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Transplantation:
doi: 10.1097/TP.0000000000000057
Clinical and Translational Research

Prolonged Immunosuppression Preserves Nonsensitization Status After Kidney Transplant Failure

Casey, Michael J.1,6; Wen, Xuerong1; Kayler, Liise K.2; Aiyer, Ravi3; Scornik, Juan C.4; Meier-Kriesche, Herwig-Ulf5

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Abstract

Background

When kidney transplants fail, transplant medications are discontinued to reduce immunosuppression-related risks. However, retransplant candidates are at risk for allosensitization which prolonging immunosuppression may minimize. We hypothesized that for these patients, a prolonged immunosuppression withdrawal after graft failure preserves nonsensitization status (PRA 0%) better than early immunosuppression withdrawal.

Methods

We retrospectively examined subjects transplanted at a single center between July 1, 1999 and December 1, 2009 with a non–death-related graft loss. Subjects were stratified by timing of immunosuppression withdrawal after graft loss: early (≤3 months) or prolonged (>3 months). Retransplant candidates were eligible for the main study where the primary outcome was nonsensitization at retransplant evaluation. Non-retransplant candidates were included in the safety analysis only.

Results

We found 102 subjects with non–death-related graft loss of which 49 were eligible for the main study. Nonsensitization rates at retransplant evaluation were 30% and 66% for the early and prolonged immunosuppression withdrawal groups, respectively (P=0.01). After adjusting for cofactors such as blood transfusion and allograft nephrectomy, prolonged immunosuppression withdrawal remained significantly associated with nonsensitization (adjusted odds ratio=5.78, 95% CI [1.37–24.44]). No adverse safety signals were seen in the prolonged immunosuppression withdrawal group compared to the early immunosuppression withdrawal group.

Conclusions

These results suggest that prolonged immunosuppression may be a safe strategy to minimize sensitization in retransplant candidates and provide the basis for larger or prospective studies for further verification.

Copyright © 2014 by Lippincott Williams & Wilkins

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