title: Anti-TNFα therapy for chronic inflammatory disease in kidney transplant recipients: Clinical outcomes.
abstract: Anti-tumor necrosis factor-α (TNFα) therapy has improved the prognosis of many chronic inflammatory diseases. It appears to be well-tolerated by liver-transplant patients. However, their use and their safety in kidney-transplant patients have yet to be determined.In this retrospective study, we identified 16 adult kidney-transplant patients aged 46.5 years (34-51.8) who received anti-TNFα therapy from 7 kidney transplantation centers. The indications for this treatment included: chronic inflammatory bowel disease (n = 8), inflammatory arthritis (n = 5), AA amyloidosis (n = 1), psoriasis (n = 1), and microscopic polyangiitis (n = 1).Anti-TNFα therapies resulted in a clinical response in 13/16 patients (81%). Estimated glomerular filtration rates (MDRD-4) were similar on day 0 and at 24 months (M24) after anti-TNFα treatment had been initiated (41 [12-55] and 40 [21-53] mL/min/1.73 m, respectively). Two allograft losses were observed. The 1st case was due to antibody-mediated rejection (M18), while the 2nd was the result of AA amyloidosis recurrence (M20). There were several complications: 8 patients (50%) developed 23 serious infections (18 bacterial, 4 viral, and 1 fungal) and 4 developed cancer. Five patients died (infection n = 2, cardiac AA amyloidosis n = 1, intraalveolar hemorrhage following microscopic polyangiitis n = 1, and acute respiratory distress syndrome n = 1). On univariate analysis, recipient age associated with death (P = 0.009) and infection development (P = 0.06).Using anti-TNFα therapies, remission can be achieved in chronic inflammatory diseases in kidney-transplant patients. However, concommitant anti-TNFα and immunosuppresive therapies must be used with caution due to the high risk of infection, particularly after the age of 50.
authors.affiliation: CHU Clermont-Ferrand, Department of Nephrology, Clermont-Ferrand Necker Hospital, Assistance Publique-Hôpitaux de Paris, Department of Nephrology and Kidney Transplantation, Paris CHU Rangueil, Nephrology, Dialysis, Transplantation, Toulouse CHU Pontchaillou, Department of Nephrology, Rennes CHU Clermont-Ferrand, Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, Nephrology-Transplantation Department, Strasbourg CHRU and FHU Transplantation, Department of Nephrology and Clinical Immunology, Tours CHU Clermont-Ferrand, Department of Rheutamology, Clermont-Ferrand Service de Néphrologie-Dialyse-Transplantation, CHU Angers, Angers Hôpital Maison Blanche-CHU Reims, Department of Nephrology, Reims Gastroenterology Department, University Hospital Estaing, Clermont-Ferrand Nephrology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris Department of Nephrology, CHU de Caen, Caen, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Garrouste
authors.forename: Dany
authors.initials: D
authors.lastname: Anglicheau
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Claire
authors.initials: C
authors.lastname: Bachelier
authors.forename: Joseph
authors.initials: J
authors.lastname: Rivalan
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.forename: Sophie
authors.initials: S
authors.lastname: Caillard
authors.forename: Julien
authors.initials: J
authors.lastname: Aniort
authors.forename: Philippe
authors.initials: P
authors.lastname: Gatault
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
authors.forename: Johnny
authors.initials: J
authors.lastname: Sayegh
authors.forename: Charlotte
authors.initials: C
authors.lastname: Colosio
authors.forename: Anthony
authors.initials: A
authors.lastname: Buisson
authors.forename: Eric
authors.initials: E
authors.lastname: Thervet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bouvier
authors.forename: Anne Elisabeth
authors.initials: AE
authors.lastname: Heng
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha