Management of immunosuppressive therapy after functional renal graft failure: Results of a practice survey of French-speaking nephrologists

Cyril Garrouste, Marine Freist, Mathilde Prezelin-Reydit, Antoine Bouquegneau, Thomas Fournier, Betoul Schvartz, Antoine Thierry, Virginie Paumier Sanson, Valentin Mayet, Bruno Pereira, Christophe Mariat
{"title":"Management of immunosuppressive therapy after functional renal graft failure: Results of a practice survey of French-speaking nephrologists","authors":"Cyril Garrouste, Marine Freist, Mathilde Prezelin-Reydit, Antoine Bouquegneau, Thomas Fournier, Betoul Schvartz, Antoine Thierry, Virginie Paumier Sanson, Valentin Mayet, Bruno Pereira, Christophe Mariat","doi":"10.1684/ndt.2024.79","DOIUrl":null,"url":null,"abstract":"<p><p>The management of patients with kidney transplant failure (KTF) remains a complex process involving multiple stakeholders. A working group of the Transplantation Commission of the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) conducted a survey on the management of immunosuppressants (IS) after KTF among nephrologists at transplant centres and general nephrologists in France, Switzerland and Belgium between March and June 2023.\nWe analysed 232 replies from 58 nephrologists at transplant centres and 174 general nephrologists, aged 43.6 (+10.6) years. In the first three months following KTF, nephrologists reported discontinuing antimetabolite, calcineurin inhibitor (CNI) and corticosteroid treatment in 83%, 39.9% and 25.8% of cases respectively. Conversely, some nephrologists reported that they were continuing to use CNI (14%) and corticosteroids (19.1%) on a long-term basis. The patient’s comorbidities associated with the discontinuation of IS treatment are cancer and opportunistic infections as KT’s complications and presence of diabetes mellitus at KTF, whereas humoral rejection encourages the IS to be maintained. Transplantectomy is proposed by nephrologists most often for graft intolerance syndrome (86.5%), more rarely to discontinue IS (17.6%) or in the absence of plans of new transplantation (9.3%). In multivariate analyses, the presence of a protocol in the centre facilitated the management of IS by the general nephrologists.\nThe management of IS after AFG by French-speaking nephrologists is heterogeneous. Specific prospective studies are needed to establish new best practice recommendations, based on more robust evidence, which could encourage better adherence by nephrologists.</p>","PeriodicalId":94153,"journal":{"name":"Nephrologie & therapeutique","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nephrologie & therapeutique","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1684/ndt.2024.79","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

The management of patients with kidney transplant failure (KTF) remains a complex process involving multiple stakeholders. A working group of the Transplantation Commission of the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) conducted a survey on the management of immunosuppressants (IS) after KTF among nephrologists at transplant centres and general nephrologists in France, Switzerland and Belgium between March and June 2023. We analysed 232 replies from 58 nephrologists at transplant centres and 174 general nephrologists, aged 43.6 (+10.6) years. In the first three months following KTF, nephrologists reported discontinuing antimetabolite, calcineurin inhibitor (CNI) and corticosteroid treatment in 83%, 39.9% and 25.8% of cases respectively. Conversely, some nephrologists reported that they were continuing to use CNI (14%) and corticosteroids (19.1%) on a long-term basis. The patient’s comorbidities associated with the discontinuation of IS treatment are cancer and opportunistic infections as KT’s complications and presence of diabetes mellitus at KTF, whereas humoral rejection encourages the IS to be maintained. Transplantectomy is proposed by nephrologists most often for graft intolerance syndrome (86.5%), more rarely to discontinue IS (17.6%) or in the absence of plans of new transplantation (9.3%). In multivariate analyses, the presence of a protocol in the centre facilitated the management of IS by the general nephrologists. The management of IS after AFG by French-speaking nephrologists is heterogeneous. Specific prospective studies are needed to establish new best practice recommendations, based on more robust evidence, which could encourage better adherence by nephrologists.

功能性肾移植失败后的免疫抑制治疗管理:法语肾病专家实践调查结果
肾移植失败(KTF)患者的管理仍然是一个复杂的过程,涉及多个利益相关方。法语区肾脏病学、透析和移植学会(SFNDT)移植委员会的一个工作组在2023年3月至6月期间对法国、瑞士和比利时的移植中心肾脏病学家和普通肾脏病学家进行了一次关于KTF后免疫抑制剂(IS)管理的调查。我们分析了来自58名移植中心肾脏病学家和174名普通肾脏病学家的232份答复,他们的年龄为43.6(+10.6)岁。在 KTF 术后的头三个月,肾病专家报告停止抗代谢药、降钙素抑制剂 (CNI) 和皮质类固醇治疗的比例分别为 83%、39.9% 和 25.8%。相反,一些肾病专家表示,他们仍在长期使用 CNI(14%)和皮质类固醇(19.1%)。与停止IS治疗相关的患者合并症有癌症和机会性感染(KT并发症),以及在KTF时存在糖尿病,而体液排斥反应则促使IS得以维持。肾脏病专家最常因移植物不耐受综合征(86.5%)而建议进行移植切除术,更少的情况是为了中止 IS(17.6%)或没有新的移植计划(9.3%)。在多变量分析中,中心内有协议有利于普通肾病专家对 IS 的管理。法语区肾病专家对AFG术后IS的处理方法各不相同,需要进行具体的前瞻性研究,以便根据更可靠的证据制定新的最佳实践建议,从而鼓励肾病专家更好地遵守这些建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信