Researchers have observed that most kidney transplant patients who received anti-TNFα therapy had undiminished kidney function, although a few experienced complications like kidney rejection, infections and cancer. Further analysis of this study supports the hypothesis that, through the cautious use of anti-TNFα agents, kidney transplant recipients have a better chance at suppressing inflammation. However, the risk of serious infections is substantial and ever-present.
The study, titled “Anti-TNFα therapy for chronic inflammatory disease in kidney transplant recipients: Clinical outcomes,” was published in Medicine.
TNF-α is a molecule produced by the immune system cells and it can affect biological processes like cell death, inflammatory cascades and immune responses. TNF-α inhibitors as pharmacological agents have shaped the landscape of rheumatoid, gastrointestinal and dermatologic therapies. However, they often are considered a treatment of last resort because they are highly immunosuppressive, making them permissive of infections and cancers.
To date, there are only case-by-case reports about how renal transplant patients react to anti-TNFα therapy. Hoping to fill that critical knowledge gap, Cyril Garrouste, MD, and her team have summarized the results of a retrospective, observational study of 16 kidney transplant patients who also took anti-TNFα agents for chronic inflammatory diseases.
Patient information like age, gender, nephropathy, past history of infection or malignancy, date of transplantation, and postoperative immunosuppressive regimen were put in the analysis. Events following anti-TNFα therapy included the appreciation of the glomerular filtration rate (GFR) as a marker of kidney function, as well as adverse events such as causes of graft loss, patient death, development of malignant neoplasms and infections.
According to results, 81% of the analyzed patients responded to the therapy and had stable kidney function. Two patients had breast, adenocarcinoma and basal-cell carcinoma, and three patients developed infections that required hospitalization. Of note, five patients began anti-TNFa treatment before kidney transplantation.
“Anti-TNFα therapies are effective for treating chronic inflammatory diseases in kidney transplant patients and do not lead to graft function deterioration. However, infection and cancer rates are particularly high among these immunocompromised patients. … Tailoring concomitant immunosuppressive therapy must be investigated in further studies to ensure that anti-TNFα therapy is safe in kidney transplant patients,” researchers concluded in their report
The research team proposed a possible way to extract all the benefits of this type of immunosuppressive therapy without the infection-related side-effects: “It may be necessary to place kidney transplant patients on anti-infection prophylaxis upon anti-TNFα therapy initiation, in addition to surveilling these patients closely, and to decrease immunosuppressive regimen dose (i.e., steroids).”