The two first and senior authors contributed equally.
The Natural History of Clinical Operational Tolerance After Kidney Transplantation Through Twenty-Seven Cases
Article first published online: 13 SEP 2012
© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 12, Issue 12, pages 3296–3307, December 2012
How to Cite
Brouard, S., Pallier, A., Renaudin, K., Foucher, Y., Danger, R., Devys, A., Cesbron, A., Guillot-Guegen, C., Ashton-Chess, J., Le Roux, S., Harb, J., Roussey, G., Subra, J.-F., Villemain, F., Legendre, C., Bemelman, F.J., Orlando, G., Garnier, A., Jambon, H., Le Monies De Sagazan, H., Braun, L., Noël, C., Pillebout, E., Moal, M.-C., Cantarell, C., Hoitsma, A., Ranbant, M., Testa, A., Soulillou, J.-P. and Giral, M. (2012), The Natural History of Clinical Operational Tolerance After Kidney Transplantation Through Twenty-Seven Cases. American Journal of Transplantation, 12: 3296–3307. doi: 10.1111/j.1600-6143.2012.04249.x
- Issue published online: 30 NOV 2012
- Article first published online: 13 SEP 2012
- Received 08 February 2012, revised 02 July 2012 and accepted for publication 19 July 2012
Appendix 1: Up-date of first published case reports; New case reports.
Table A1: Main characteristics of the operationally tolerant patients.
Table A2: Infections and neoplasia during immunosuppressive treatment and after withdrawal.
Table A3: Inflammatory infiltrate immunophenotype. Absolute percentages of positive cells relative to the entire inflammatory infiltrate (set at 100%). And two-patient who degrade their function refused biopsy
Table A4: De novo anti- DSA antibody subclasses.
Table A5: Composite table of studies performed on operationally tolerant recipients.
Figure A1: Posttransplant evolution of creatininemia and proteinuria. Each graph indicates the posttransplant evolution of creatininemia (μmol/L) (▪) and proteinuria (g/day) (•) for each patient. The horizontal arrow corresponds to the period of progressive immunosuppressive medication withdrawal. The grey area indicates the immunosuppression-free period. Creatininemia and proteinuria remained stable over time, except for cases 9 and 10 whose renal function deteriorated 14 and 9 years after immunosuppression cessation. In the latter two cases the scale of the graph was adjusted to the level of creatinemia and proteinuria.
Figure A2: Graft biopsy performed following deterioration of renal function in cases 4, 5, 7, 9, 10 and 13. Figure 1: Graft biopsy performed following degradation of renal function in cases 4, 5, 7, 9, 10 and 13. Panels 2a and 2b correspond to the graft biopsy of patient 4 (a: Jones coloration – b: anti-cd68 immunostaining). It revealed lesions of TG with numerous double contours in glomerular basement membrane (arrows) and glomerulitis (2a). High percentage of macrophages in the interstitial and glomerular infiltrate (2b). Panels 2c and 2d correspond to the graft biopsy of patient 5 (c: HES coloration – d: PAS coloration). It revealed mild inflammatory interstitial fibrosis with tubular atrophy (IFTA grade I) (2c) associated with focus of mild tubulitis and minimal inflammation considered as insignificant (2d). Panel 2e correspond to the graft biopsy of patient 7 (PAS coloration) that revealed TG with glomerulitis. Panel 2f correspond to the graft biopsy of patient 9 (Masson's trichrome coloration) that revealed mild interstitial fibrosis and tubular atrophy (IFTA grade I) with moderate nephroangiosclerosis without specific changes suggestive of acute or chronic rejection. Panel 2g correspond to the transplantectomy of patient 10 (PAS coloration). It showed evidence of chronic rejection lesions as transplant arteriopathy with scattered T-cells in the intima (arrows) and TG with glomerulitis associated with diffuse interstitial fibrosis and tubular atrophy. Panel 2h correspond to the graft biopsy of patient 13 (Masson's trichrome coloration) that revealed diffuse interstitial fibrosis and tubular atrophy (IFTA grade III) without evidence of acute or chronic rejection.
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