Rachel Hellemans

Professor in nephrology at the Antwerp University Hospital in Belgium @UZAnieuws

[Rachel Hellemans @HellemansRachel]

@ESOTtransplant @UMaggiore Very few in favor of CNI withdrawal... Although it might be safe if you give enough MMF ( targetting MPA-AUC concentrations around 75) as shown in 1 RCT (Mourer 2012)...#ESOTchat

[Rachel Hellemans @HellemansRachel]

@UMaggiore @ESOTtransplant Exactly, as you will read in our paper the evidence for switching to mTORi in non-skin cancer is still very weak...#ESOTchat

[Rachel Hellemans @HellemansRachel]

@UMaggiore @Ferchu_Ortiz @ESOTtransplant I also think that stopping MMF and continuing with just Tac (level of 5 ng/ml) and steroids could be attractive option: you reduce overall immuunsuppression and stay quite safe in terms of rejection #ESOTchat

[Rachel Hellemans @HellemansRachel]

@gratefull080504 Thanks for your very valuable contribution! All the best, Rachel #ESOTchat

[Rachel Hellemans @HellemansRachel]

@gratefull080504 @Transpl_Int Very important topic indeed! We focused more on treatment than on diagnosis, but I could check if we find evidence on how these tests could help us on decisions on treatment #ESOTchat

[Rachel Hellemans @HellemansRachel]

@gratefull080504 That would be great, until now there is very little collaboration between US and Europe #ESOTchat

[Rachel Hellemans @HellemansRachel]

@dr_JelaS @ESOTtransplant @UMaggiore @SanemGulerCime1 A meta-analysis of (older) RCTs) found a 43% higher risk of death in CNI-free mTORi regimens compared to classic CNI-based regimens. But the most recent study (ZEUS) on the conversion from CsA to EVL did not confirm this increased risk. #ESOTchat

[Rachel Hellemans @HellemansRachel]

@dr_JelaS @ESOTtransplant @UMaggiore @SanemGulerCime1 From studies in oncology it appears that the mTORi anti-cancer effect is dose-dependent. Unfortunately, the mTORi dosage that is most effective against cancer is often poorly tolerated. I suggest an EVL trough level of about 6 ng/mL and Tac level of 4 ng/ml. #ESOTchat

[Rachel Hellemans @HellemansRachel]

@dr_JelaS @ESOTtransplant @UMaggiore @SanemGulerCime1 Such levels are higher than those that were targeted to prevent rejection after SOT in CNI-free regimens, and are generally poorly tolerated #ESOTchat

[Rachel Hellemans @HellemansRachel]

@dr_JelaS @ESOTtransplant @UMaggiore @SanemGulerCime1 In oncology, EVL is often dosed at 10 mg daily, generally yielding EVL blood trough levels > 10ng/mL. In cancer literature a therapeutic window of 10 to 26ng/mL has been proposed. #ESOTchat

[Rachel Hellemans @HellemansRachel]

@dr_JelaS @ESOTtransplant @UMaggiore @SanemGulerCime1 The dose of mTORi probably is important: a high dose (say, an EVL trough level > 8 ng/ml) – as is more common in CNI-free regimens – might have a larger anti-cancer effect. However, such a high mTORi dose is often poorly tolerated… #ESOTchat

[Rachel Hellemans @HellemansRachel]

@dr_JelaS @ESOTtransplant @UMaggiore @SanemGulerCime1 Not sure. Data on cancer risk using mTORi + low-dose CNI are limited. Preliminary data from a meta-analysis on RCTs showed a reduction in cancer risk with mTORi+CNI, but more studies are needed to confirm this. #ESOTchat

[Rachel Hellemans @HellemansRachel]

@alanephro Very attractive option indeed. I wonder if it has been tested in transplant patients yet #ESOTchat

[Rachel Hellemans @HellemansRachel]

@gratefull080504 @dr_JelaS @SanemGulerCime1 I agree. Another possibility could be to minimize immunosuppression to tacrolimus and steroids#ESOTchat

[Rachel Hellemans @HellemansRachel]

@gratefull080504 I understand your concern, I am not sure it will impact on melanoma risk, but it is probably quite safe in terms of rejection #ESOTchat

[Rachel Hellemans @HellemansRachel]

@gratefull080504 @dr_JelaS @SanemGulerCime1 You're right , mTORi have anti-cancer properties and are used (in high dose) for treating some kinds of cancer. They showed to reduce the risk of skin cancer posttransplant, but the effect on non-skin cancer risk is less certain #ESOTchat

[Rachel Hellemans @HellemansRachel]

Hope to meet you all there for a great discussion!#esotchat

[ESOTtransplant @ESOTtransplant]

Do not miss the next #ESOTchat on
𝗠𝗮𝗻𝗮𝗴𝗶𝗻𝗴 𝗶𝗺𝗺𝘂𝗻𝗼𝘀𝘂𝗽𝗽𝗿𝗲𝘀𝘀𝗶𝗼𝗻 𝗶𝗻 𝗽𝗼𝘁𝗲𝗻𝘁𝗶𝗮𝗹𝗹𝘆 𝗰𝘂𝗿𝗲𝗱 𝗽𝗼𝘀𝘁-𝗸𝗶𝗱𝗻𝗲𝘆 𝘁𝗿𝗮𝗻𝘀𝗽𝗹𝗮𝗻𝘁 𝗰𝗮𝗻𝗰𝗲𝗿 !

#ESOTTLJ Guests: @HellemansRachel & @UMaggiore

See you on Wednesday, 31 March at 21:00 CEST

[ESOTtransplant @ESOTtransplant]

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