Purpose: The current standard of practice after allograft loss is to discontinue immunosuppression (IS) to decrease complications related to prolonged exposure. There is a paucity of data regarding the impact this has on allosensitization for those who would be candidates for another transplant. We hypothesized that continuation of IS after graft failure in individuals who are candidates for another transplant would reduce the risk of allosensitization thereby proving beneficial from a transplant standpoint.

Methods: We performed a retrospective analysis on all patients currently listed for a kidney transplant at our center who had undergone a prior solid organ transplant. Previous liver transplant and > 1 kidney transplant recipients were excluded. We compared the effects of continuation or discontinuation of IS on allosensitization by evaluating serial calculated panel reactive antibody (cPRA) levels. Fishers exact test was used for statistical analysis.

Results: 33 patients met our inclusion criteria. 1 patient in this group was eliminated due to a cPRA of 100% even prior to graft failure. The remaining 32 patients were divided into two groups: those who had IS continued (18 patients) and those who had IS discontinued (14 patients)(Table1). cPRA remained stable or decreased in all 18 of those who had IS continued. In the 14 patients that had IS discontinued, 11 experienced an increase in cPRA while cPRA remained stable in 3 patients. There was a significant difference in the incidence of patients who had a stable cPRA compared to those who experienced allosensitization (p< .0001). The associated Odds ratio for an increase in cPRA after IS discontinuation was 121.57 (CI 5.74-2575.3) compared to having a stable cPRA with continuation of IS.

Conclusions:In this single center retrospective analysis continuation of IS appears to have a large protective effect against the risk of allosensitization when listing for a second transplant. Though this study has a small sample size the paucity of data in literature regarding management of IS after graft failure makes it relevant. Larger prospective studies on IS management after graft failure are necessary to better determine appropriate IS regimens which will balance risk with benefit.

CITATION INFORMATION: Kuppachi S, Sanders M, Kalil R, Stewart Z, Thomas C. Continuation of Immunosuppression Appears to Protect Against Allosensitization in Patients Listed for a Second Kidney Transplant. Am J Transplant. 2017;17 (suppl 3).

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