*Purpose: The standard of care following renal allograft failure is to discontinue immunosuppression (IS) to limit risks from further IS. We hypothesized that continuation of IS after kidney transplant (KT) allograft failure would prevent worsening of sensitization status as reflected by calculated panel reactive antibodies (cPRA) before second KT.

*Methods: We retrospectively analyzed cPRA of KT recipients at our center from January 2009 to December 2019 who had previously undergone KT or simultaneous kidney-pancreas transplantation (KPT). Patients with more than two KT were excluded. We compared sensitization status based on cPRA analysis at the time of first and second KT, between those who remained on IS, and those who did not, using odds risk ratio (OR) and Fisher’s exact test for statistical significance.

*Results: Out of 47 patients who met the inclusion criteria, 42 had received a prior KT, while 5 patients had prior KPT. In 17 out of 47 patients (36.1%), IS was continued after allograft failure. In 9 out of 17 patients (52.9%), cPRA remained unchanged between the first and second KT. IS was discontinued in 30 out of 47 patients (63.8%). Among these patients, 27 (90%) experienced an increase in their cPRA. The odds of having an increased cPRA at the time of second KT in patients after stopping IS compared to continuing IS was 10.1 (confidence interval 2.2-46.59, Fisher exact p-value = 0.002).

*Conclusions: In our single center analysis, the discontinuation of IS after renal allograft failure significantly increased the OR for increased cPRA at the time of a second KT. Prospective, multicenter studies on a larger scale are necessary to confirm these findings as well as study the risks of infection and malignancy with continued IS.

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