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Nephrol Dial Transplant (2004) 19: IV61-IV63
Nephrol Dial Transplant Vol. 19 Suppl 4 © ERA–EDTA 2004; all rights reserved

Tapering immunosuppression in recipients of living donor kidney transplants

Willem Weimar1, Jacqueline Rischen-Vos1, Petronella de Kuiper1, Peter J. H. Smak Gregoor1, Jan N. M. IJzermans2, Nicole M. van Besouw1, Carla C. Baan1 and Barbara J. van der Mast1

1 Department of Internal Medicine, Section Transplantation and 2 Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Correspondence and offprint requests to: Willem Weimar, MD, Department of Internal Medicine, Room D-410, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Email: w.weimar{at}erasmusmc.nl

Abstract

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


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