Effect of Maintaining Immunosuppression After Kidney Allograft Failure on Mortality and Retransplantation.
Journal
Transplantation direct
ISSN: 2373-8731
Titre abrégé: Transplant Direct
Pays: United States
ID NLM: 101651609
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
11
10
2022
accepted:
11
10
2022
entrez:
15
12
2022
pubmed:
16
12
2022
medline:
16
12
2022
Statut:
epublish
Résumé
Few studies have addressed immunosuppression management after allograft failure (AF). Immunosuppression withdrawal to minimize complications must be balanced with the risk of sensitization and potentially reduced retransplantation. We aimed to determine relationships between immunosuppression, death, sensitization, and retransplantation among patients with AF. We performed a single-center retrospective study of patients transplanted from October 2007 to May 2017 with AF. We collected data on demographics, immunosuppression, calculated panel reactive antibody (cPRA) levels, death, retransplantation, and dialysis. Cox regression models were used to evaluate factors associated with death and retransplantation. From October 2007 to May 2017, 1354 solitary ABO-compatible transplants were performed, of which 97 failed. Ten percent of patients received a preemptive retransplant. Among those who returned to dialysis (n = 87), 35% died, 25% received another transplant, and 30% remained on dialysis. After AF, 46% of patients discontinued immunosuppression. The cPRA was unchanged if immunosuppression was maintained, but immunosuppression discontinuation was associated with increased cPRA from a median (interquartile range) of 18 (0-99) to 96 (88.5-100.0; Kidney transplant recipients with AF have a high mortality rate after dialysis initiation. Although immunosuppression withdrawal was associated with increased cPRA, it was not associated with reduced retransplantation. Therefore, it is reasonable to discontinue immunosuppression after AF despite sensitization if retransplantation is delayed.
Identifiants
pubmed: 36518791
doi: 10.1097/TXD.0000000000001415
pmc: PMC9742100
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e1415Informations de copyright
Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors declare no funding or conflicts of interest.
Références
Kidney Int. 2014 Nov;86(5):1039-48
pubmed: 24717292
Curr Opin Organ Transplant. 2019 Aug;24(4):416-423
pubmed: 31135561
Kidney Int. 1998 Jul;54(1):236-44
pubmed: 9648084
Am J Transplant. 2004 Aug;4(8):1289-95
pubmed: 15268730
Am J Kidney Dis. 2007 Feb;49(2):294-300
pubmed: 17261432
Transplant Direct. 2018 Nov 23;4(12):e409
pubmed: 30584590
Clin Transplant. 2016 Jan;30(1):71-80
pubmed: 26529289
Blood Purif. 2020;49(1-2):228-231
pubmed: 31910422
Clin Transplant. 2019 Dec;33(12):e13751
pubmed: 31769104
Am J Transplant. 2002 Nov;2(10):970-4
pubmed: 12482151
Clin J Am Soc Nephrol. 2012 Aug;7(8):1310-9
pubmed: 22626959
Am J Transplant. 2018 May;18(5):1158-1167
pubmed: 29139625
Transplantation. 1997 May 27;63(10):1528-30
pubmed: 9175823
Clin J Am Soc Nephrol. 2022 Mar;17(3):444-451
pubmed: 33692118
Am J Transplant. 2011 Mar;11(3):450-62
pubmed: 20973913
Transplantation. 2014 Aug 15;98(3):306-11
pubmed: 24717218
Am J Transplant. 2018 Nov;18(11):2730-2738
pubmed: 29603640
Kidney Int. 2002 Nov;62(5):1875-83
pubmed: 12371992
Transplantation. 2012 Oct 15;94(7):738-43
pubmed: 22955228
Clin Transplant. 2001 Dec;15(6):397-401
pubmed: 11737116
Am J Transplant. 2016 Jun;16(6):1834-47
pubmed: 26932731
Clin J Am Soc Nephrol. 2008 Sep;3(5):1526-33
pubmed: 18701615