Humoral immunity after kidney transplantation: impact of two randomized immunosuppressive protocols.
Legris T, Picard C, et al.Annals of Transplantation 2013; 18: 622-634.
Aims
To compare several blood humoral parameters of kidney transplant recipients (KTR) treated with antithymocyte globulin (ATG) induction and steroids, in addition to either tacrolimus/mycophenolate mofetil (Tac/MMF) or cyclosporine/azathioprine (CsA/AZA).
Interventions
This was a post-hoc analysis of a previous randomized controlled trial* where participants were treated by an ATG induction, prednisone, a calcineurin inhibitor, and an antimetabolite. Participants were randomized and treated with either CsA/AZA or Tac/MMF.
Participants
307 kidney transplant recipients aged between 18-65 years.
Outcomes
Primary outcomes measured were peripheral B-cell counts, immunoglobulin blood levels, and HLA antibodies. Other outcomes measured included biopsy proven acute rejection, estimated glomular filtration rate, humoral rejection and the incidence of bacterial, humoral, viral and fungal infections.
Follow-up
12 months
CET Conclusions
This manuscript reports a post-hoc analysis of the effects on humoral immunity in an RCT comparing a Tac/MMF/ATG/Steroid protocol with a CsA/AZA/ATG/Steroid protocol in de novo renal transplant recipients. Lower IgG, IgA and IgM levels were seen in the Tac/MMF group at 12-months post-transplant, and there was a greater reduction in the proportion of sensitised patients in this group by month 12. These results support the common practice of using Tac/MMF-based protocols in high risk recipients. Given the emerging importance of humoral immunity in post-transplant outcomes, it would be good to see similar data presented prospectively in future trials of immunosuppression.
Data analysis
Modified intention-to-treat analysis
Quality notes
Previously assessed as *Vacher-Coponat H, et al. A randomized trial with steroids and antithymocyte globulins comparing cyclosporine/azathioprine versus tacrolimus/mycophenolate mofetil (CATM2) in renal transplantation. Transplantation, 2012; 93(4): 437–43
Trial registration
None