Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
BACKGROUND: Operational Tolerance (opTOL) is deemed to be extremely rare in kidney transplantation. We launched a Europe-wide survey to assess the frequency of opTOL.
METHODS: 18 coordinators in 27 countries were recruited through a European consortium. They sent a questionnaire to 246 transplant centers to identify tolerant (defined as having a S creat <1.7 mg/dL w/o glomerular proteinuria despite at least one year w/o any immunosuppressive drug) or almost tolerant patients (same criteria as above but with minimal immunosuppression: prednisone <10 mg/day). They also recorded the number of kidney recipients, tolerant or almost tolerant patients ever followed at each center.
RESULTS: 140 questionnaires covering 202,643 transplants were returned, which identified 63 tolerant and 77 almost tolerant patients. Hence, tolerance and almost tolerance were declared in 1/3,333 and 1/2,500 kidney transplantations, respectively. 22 of the 63 tolerant patients were previously reported. We had insufficient data in 6. Therefore, we describe 35 new tolerant patients, mostly males (n= 26/35) who withdrew immunosuppressive medications for noncompliance (n= 28/32). They displayed a median HLA mismatch number of 2 (IQR 0-3). The mean follow-up was 203±95 months. The mean duration of tolerance, according to our strict criteria, was 75±55 months. The mean duration of a functioning transplant not requiring dialysis w/o any immunosuppressive drug, irrespective of creatinine, was 88±63 months. At the end of the observation period, 31/35 patients were alive and 24/31 still tolerant. The remaining 7/31 had rising creatinine of which 4 resumed dialysis.
CONCLUSION: We confirmed that incidence of OpTOL in kidney transplantation is low, declared as 1/3,333, but also that tolerance is only a metastable status with patients losing their graft or harboring graft dysfunction over time.
*The two first and senior authors contributed equally.
To cite this abstract in AMA style:Massart A, Pallier A, Viklicky O, Pascual J, Budde K, Sorensen S, Oberbauer R, Klinger M, Dudley C, Sever 10M, Spasovski 11G, Guérif 13P, Maggiore U, Abramowicz 12M, Giral M, Abramowicz D, Brouard S. Operational Tolerance in Kidney Transplantation: Results of a Europe-Wide Survey [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/operational-tolerance-in-kidney-transplantation-results-of-a-europe-wide-survey/. Accessed January 18, 2021.
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