Immunosuppressant Medications Use in Patients with Transplant Failure: A Canadian Multi-Centre Prospective Study
1Nephrology, Ottawa Hospital Research Institute, Ottawa, ON, Canada, 2University of Montreal, Montreal, QC, Canada, 3Ottawa Hospital Research Institute, Ottawa, ON, Canada, 4Nephrology, Western University, London, ON, Canada, 5Nephrology, University of British Columbia, Vancouver, BC, Canada, 6Nephrology, University of Saskatchewan, Saskatoon, SK, Canada, 7Nephrology, McGill University, Montreal, QC, Canada, 8Nephrology, McMaster University, Hamilton, ON, Canada, 9Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada, 10Nephrology, University of Calgary, Calgary, AB, Canada, 11Nephrology, University of Montreal, Montreal, QC, Canada, 12Nephrology, University of Manitoba, Winnipeg, MB, Canada, 13University of Alberta, Alberta, AB, Canada, 14Ottawa Hospital Research Institute, Ottawa, ON, Canada, 15University of Toronto, Toronto, ON, Canada, 16Laval University, Que´bec, QC, Canada, 17Queen's University, Kingston, ON, Canada, 18Ottawa Health Research Institute, Ottawa, ON, Canada
Meeting: 2022 American Transplant Congress
Abstract number: 772
Keywords: Infection, Panel reactive antibodies, Rejection, Survival
Topic: Clinical Science » Kidney » 35 - Kidney: Cardiovascular and Metabolic Complications
Session Information
Session Name: Kidney: Cardiovascular and Metabolic Complications
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: This prospective study determined the association of immunosuppressant medication use with the outcomes of death, hospitalized infection, rejection of the failed allograft, and panel reactive anti-HLA antibodies.
*Methods: Patients were enrolled within 21 days of starting dialysis after transplant failure in 16 Canadian centers and had follow-up visits and measurement of panel reactive antibodies (PRA) at 1,3,6, 12 months and then biannually until death, re-transplant or loss to follow-up.
*Results: 269 patients were followed for a median 558 days. The mean (SD) age was 52(15) years, and 76% had mild or no physical limitation. There were 33 deaths, 143 hospitalized infections and 21 rejections. The mean Class I and Class II PRA increased from 11% to 27% and 25% to 47% respectively. The majority (65%) of patients continued immunosuppressants during follow up, 15% discontinued all immunosuppressants, and 20% discontinued all immunosuppressants except prednisone. In a multivariable model, continuation of immunosuppressants was not associated with an increased risk death (HR = 0.4, 955 CI (0.17-0.93) or hospitalized infection (HR =0.76, 95% CI (0.44-1.34). However, the increase in anti-HLA antibodies did not differ between patients who did or did not continue immunosuppressants and patients who continued immunosuppressants were not protected from rejection of the failed allograft (HR 0.81; 95% CI 0.22 to 2.92).
*Conclusions: Continued use of immunosuppressants was not associated with an increased risk of death or hospitalized infection but was insufficient to prevent sensitization or rejection. The findings challenge recommendations to discontinue immunosuppressants after transplant failure and indicate the need for a controlled trial of immunosuppression use.
To cite this abstract in AMA style:
Knoll G, Chassé M, Fergusson D, House AA, Johnston O, Mainra R, Baran D, Treleaven D, senecal l, Tibbles L, Hebert M, Karpinski M, Campbell T, Ramsay T, Kim J, Houde I, White C, Perl J, Karnabi P, Gill J. Immunosuppressant Medications Use in Patients with Transplant Failure: A Canadian Multi-Centre Prospective Study [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/immunosuppressant-medications-use-in-patients-with-transplant-failure-a-canadian-multi-centre-prospective-study/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress