Background: Renal transplantation is the treatment of choice for endstage renal disease. Nevertheless, it involves immunosuppressive treatments with Serious Adverse Events (SAE) such as infections and cancers. In these cases, maintaining or withdrawing immunosuppression is a real dilemma. No study has been published to describe the clinical profile and the outcomes of Kidney Transplant Recipients (KTR) with a Minimally ImmunoSuppression (MIS). That may explain the high variability in the weaning decision after SAE.

Methods: We performed a retrospective study in Nantes University Hospital (France) of renal transplantations between 1982 and 2011. We included KTR weaned for calcineurin inhibitor, mammalian target of rapamycin inhibitors or CTLA4-Ig. Cumulative incidences of graft loss and death with a functional graft were analyzed using the Aalen-Johansen estimator for competing risks.

Results: In our cohort of 73 KTR, main reason for MIS was cancer (71%). The median follow-up time from the MIS was 1.8 years (range 26 days to 12.8 years). Twenty-six patients died with a functional graft and eight returned to dialysis during the follow-up. The cumulative incidences at 5 years post-MIS for death with a functional graft and for return to dialysis were estimated to be 32.5% (95% CI from 22.1% to 46.2%) and 10.2% (95% CI from 5.0% to 20.2%) respectively. KTR living with a functional graft maintained a correct renal function, and a very low rate of acute rejection episode.

Conclusion: In our cohort of KTR after minimally immunosuppression, the graft failure risk was much lower than the risk of death. Regarding the absence of clinical trial due to obvious ethical arguments, our results from routine clinical practice suggest that minimizing immunosuppressive therapy is justified for patients with related immunosuppressive SAE.

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