Evidence map›Paper›PMID 19696637›Full record

Trial reportTransplantation2009

Successful reduction of immunosuppression in older renal transplant recipients who exhibit donor-specific regulation.

Ewa Jankowska-Gan, Hans W Sollinger, John D Pirsch, Junchao Cai, Julio Pascual, Lynn D Haynes, Alenjandro Munoz del Rio, William J Burlingham

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Transplantation, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Steroid avoidance or withdrawal for kidney transplant recipients.The Cochrane database of systematic reviews · 2026
    Pooled it
  2. Steroid avoidance or withdrawal for kidney transplant recipients.The Cochrane database of systematic reviews · 2016
    Pooled it
  3. Regulatory T cells in renal disease.Clinical & translational immunology · 2018
    Review
  4. Review
  5. Article
  6. Donor-specific indirect pathway analysis reveals a B-cell-independent signature which reflects outcomes in kidney transplant recipients.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2012
    Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ewa Jankowska-GanDepartment of Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA.
Hans W Sollinger
John D Pirsch
Junchao Cai
Julio Pascual
Lynn D Haynes
Alenjandro Munoz del Rio
William J Burlingham

Funding

Maternal Microchimerism and Neonatal ToleranceR01AI066219 · NIAID · UNIVERSITY OF WISCONSIN-MADISON · PI BURLINGHAM, WILLIAM J · 2006 to 2016
$3.3M
Minor H Antigen Regulatory Networks as an Alternative to Calcineurin Inhibitors iR21DK077354 · NIDDK · UNIVERSITY OF WISCONSIN-MADISON · PI BURLINGHAM, WILLIAM J · 2007 to 2008
$399k
NIAID NIH HHS R01 AI066219NIDDK NIH HHS 1R21-DK077354-01NIDDK NIH HHS R21 DK077354
6 · The paper itself

Abstract

backgroundWe hypothesized that T-regulatory cells specific for donor alloantigens would protect a renal transplant during partial withdrawal of immunosuppression.

methodsTo test this hypothesis, 32 renal transplant recipients aged 55 years and older with excellent renal function were tested for donor-specific regulation (DSR) by trans-vivo delayed type hypersensitivity assay at the time of enrollment (T=0) and 6 months later (T=6). Twenty-two patients had prednisone withdrawn during a 3-month period, whereas 10 controls were maintained on triple therapy (prednisone, cyclosporine, and mycophenolate).

resultsOf 22 patients in the steroid withdrawal group, 10 were DSR+ and 12 were DSR- at the time of enrollment (T=0). None of the DSR+ patients experienced acute rejection, nor did any have donor-specific human leukocyte antigen (HLA) antibody during or after withdrawal. Of 12 DSR- patients, three developed acute rejection, which were reversed with bolus steroid treatment, and four were donor-specific antibody+ at T=0 or T=6. Two years later, 80% (8 of 10) of DSR+ patients in the withdrawal group remain steroid free while maintaining excellent renal function, as compared with only 58% (7 of 12) DSR- patients. Patient survival at 4 years was similar for DSR+ (9 of 10) and DSR- (11 of 12) patients in the withdrawal group. Patients maintained on triple therapy remained rejection free during the 4-year follow-up regardless of initial DSR status, with patient survival rate of 70% (7 of 10).

conclusionsDSR before steroid withdrawal may identify a subset of transplant patients who could benefit from reduction of immunosuppression without elevated risk of rejection or deteriorating renal function.

Indexed as

Acute DiseaseAgedAgingAnimalsCalcineurin InhibitorsFemaleFollow-Up StudiesGraft RejectionHumansHypersensitivity, DelayedImmunosuppressive AgentsKidney TransplantationMaleMiceMice, SCIDMiddle AgedCalcineurin InhibitorsImmunosuppressive AgentsMycophenolic AcidPrednisone

Identifiers

PMID19696637
PMCPMC2747510

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.