What is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham
|
|
|
- Bryce Stanley
- 5 years ago
- Views:
Transcription
1 What is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham
2
3 SYMPHONY Study Ekberg et al. NEJM 2008
4 Excluded: DCD kidneys; CIT>30hours; PRA>20%; positive cross match; retransplantwhere 1 st graft lost to AR within first year All received MMF and steroid Basiliximab to all except standard dose Cyclosporine
5 SYMPHONY Study: Acute Rejection
6 SYMPHONY Study
7 SYMPHONY Study
8 SYMPHONY Study
9 SYMPHONY Study Anti CD25 mab Tacrolimus MMF Steroid
10
11 Alternative Induction Agents Alternative CNI or CNI avoidance MMF or AZA? Steroids or Steroid Avoidance?
12 1. Induction or no induction and which agent?
13 Anti CD25 mab induction meta analysis: acute rejection Adu et al. BMJ 2003
14 Anti CD25 mabinduction meta analysis: Graft Failure Adu et al. BMJ 2003
15 Another Anti CD25 mab induction meta analysis: 24 Studies Anti CD25mAb versus Placebo Death Censored Graft Failure at 1 year (24 studies) Reduced Overall Graft failure Reduced Death No difference Webster AC et al. Transplantation 2004; Webster AC et al. Cochrane Review 2010
16 Another Anti CD25 mab induction meta analysis: 24 Studies Anti CD25mAb versus Placebo Death Censored Graft Failure at 1 year (24 studies) Reduced Overall Graft failure Reduced Death No difference BPAR within 1 st year Reduced Malignancy within 6 months CMV disease within 1 st year Decreased Decreased Webster AC et al. Transplantation 2004; Webster AC et al. Cochrane Review 2010
17 Is there a further advantage with ALG induction over anti CD25 mab: meta analysis ALG versus Anti CD25mAb in allcomers BPAR within 1 st year 30% reduction Death Censored Graft Failure No difference Overall Graft failure No difference Death No difference Malignancy Increased CMV disease within 1 st year Increased Webster AC et al. Transplantation 2004; Webster AC et al. Cochrane Review 2010
18
19 Anti CD25 versus ALG in High Immune Risk Settings: Noel et al. JASN 2009 Current PRA>30% Peak PRA>50% 2 nd Transplant with 1 st lost to Acute Rejection 3 rd or 4 th Transplant (Cytotoxic cross match negative) Thymoglobulin versus Daclizumab Tacrolimus MMF Steroid
20 Anti CD25 versus ALG in High Immune Risk Settings: Noel et al. JASN 2009
21
22 Anti CD25 mabinduction meta analysis: Do we need it in low immune risk settings Anti CD25mAb versus placebo (11 studies) BPAR within 1 st year 32% reduction Death Censored Graft Failure No difference Overall Graft failure No difference Death No difference Malignancy No difference CMV disease within 1 st year No difference Webster AC et al. Cochrane Review 2010
23 Alemtuzumab( Campath ; anti CD52 mab) Morgan et al. Transplantation 2012
24 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
25 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
26 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
27 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
28 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
29 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
30 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
31 Alemtuzumab( Campath ) Morgan et al. Transplantation 2012
32
33
34
35
36
37
38 INTAC Study Hanawayet al. NEJM 2011
39 INTAC Study Excluded: ECD and DCD kidneys; CIT>36 hours; positive cross match; fully matched live donor First Transplant and Peak or Current PRA<20% and Not Black Race Not low risk!
40 INTAC Study Rejection Graft Failure Death
41 INTAC Study: Adverse Events
42 INTAC Study
43 INTAC Study Increased rates of late biopsyproven acute rejection: 8% vs 2% (p=0.03)
44 INTAC Study: Lymphocyte repopulation
45 Alemtuzumab compared with alternative contemporary induction regimens LaMattina et al. Transplant International 2012 UW experience Campath(n=632; ) Basiliximab(n=690; low risk ) ATG (n=125; high risk ) Campath vs Other Overall Graft Survival Decreased 1 st Deceased Donor Graft Survival Decreased Repeat Deceased Donor Graft Survival Decreased 1 st Live Donor Graft Survival Decreased Antibody Associated Rejection Increased Overall Infection Increased CMV infection Increased Death due to Infection Increased Patient Survival Same
46 Alemtuzumab compared with alternative contemporary induction regimens LaMattina et al. Transplant International 2012 UW experience Campath(n=632; ) Basiliximab(n=690; low risk ) ATG (n=125; high risk ) Campath vs Other Overall Graft Survival Decreased 1 st Deceased Donor Graft Survival Decreased Repeat Deceased Donor Graft Survival Decreased 1 st Live Donor Graft Survival Decreased Antibody Associated Rejection Increased Overall Infection Increased CMV infection Increased Death due to Infection Increased Patient Survival Same
47 Rituximab(anti CD20 mab) Rituximab versus Daclizumab Tacrolimus; MMF; Induction MP only Clatworthy. NEJM 2009
48 Rituximab(anti CD20) Rituximab versus Placebo Tacrolimus; MMF; Steroid Transplantation 2009
49 2. Choice of CNI Tacrolimus versus Ciclosporin
50 Tacrolimus versus Ciclosporin meta analysis: Acute rejection Webster et al. BMJ 2005
51 Tacrolimus versus Ciclosporin meta analysis: Death censored graft failure
52 Tacrolimus versus Ciclosporin meta analysis: Death censored graft failure Meta-regression p=0.04
53 Tacrolimus versus Ciclosporin meta analysis: Death censored graft failure Meta-regression p=0.04
54 SYMPHONY Study
55 SYMPHONY Study vs vs
56 3. Can we avoid CNIsaltogether de novo?
57 CNI versus mtori meta analysis: Overall graft failure Sharif et al JASN 2011
58 CNI versus new agents meta analysis: Overall graft failure CP 690,550 Tazocitinib Belatacept Tofacitinib Sharif et al JASN 2011
59 4. Alternative adjunctive antimetabolites Azathioprine versus Mycophenolate
60 Meta analysis: Mycophenolate versus Azathioprine 3143 patients 19 studies CNI: Neoral or Tacrolimus MMF versus Azathioprine Transplantation 2009 MMF vs Azathioprine Acute Rejection Decreased (0.62[95%CI: ]) Overall Graft Failure Decreased (0.76[95%CI: ]) Mortality No difference Transplant Function No difference Infection No difference CMV No difference Anaemia No difference Leucopaemia No difference Malignancy No difference Diarrhoea Increased
61 5. Steroid avoidance
62 Steroid avoidance or withdrawal: a meta analysis 34 RCTs (n=5637 patients) Knight and Morris. Transplantation 2010 Acute Rejection
63
64 However... Hypercholesterolaemia NODAT
65 N=397 Exclusions Rejection or dialysis in first 7 days; n=5 (five!) Current PRA>25% CIT>36 hours 55% live donor Ann Surgery 2008
66 Early corticosteroid withdrawal (Day 7) versus 5mg prednisolone maintainance Woodleet al. Ann Surgery 2008 Biopsy confirmed Moderate/Severe Acute Rejection Graft Failure Death No difference No difference No difference
67 Metabolic complications through 5 years
68 Metabolic complications through 5 years Hypolipidaemic Agent commencement and ongoing therapy Lower (50% vs 67%; p=0.04) NODAT No difference (21.5 vs 21%) Insulin requirement Lower (3.7 vs 11.6%; p=0.05) Bone Complications Lower (5% vs 11%; p=0.04) Cataract No difference Weight Gain (median) Less (5.1 vs 7.7kg)
69
70 Acute rejection Biopsy confirmed Rejection For cause Biopsies Biopsiesshowing Chronic Allograft Nephropathy Increased Increased Increased Risk Factors for Graft Loss Acute Rejection RR: 5.0; 95% CI: ; p=0.003 CAN RR: 41; 95% CI: ; p<0.001
71 In Summary
72 So what is the best induction immunosuppression regimen? 1] Anti CD25 mab induction reduces rejection and graft failure 2] ATG and Campath further reduce rejection but not graft failure, and an increase in toxicity 3] The spectre of late rejection and antibody-associated rejection remains with Campath 4] Further data on Rituximab required 5] Tacrolimus reduces rejection compared with Ciclosporin 6] This may not translate into a clinically relevant reduction in graft survival in low dose setting 7] CNI avoidance with mtori is fraught 8] Newer Agents improve graft survival and may herald breakthrough of true CNI avoidance 9] MMF reduces rejection and graft failure compared with Azathioprine 10] Steroid avoidance is associated with increased rates of rejection 11] Metabolic complications of 5mg prednisolone are slight / manageable
73
American Journal of Transplantation 2009; 9 (Suppl 3): S1 S157 Wiley Periodicals Inc.
American Journal of Transplantation 2009; 9 (Suppl 3): S1 S157 Wiley Periodicals Inc. 2009 The Authors Journal compilation 2009 The American Society of Transplantation and the American Society of Transplant
Overview 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
Controversies 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
SELECTED 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
Literature 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
Tolerance Induction in Transplantation
Tolerance Induction in Transplantation Reza F. Saidi, MD, FACS, FICS Assistant Professor of Surgery Division of Organ Transplantation Department of Surgery University of Massachusetts Medical School Percent
Immunopathology 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
BK 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
OUT 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
Steroid 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,
Victims 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
Alemtuzumab-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
The addition of anti-cd25 antibody induction to standard immunosuppressive therapy for kidney transplant recipients GUIDELINES SEARCH STRATEGY
nep_2.fm Page 5 Friday, January 26, 200 6:46 PM Blackwell Publishing AsiaMelbourne, AustraliaNEPNephrology120-558 2006 The Author; Journal compilation 2006 Asian Pacific Society of Nephrology? 20012S1584MiscellaneousCalcineurin
Better 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
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 30 November 2011
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 30 November 2011 NULOJIX 250 mg, powder for concentrate for solution for infusion B/1 (CIP code: 580 415-7) B/2 (CIP
Kidney 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
Transplantation in Australia and New Zealand
Transplantation in Australia and New Zealand Matthew D. Jose MBBS (Adel), FRACP, FASN, PhD (Monash), AFRACMA Professor of Medicine, UTAS Renal Physician, Royal Hobart Hospital Overview CKD in Australia
Transplantation: 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:
TRANSPLANT IMMUNOLOGY. Shiv Pillai Ragon Institute of MGH, MIT and Harvard
TRANSPLANT IMMUNOLOGY Shiv Pillai Ragon Institute of MGH, MIT and Harvard Outline MHC / HLA Direct vs indirect allorecognition Alloreactive cells: where do they come from? Rejection and Immunosuppression
Immunosuppressant medicines have allowed patients
48 Clinical Pharmacist February 2010 Vol 2 Patients who tolerate a transplanted organ without the need for pharmacological intervention are few and far between. Several immunosuppressants can be used to
Emerging 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
EARLY 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,
Chapter 22: Hematological Complications
Chapter 22: Hematological Complications 22.1: Perform a complete blood count at least (Not Graded): daily for 7 days, or until hospital discharge, whichever is earlier; two to three times per week for
Transplantation simplified. Dr Jasna Macanovic Consultant Nephrologist Wessex Renal and Transplant Services Portsmouth, UK
Transplantation simplified Dr Jasna Macanovic Consultant Nephrologist Wessex Renal and Transplant Services Portsmouth, UK HISTORY The first successful kidney transplant was performed in 1954 between identical
ASSESSMENT OF THE PAEDIATRIC NEEDS IMMUNOLOGY DISCLAIMER
European Medicines Agency Evaluation of Medicines for Human Use London, September 2006 Doc. Ref.: EMEA/381922/2006 ASSESSMENT OF THE PAEDIATRIC NEEDS IMMUNOLOGY DISCLAIMER The Paediatric Working Party
European Risk Management Plan. Measures impairment. Retreatment after Discontinuation
European Risk Management Plan Table 6.1.4-1: Safety Concern 55024.1 Summary of Risk Minimization Measures Routine Risk Minimization Measures Additional Risk Minimization Measures impairment. Retreatment
CAMPATH INDUCTION IN RENAL TRANSPLANTATION. by Kakit Edmond Chan. Thesis is submitted for the degree of MD [Res] of Imperial College London
![CAMPATH INDUCTION IN RENAL TRANSPLANTATION. by Kakit Edmond Chan. Thesis is submitted for the degree of MD [Res] of Imperial College London](/thumbs/80/80968355.jpg "CAMPATH INDUCTION IN RENAL TRANSPLANTATION. by Kakit Edmond Chan. Thesis is submitted for the degree of MD [Res] of Imperial College London")
CAMPATH INDUCTION IN RENAL TRANSPLANTATION by Kakit Edmond Chan Thesis is submitted for the degree of MD [Res] of Imperial College London Department of Medicine Imperial College London kkchan 1 Abstract
New-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
Renal Transplant Past Present and Future David Landsberg
2012 Renal Transplant Past Present and Future David Landsberg Outline Changing pattern of Donors Types of Donors Allocation Results Challenges in the Elderly LDPE Transplants By Year LD LRD LUD NDAD DD
Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant
SDC, Patients and Methods Complement-dependent lymphocytotoxic crossmatch test () Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant donor-specific CXM was
Long term liver transplant management
Long term liver transplant management Dr Bill Griffiths Cambridge Liver Unit Royal College of Physicians 5.7.17 Success of Liver Transplantation Current survival, 1 st elective transplant: 1 yr survival
Literature 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
Induction Therapy for Kidney Transplant Recipients: Do We Still Need Anti-IL2 Receptor Monoclonal Antibodies?
American Journal of Transplantation 2017; 17: 22 27 Wiley Periodicals Inc. Minireview 2016 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of American Society
Considering 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
Chapter 4: Steroid-resistant nephrotic syndrome in children Kidney International Supplements (2012) 2, ; doi: /kisup.2012.
http://www.kidney-international.org & 2012 KDIGO Chapter 4: Steroid-resistant nephrotic syndrome in children Kidney International Supplements (2012) 2, 172 176; doi:10.1038/kisup.2012.17 INTRODUCTION This
For Immediate Release Contacts: Jenny Keeney Astellas US LLC (847)
For Immediate Release Contacts: Jenny Keeney Astellas US LLC (847) 317-5405 Lauren McDonnell GolinHarris (312) 729-4233 ASTELLAS RECEIVES FDA APPROVAL FOR USE OF PROGRAF (TACROLIMUS) IN CONJUNCTION WITH
Immunosuppressants. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Immunosuppressants Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Immunosuppressive Agents Very useful in minimizing the occurrence of exaggerated or inappropriate
Rabbit Antithymocyte Globulin (Thymoglobulin Ò )
REVIEW ARTICLE Drugs 2010; 70 (6): 691-732 0012-6667/10/0006-0691/$55.55/0 ª 2010 Adis Data Information BV. All rights reserved. Rabbit Antithymocyte Globulin (Thymoglobulin Ò ) 25 Years and New Frontiers
Progress in Pediatric Kidney Transplantation
Send Orders for Reprints to reprints@benthamscience.net The Open Urology & Nephrology Journal, 214, 7, (Suppl 2: M2) 115-122 115 Progress in Pediatric Kidney Transplantation Jodi M. Smith *,1 and Vikas
Significance of Basiliximab Induction Therapy in Standard-Risk Renal Transplant in Tacrolimus Era: A Meta-Analysis
Significance of Basiliximab Induction Therapy in Standard-Risk Renal Transplant in Tacrolimus Era: A Meta-Analysis Hatem Ali 1,2, Atif Mohiuddin 2,3, Ajay Sharma 2,3, Mohsen El Kosi 2,4 and Ahmed Halawa
Why 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
CHAPTER 3 HEART AND LUNG TRANSPLANTATION. Editors: Mr. Mohamed Ezani Hj Md. Taib Dato Dr. David Chew Soon Ping
CHAPTER 3 Editors: Mr. Mohamed Ezani Hj Md. Taib Dato Dr. David Chew Soon Ping Expert Panel: Tan Sri Dato Dr. Yahya Awang (Chair) Mr. Mohamed Ezani Hj Md. Taib (Co-chair) Datin Dr. Aziah Ahmad Mahayiddin
clevelandclinic.org/transplant
carolyn spiotta Pancreas/Kidney Transplant Recipient I feel so fortunate and thankful that I have received a second chance at life. Carolyn Spiotta, 44, Pittsburgh. Carolyn needed a new pancreas and kidney
Why 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
Innovation In Transplantation:
Innovation In Transplantation: Improving outcomes Thomas C. Pearson Department of Surgery Emory Transplant Center CHOA Symposium October 22, 2016 Disclosures Belatacept preclinical and clinical trial were
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
KDIGO GN Guideline update Evidence summary. Steroid-sensitive nephrotic syndrome. Corticosteroid therapy for nephrotic syndrome in children
KDIGO GN Guideline update Evidence summary Steroid-sensitive nephrotic syndrome Corticosteroid therapy for nephrotic syndrome in children PICO question In children (aged 3 to 18 years of age) with steroid-sensitive
Chapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
This study is currently recruiting participants.
A Two Part, Phase 1/2, Safety, PK and PD Study of TOL101, an Anti-TCR Monoclonal Antibody for Prophylaxis of Acute Organ Rejection in Patients Receiving Renal Transplantation This study is currently recruiting
Pleiotropic 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
Chronic Kidney Disease & Transplantation. Paediatrics : 2004 FRACP
Chronic Kidney Disease & Transplantation Paediatrics : 2004 FRACP ANZDATA Registry Mode of First Treatment - Paediatric 14 12 10 8 6 4 2 0 0-4 y 5-9 y 10-14 y 15-19 y Hospital CAPD Hospital HD Hospital
NAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2010 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE I INTRODUCTION 1 II
Strategies for Desensitization
Strategies for Desensitization Olwyn Johnston MB, MRCPI, MD, MHSc BC Nephrology Day October 8 th 2010 Pre-transplant crossmatch (CMX) with donor lymphocytes has been standard of practice Positive CDC CXM
1980s-1990s1990s 9/24/2010. David Wojciechowski and. Mary Kennedy-Breiner. Laurie Carlson. Janine Sabatte- Caspillo
Factors Influencing Length of Stay: 1980s-1990s1990s Mail the Get Well Cards Home!! Effectively Managing Shorter Length of Stays David Wojciechowski and Higher rejection rates Longer duration of induction
Current 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
NAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section
Alemtuzumab Induction in Renal Transplantation
original article Induction in Renal Transplantation Michael J. Hanaway, M.D., E. Steve Woodle, M.D., Shamkant Mulgaonkar, M.D., V. Ram Peddi, M.D., Dixon B. Kaufman, M.D., Ph.D., M. Roy First, M.D., Richard
Immunosuppression: evolution in practice and trends,
American Journal of Transplantation 25; 5 (Part 2): 874 886 Blackwell Munksgaard Blackwell Munksgaard 25 Immunosuppression: evolution in practice and trends, 1993 23 Ron Shapiro a,, James B. Young b, Edgar
Liver Transplant Immunosuppression
Liver Transplant Immunosuppression Michael Daily, MD, MS, FACS Surgical Director, Kidney and Pancreas Transplantation University of Kentucky Medical Center Disclosures No financial disclosures I will be
Renal transplantation
NEPHROLOGY 2008; 13, S37 S43 doi:10.1111/j.1440-1797.2008.00996.x Renal transplantation Date written: November 2006 Final submission: July 2007 Author: Nigel Toussaint GUIDELINES No recommendations possible
Nephrology Grand Rounds
Nephrology Grand Rounds PTLD in Kidney Transplantation Charles Le University of Colorado 6/15/12 Objectives Background Pathogenesis Epidemiology and Clinical Manifestation Incidence Risk Factors CNS Lymphoma
Meta-analysis to compare combination therapies: A case study in kidney transplantation
Meta-analysis to compare combination therapies: A case study in kidney transplantation Steffen Witte, Amy Racine, Heinz Schmidli Novartis Pharma AG, Switzerland, Basel, June 2009 Outline Introduction Methods
OBJECTIVES. Phases of Transplantation and Immunosuppression
Transplant and Immunosuppression: Texas Transplant Center April 29, 2017 Regina L. Ramirez, Pharm.D., BCPS PGY1 Pharmacy Residency Program Director Clinical Practice Specialist Solid Organ Transplant and
Efficacy 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
Fellows Conference 01/21/2016
Fellows Conference 01/21/2016 Outline Basics of transplantation Benefits of transplantation Immunosuppressive medications Anatomy of Renal Transplantation Recipient Selection General medical condition.
("T-Lymphocytes, Regulatory"[Mesh]) AND "Immunosuppression"[Mesh] ("T-Lymphocytes, Regulatory"[Mesh]) AND "Immunosuppressive Agents"[Mesh]
![(T-Lymphocytes, Regulatory[Mesh]) AND Immunosuppression[Mesh] (T-Lymphocytes, Regulatory[Mesh]) AND Immunosuppressive Agents[Mesh]](/thumbs/78/78435006.jpg "(T-Lymphocytes, Regulatory[Mesh]) AND Immunosuppression[Mesh] (T-Lymphocytes, Regulatory[Mesh]) AND Immunosuppressive Agents[Mesh]")
SEARCH STRATEGY PubMed: ("T-Lymphocytes, Regulatory"[Mesh]) AND "Immunosuppression"[Mesh] ("T-Lymphocytes, Regulatory"[Mesh]) AND "Immunosuppressive Agents"[Mesh] ("T-Lymphocytes, Regulatory"[Mesh]) AND
Management 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
Kidney and Pancreas Transplantation in the United States,
American Journal of Transplantation 2006; 6 (Part 2): 1153 1169 Blackwell Munksgaard No claim to original US government works Journal compilation C 2006 The American Society of Transplantation and the
Heart 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
Transplant Immunosuppression in 2017 Hepatobiliary Liver Transplant Symposium 2017
Transplant Immunosuppression in 2017 Hepatobiliary Liver Transplant Symposium 2017 Dr AJ Terblanche Paediatric Gastroenterology and Hepatology Unit, SBAH Paediatric Transplant Unit Wits Donald Gordon Medical
Donor-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
Post-operative Care of the Kidney Transplant Recipient
Clinical Practice Guidelines Post-operative Care of the Kidney Transplant Recipient 5th Edition Draft Version (10th August 2010) Contents Introduction Summary of clinical practice guidelines for Post-operative
Belatacept: An Update of Ongoing Clinical Trials
Belatacept: An Update of Ongoing Clinical Trials Michael D. Rizzari, MD University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin Abstract Belatacept is a fusion protein
Date: 23 June Context and policy issues:
Title: Basiliximab for Immunosuppression During a Calcineurin Inhibitor Holiday in Renal Transplant Patients with Acute Renal Dysfunction: Guidelines for Use and a Clinical and Cost-Effectiveness Review
Post Transplant Immunosuppression: Consideration for Primary Care. Sameh Abul-Ezz, M.D., Dr.P.H.
Post Transplant Immunosuppression: Consideration for Primary Care Sameh Abul-Ezz, M.D., Dr.P.H. Objectives Discuss the commonly used immunosuppressive medications and what you need to know to care for
Intruduction 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
Recognition 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
Kidney Transplant. November 4 th, 2016
Kidney Transplant November 4 th, 2016 Brad West, MD, FACP Medical Director of Transplant Services, Memorial Medical Center Chairman Department of Nephrology, Springfield Clinic 1 Adjusted survival: 1993-1997
Results of a Phase 1 Trial of Treg Adoptive Cell Transfer (TRACT) in De Novo Living Donor Kidney Transplant Recipients
Results of a Phase 1 Trial of Treg Adoptive Cell Transfer (TRACT) in De Novo Living Donor Kidney Transplant Recipients A Skaro, A LeFever, J Mathew, L Gallon, J Hie, C Hansen, D Stare, G Johnson, J Leventhal
Immunosuppression is now manageable in the
EVOLVING STRATEGIES FOR IMMUNOSUPPRESSION IN RENAL TRANSPLANTATION: A REVIEW OF RECENT CLINICAL TRIALS* Stephen J. Tomlanovich, MD, Thomas C. Pearson, MD, DPhil, and Lorenzo Gallon, MD ABSTRACT When using
Ryszard Grenda: Steroid-Free Pediatric Transplantation. Early Steroid Withdrawal in Pediatric Renal Transplantation
Trends in Transplant. 2011;5:115-20 Ryszard Grenda: Steroid-Free Pediatric Transplantation Early Steroid Withdrawal in Pediatric Renal Transplantation Ryszard Grenda Department of Nephrology, Kidney Transplantation
Precision 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
Overview of Immunosuppression in Renal Transplantation
Chapter 10 Overview of Immunosuppression in Renal Transplantation M. Ghanta, J. Dreier, R. Jacob and I. Lee Additional information is available at the end of the chapter http://dx.doi.org/10.5772/54865
IMMUNOSUPPRESSIVE THERAPY Overview. Desensitization
IMMUNOSUPPRESSIVE THERAPY Overview Two types of immune responses to allografts: Cellular response: foreign antigen recognition activate antigen-specific lymphocytes (T-cells) o Key mediator: T-cells o
PRETRANSPLANT IMMUNOLOGIC RISK ASSESMENT FOR IMMUNOSUPPRESSIVE MANAGEMENT
PRETRANSPLANT IMMUNOLOGIC RISK ASSESMENT FOR IMMUNOSUPPRESSIVE MANAGEMENT OF KIDNEY TRANSPLANT RECIPIENTS Enver Akalin, M.D. Professor of Clinical Medicine and Surgery Albert Einstein College of Medicine
Re: Final Appraisal Determination - Immunosuppressive therapy for kidney transplant in adults (review of technology appraisal guidance 85)
January 19 th, 2016 Dr Margaret Helliwell Vice chair National Institute for Health and Care Excellence 10 Spring Gardens London SW1A 2BU Dear Margaret Re: Final Appraisal Determination - Immunosuppressive
Cancer in kidney transplant recipients: epidemiology and prevention
BTS 2018, Brighton Cancer in kidney transplant recipients: epidemiology and prevention Adnan Sharif Queen Elizabeth Hospital Birmingham Outline 1. The burden of cancer after kidney transplantation 2. Epidemiology
In-situ v Normothermic Regional Perfusion for Abdominal Organs
In-situ v Normothermic Regional Perfusion for Abdominal Organs ANGEL RUIZ M.D. DONATION AND TRANSPLNAT COORDINATION UNIT MEDICAL DIRECTION HOSPITAL CLÍNIC DE BARCELONA Introduction Donation after circulatory
Technology appraisal guidance Published: 11 October 2017 nice.org.uk/guidance/ta481
Immunosuppressive e therapy for kidney transplant in adults Technology appraisal guidance Published: 11 October 2017 nice.org.uk/guidance/ta481 NICE 2018. All rights reserved. Subject to Notice of rights
Potential Catalysts in Therapeutics
LIVER TRANSPLANTATION 20:S22 S31, 2014 SUPPLEMENT Potential Catalysts in Therapeutics Bruce A. Luxon Division of Gastroenterology-Hepatology, University of Iowa, Iowa City, IA Received July 23, 2014; accepted
Health technology Two prophylaxis schemes against organ rejection in renal transplantation were compared in the study:
An economic and quality-of-life assessment of basiliximab vs antithymocyte globulin immunoprophylaxis in renal transplantation Polsky D, Weinfurt K P, Kaplan B, Kim J, Fastenau J, Schulman K A Record Status
REACH Risk Evaluation to Achieve Cardiovascular Health
Dyslipidemia and transplantation History: An 8-year-old boy presented with generalized edema and hypertension. A renal biopsy confirmed a diagnosis of focal segmental glomerulosclerosis (FSGS). After his
Pathology 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
TRANSPLANTATION IN DIABETIC PATIENTS. A.Tarik Kizilisik, MD, MSc, FACS, FICS Director & Primary Transplant Surgeon Lutheran Transplant Center
TRANSPLANTATION IN DIABETIC PATIENTS A.Tarik Kizilisik, MD, MSc, FACS, FICS Director & Primary Transplant Surgeon Lutheran Transplant Center Diabetes is the pandemic of the new millennium 24 million diabetics
Proton pump inhibitors do not increase the risk of acute rejection
ORIGINAL ARTICLE Proton pump inhibitors do not increase the risk of acute rejection G.A.J. van Boekel*, C.H.H. Kerkhofs, F. van de Logt, L.B. Hilbrands Department of Nephrology, Radboud University Medical
Desensitization 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
Graft and Patient Survival in Kidney Transplant Recipients Selected for de novo Steroid-Free Maintenance Immunosuppression
American Journal of Transplantation 2009; 9: 160 168 Wiley Periodicals Inc. C 2009 The Authors Journal compilation C 2009 The American Society of Transplantation and the American Society of Transplant
Long-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
Marta Farrero Torres₁, Marcelo Pando₂, Dolly Tyan₂, Hannah Valantine₃, Spenser Smith₃, Kiran Khush₃
Development of HLA donor specific antibodies after heart transplantation: importance of a new method to detect the first component of the complement cascade Marta Farrero Torres₁, Marcelo Pando₂, Dolly
Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study
Health Technology Assessment 2005; Vol. 9: No. 21 Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study R Woodroffe, GL Yao,