expression of innate and adaptive immunity genes
http://www.kidney-international.org & 2011 International Society of Nephrology see commentary on page 1254 Progressive histological damage in renal allografts is associated with expression of innate and
More informationWhy we need a new paradigm in immunosuppression USHERING A NEW ERA OF IMMUNOSUPPRESSION. Causes of death and graft loss after kidney transplantation
USHERING A NEW ERA OF IMMUNOSUPPRESSION Flavio Vincenti 45 35 AR 3 (%) 25 15 5 35.7 Why we need a new paradigm in immunosuppression Incidence of early acute rejection episodes ( 6 months) 43.7 27.4 17.9
More informationCombination of a Calcineurin Inhibitor and a Mammalian Target of Rapamycin Inhibitor: Not So Nephrotoxic As We Thought?
Trends in Transplant. 2011;5:49-56Helio Tedesco Silva Junior: Calcineurin and mtor inhibitor nephrotoxicity Combination of a Calcineurin Inhibitor and a Mammalian Target of Rapamycin Inhibitor: Not So
More informationThe Histology of Solitary Renal Allografts at 1 and 5 Years After Transplantation
American Journal of Transplantation 2011; 11: 698 707 Wiley Periodicals Inc. C 2010 CSIRO C 2010 The Authors Journal compilation C 2010 The American Society of Transplantation and the American Society
More informationLong-term prognosis of BK virus-associated nephropathy in kidney transplant recipients
Original Article Kidney Res Clin Pract 37:167-173, 2018(2) pissn: 2211-9132 eissn: 2211-9140 https://doi.org/10.23876/j.krcp.2018.37.2.167 KIDNEY RESEARCH AND CLINICAL PRACTICE Long-term prognosis of BK
More informationEffects of Tacrolimus Pharmacokinetic Variability on Acute Rejection and Long-Term Graft Function after Kidney Transplantation
: Journal of Student Solutions to Pharmacy Challenges Volume 1 Issue 1 Article 4 2017 Effects of Tacrolimus Pharmacokinetic Variability on Acute Rejection and Long-Term Graft Function after Kidney Transplantation
More informationPost-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies
Post-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies Lorita M Rebellato, Ph.D., D (ABHI) Associate Professor Department of Pathology The Brody School of Medicine at ECU Scientific
More informationPDF of Trial CTRI Website URL -
Clinical Trial Details (PDF Generation Date :- Sat, 09 Mar 2019 16:29:06 GMT) CTRI Number CTRI/2010/091/000679 [Registered on: 23/08/2010] - Last Modified On 10/07/2015 Post Graduate Thesis Type of Trial
More informationReview Article The Role of mtor Inhibitors in Liver Transplantation: Reviewing the Evidence
Hindawi Publishing Corporation Journal of Transplantation Volume 2014, Article ID 845438, 45 pages http://dx.doi.org/10.1155/2014/845438 Review Article The Role of mtor Inhibitors in Liver Transplantation:
More informationPathology of Kidney Allograft Dysfunction. B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Pathology of Kidney Allograft Dysfunction B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary The gold standard for exploration of the cause of an allograft dysfunction is to perform
More informationEarly Conversion from a Calcineurin Inhibitor-Based Regimen to Everolimus-Based Immunosuppression after Kidney Transplantation
Trends in Transplantation Transplant. 2012;6:28-33 Early Conversion from a Calcineurin Inhibitor-Based Regimen to Everolimus-Based Immunosuppression after Kidney Transplantation Hallvard Holdaas Department
More informationSirolimus versus Calcineurin Inhibitor-based Immunosuppressive Therapy in Kidney Transplantation A 4-year Follow-up
Transplantation Sirolimus versus Calcineurin Inhibitor-based Immunosuppressive Therapy in Kidney Transplantation A 4-year Follow-up Mohsen Nafar, 1 Behrang Alipour, 2 Pedram Ahmadpoor, 1 Fatemeh Pour-Reza-Gholi,
More informationMonitoring of human uterus transplantation with cervical biopsies - a provisional scoring system for rejection. Johan Mölne
Monitoring of human uterus transplantation with cervical biopsies - a provisional scoring system for rejection. Johan Mölne Department of Pathology and Genetics, Sahlgrenska Academy, University of Gothenburg,
More informationE possibile creare un ambiente tollerogenico dopo il trapianto d organo utilizzando cellule staminali come se fossero farmaci?
E possibile creare un ambiente tollerogenico dopo il trapianto d organo utilizzando cellule staminali come se fossero farmaci? Giuseppe Remuzzi 1 Infections & Transplantation Varese, 18 maggio 2017 LONG
More informationManagement of a Recipient with a Failed Kidney Transplant. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Management of a Recipient with a Failed Kidney Transplant Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Objectives Epidemiology of transplant failure Timing of dialysis
More informationIntroduction and Overview of the Current Landscape on Organ Donation and Transplantation in Canada Jag Gill, MD
2017 CST-Astellas Canadian Transplant Fellows Symposium Introduction and Overview of the Current Landscape on Organ Donation and Transplantation in Canada Jag Gill, MD Dr. Gill graduated from Medicine
More informationKidney Summary. Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA
Kidney Summary Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA Key Issues to Address re: the Classification 1. Incorporation of i-ifta + tubulitis into the TCMR classification - Defining
More informationTreatment of Chronic Antibody Mediated Rejection
Treatment of Chronic Antibody Mediated Rejection Robert A. Montgomery MD, DPhil Professor of Surgery Director of the NYU Langone Transplant Institute Disclosures: Served on Advisory Boards for Genentech
More informationDonor-Specific HLA Antibodies in a Cohort Comparing Everolimus With Cyclosporine After Kidney Transplantation
American Journal of Transplantation 2012; 12: 1192 1198 Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2011.03961.x
More informationIMMUNOBIOLOGY OF TRANSPLANTATION. Wasim Dar
IMMUNOBIOLOGY OF TRANSPLANTATION Wasim Dar Immunobiology of Transplantation Overview Transplantation: A complex immunologic process Contributions Innate Immunity Adaptive immunity T Cells B Cells HLA Consequences
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/29755 holds various files of this Leiden University dissertation. Author: Moes, Dirk Jan Alie Roelof Title: Optimizing immunosuppression with mtor inhibitors
More informationRisk factors associated with the deterioration of renal function after kidney transplantation
Kidney International, Vol. 68, Supplement 99 (2005), pp. S113 S117 Risk factors associated with the deterioration of renal function after kidney transplantation DANIEL SERÓN, XAVIER FULLADOSA, and FRANCESC
More informationProteinuria and Mammalian Target of Rapamycin Inhibitors in Renal Transplantation
Trends Fritz in Transplant. Diekmann: 2011;5:139-43 Proteinuria and Mammalian Target of Rapamycin Inhibitors in Renal Transplantation Proteinuria and Mammalian Target of Rapamycin Inhibitors in Renal Transplantation
More informationEmerging Drug List EVEROLIMUS
Generic (Trade Name): Manufacturer: Everolimus (Certican ) Novartis Pharmaceuticals NO. 57 MAY 2004 Indication: Current Regulatory Status: Description: Current Treatment: Cost: Evidence: For use with cyclosporine
More informationCase Presentation Turki Al-Hussain, MD
Case Presentation Turki Al-Hussain, MD Director, Renal Pathology Chapter Saudi Society of Nephrology & Transplantation Consultant Nephropathologist & Urological Pathologist Department of Pathology & Laboratory
More informationEfficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function
ArtIcle Efficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function Guodong Chen, 1 Jingli Gu, 2 Jiang Qiu, 1 Changxi
More informationSupporting a Pediatric Investigational Plan for Everolimus - Defining the extrapolation plan
Supporting a Pediatric Investigational Plan for Everolimus - Defining the extrapolation plan Thomas Dumortier, Mick Looby Novartis Pharma AG, Basel, Switzerland EMA public workshop on extrapolation of
More informationHeart Transplant: State of the Art. Dr Nick Banner
Heart Transplant: State of the Art Dr Nick Banner Heart Transplantation What is achieved Current challenges Donor scarcity More complex recipients Long-term limitations Non-specific Pharmacological Immunosuppression
More informationOverview of New Approaches to Immunosuppression in Renal Transplantation
Overview of New Approaches to Immunosuppression in Renal Transplantation Ron Shapiro, M.D. Professor of Surgery Surgical Director, Kidney/Pancreas Transplant Program Recanati/Miller Transplantation Institute
More informationThe diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk factor for graft loss
http://www.kidney-international.org 2015 International Society of Nephrology see commentary on page 218 The diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk
More information