Josep Grinyo

..Meanwhile, the assessment of immunological risk by new monitoring tools could be a prerequisite to further implement such CNI sparing strategies...

..Future studies will clarify the optimal regimen for belatacept usage...

..Switching to a belatacept-based regimen from a CNI-based regimen resulted in a continued trend toward improved renal function at 2 years after switching...

..The majority of these new immunosuppressive agents are polyclonal or monoclonal antibodies and recently the so-called fusion proteins may be the start of a new era of biological immunosuppression for maintenance regimens...

..Exposure to mycophenolic acid (MPA), the primary active metabolite of mycophenolate mofetil (MMF), is correlated with therapeutic efficacy of MMF but varies depending on the concomitantly administered immunosuppressive drugs...

..The current analysis examined pooled safety data for belatacept versus cyclosporine used in combination with basiliximab, mycophenolate mofetil, and steroids...

..Importantly, in any case, longer-term analyses of all these CNI-avoidance strategies are warranted in order to confirm whether persistent immune-mediated graft damage can be safely overcome...

..Current knowledge about the natural history, treatment and physicians' perception of chronic allograft nephropathy (CAN) is limited. The present study evaluated the prevalence and determinants of CAN in renal transplant patients...

..Clinical data are lacking concerning therapeutic action and systemic exposure of tacrolimus (TAC) and everolimus (EVL) in a combined regimen in renal transplantation...

..Variation in genes of immune response and pharmacodynamic/pharmacokinetic relevance may be important in understanding acute rejection after renal transplant...

..We aimed to analyse the functional and histological profiles of damage and to define the contribution of inflammatory and pro-fibrotic mediators in the association of cyclosporine (CsA) and/or tacrolimus (Tac) with sirolimus (SRL)...

..Perhaps, association of T-cell depleting agents with CD40-CD40L blockade may avoid both cellular rejection and, more interestingly, human leukocyte antigen sensitization...

..Starting MMF at low dose, MPA monitoring and probably CMV prophylaxis may improve the results of this regimen...

....

..Long-term follow-up studies must be performed to confirm the encouraging short-term data...

..The absence of any clinically significant effect of FTY720 on cardiac rhythm demonstrates that the reduction in HR seen after the first dose does not persist in the maintenance phase...

..009). Tacrolimus withdrawal from a combination of sirolimus and tacrolimus, in selected patients, may be observed at 2 years by an improvement in renal function and blood pressure without a higher incidence of proteinuria...

..Interference of CD40 by siRNA technology is able to induce a protective phenotype (anti-inflammatory, anti-apoptotic, anticoagulant) in endothelial cells in conjunction with fully avoidance of adaptative humoral immunity in the host...

..Discontinuation of steroids has long been a goal of transplant teams. However, whether this strategy is associated or not with a higher risk of long-term graft loss has not been resolved...

..T lymphocytes and macrophages interstitial infiltration was reduced in tacrolimus treated patients evaluated with protocol biopsies in comparison to cyclosporine-treated patients...

..Thus, our results suggest that MMF could be synergistic with the pharmacodynamic effect of low CsA in maintenance immunosuppression...

..In conclusion, reaching donor-specific hyporesponsiveness is feasible after renal transplantation and associated with Treg recruitment in the graft...

..The purpose of this study was to evaluate the potential synergistic effect of this combination on diabetic kidney disease in rats...

..However, the utility of protocol biopsies to manage baseline immunosuppression has not been well characterized...

..Here, we discuss and analyze the main mechanisms by which sirolimus may modulate the alloimmune response, thus facilitating a protolerogenic state in renal transplantation...

..Membranous nephropathy is a common cause of nephrotic syndrome (NS) in adults. Its treatment is still under debate...

..Assessment of alloreactive memory/effector T cells might be helpful to tailor individual immunosuppression regimens for transplant recipients in the future...

..In conclusion, mTOR blockade by low-dose SRL has a beneficial effect in diabetic kidney disease, suggesting that the mTOR pathway has an important pathogenic role in diabetic nephropathy...

..Here, we review recent important biomarkers that have shown relevant impact on renal graft outcome...

..This study aims to assess the rate of microchimerism after kidney transplantation and determine its influence on acute rejection in a 4-year follow-up...

..These results suggest that the up-regulation of the IL-10 gene expression, as well as an increased proportion of B-lymphocytes in the inflammatory infiltrates, might be useful as markers of early chronic lesions in grafts with SCR...

....

..Severe CAN may be prevented by reducing cold ischemia or strengthening immunosuppression. Because the former approach is not always possible, reinforcement of early immunosuppression constitutes an excellent alternative...

..In contrast, there are studies showing a nephro-protective effect of rapamycin in proteinuric diseases characterized by progressive interstitial inflammatory fibrosis...

..Our study also highlights the anti-inflammatory potential of RNAi-mediated CD40 inhibition, and the relevance of CD40 signaling for therapeutic intervention...

..Our results indicate that histology may be superior to RI in predicting graft function deterioration, at least in patients with stable renal function...

..Glomerular enlargement is impaired in patients with chronic allograft nephropathy...

..Thus, we used early protocol biopsies to analyze structural and functional correlations in stable grafts...

..Our results suggest that the indication for pretransplant interferon should be extended to treat all HCV-RNA positive candidates for renal transplantation...

..01) and the lower N(g)-W&G (r = -0.40, P = 0.01). Total glomerular number can be estimated in stable renal allografts by means of a renal biopsy and MRI. Our data show that N(g) depends on donor age and positively correlates with GFR...

..Although the presence of CAN in protocol renal biopsies is a predictor of outcome, the reliability of this diagnosis according to Banff criteria has not been characterized...

..We evaluate the relationship among serum mannose-binding lectin (MBL), chronic inflammation, NODAT, and infection...

..Meanwhile, we should empirically balance case to case the pros and cons of RAS blockade in renal transplantation...

..These results allow standardization of Pgp activity measurement in different individuals with different timing of blood sampling and in different geographic areas...