This document discusses various topics related to immunosuppressive drugs in renal transplantation, including the use of belatacept, diabetes management, and the implications of bariatric surgery on immunosuppression. It emphasizes the importance of personalized desensitization approaches based on patient-level and donor-related factors, and outlines biomarkers of immunosuppression. Additionally, it highlights the role of immune checkpoint inhibitors in enhancing immune responses against cancers and their potential implications for allograft rejection.

1. Immune-modulatory module:
immunosuppressive drugs in renal
transplantation (part 3)
By
Salwa M. Elwasif, MD
Fellow of Internal Medicine and Nephrology
23/1/2021

2. Agenda
• Belatacept
• Diabetes
• Bariatric surgery
• Immune know
• Check point inhibitors
• immunometery

3. Belatacept

4. The BEST Trial
Am J Transplant. 2019, Accepted First Published: 04 November 2019
Belatacept Early Steroid Withdrawal Trial

5. Am J Transplant. 2019, Accepted First Published: 04 November 2019
The BEST Trial

6. Am J Transplant. 2019,
The BEST Trial

7. Transplantation. 2019 Aug;103(8):1574-1581
Desensitization in The Era of
Precision Medicine

8. A personalized approach to desensitization: precision-based
immune modulation & clinical context. A, The adaptive
response can be considered as a “pyramid,” with antibodies
at the apex. Plasma cells form the middle tier while B cells
at their various stages of development are at the base in
close and continual interaction with their T-cell
counterparts.

9. • B, Patient-level factors affecting the
desensitization approach. Defining the
appropriate approach to desensitization
depends on the patient's clinical status, their
overall immunological risk, and donor related
factors. and donor-related factors.

10. Biomarkers
of Immunosuppression
Kidney Int Rep (December 2019) 4, 1664–1665

11. Immunometer?
Kidney International Reports (2019) 4, 1446–1453

12. Immunometer?
Kidney International Reports (2019) 4, 1446–1453

13. Immuknow
Exp Ther Med. 2019 Nov;18(5):3823-3828.

14. Nephrol Dial Transplant (August 2019) 34: 1292–1300
Oncology and Renal Transplant

15. PTLD
Nephrol Dial Transplant (2019), in press

16. Drug Induced HTN

17. Nephrol Dial Transplant (May 2019) 34: 727–730
Renal Transplant:
CV Risk Factors

18. PTDM

19. Diagnosis of Diabetes: 2019 ADA
Standards
Diabetes Care 2019;42(Suppl. 1):S13–S28

20. ADA 2019 Standards:
PTDM Diagnosis
Diabetes Care 2019;42(Suppl. 1):S13–S28

21. American Journal of Transplantation 2014; 14: 1992–2000
PTDM:
Diagnosis

22. PTDM Risk Factors:
At A Glance
Endocrine Reviews, February 2016, 37(1):37– 61

23. Risk factors: Age, positive family history of DM,
high BMI, HCV infection and hypercholesterolemia
PTDM:
Risks Factors

24. PTDM:
Impact of IS and Virology
Nephrol Dial Transplant (2018) 33: 177–184

25. Metabolism. 2016 Oct;65(10):1559-69.
PTDM Risk Factors:
Immunosuppression

26. Tacrolimus Effects on Pancreas
and kidney
American Journal of Transplantation 2017; 17: 2601–2616

27. PTDM Risk Factors:
mTORi
Transplantation Feb 2018;102: S47–S49

28. Acta Diabetologica (2018) 55:763–779
PTDM:
Management Overview
PTDM

29. Bariatric Surgery and
Immunosuppression
Obesity Surgery (October 2019) 29:3309–3315

30. Am J Transplant. 2019, in press
Bariatric Surgery and Immunosuppression

31. Am J Transplant. 2019, in press
Bariatric Surgery and Immunosuppression

32. Am J Transplant. 2019, in press
Bariatric Surgery and
Immunosuppression

33. Immune check point inhibitors
• The therapy targets immune checkpoints, key
regulators of the immune system that when
stimulated can dampen the immune response to an
immunologic stimulus. Some cancers can protect
themselves from attack by stimulating immune
checkpoint targets. Checkpoint therapy can block
inhibitory checkpoints, restoring immune system
function.

35. • PDL-1 expression on the allograft lymphocytes has
been suggested as a marker of rejection after
treatment with ICIs.

36. Thank you