title: Tapering immunosuppression in recipients of living donor kidney transplants.
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 (<10/10(6) 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 <10/10(6) 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.
authors.affiliation: Department of Internal Medicine, Section of Transplantation, Room D-410, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. w.weimar@erasmusmc.nl
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Rischen-Vos
authors.forename: Petronella
authors.initials: P
authors.lastname: de Kuiper
authors.forename: Peter J H Smak
authors.initials: PJ
authors.lastname: Gregoor
authors.forename: Jan N M
authors.initials: JN
authors.lastname: IJzermans
authors.forename: Nicole M
authors.initials: NM
authors.lastname: van Besouw
authors.forename: Carla C
authors.initials: CC
authors.lastname: Baan
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: van der Mast
mesh_terms: D002478:Cells, Cultured; D015536:Down-Regulation / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D019520:Living Donors; D011446:Prospective Studies; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*
chemical_list: D007166:Immunosuppressive Agents