*Purpose: The risk and benefit of immunosuppression use after graft failure need to be addressed to improve patient and graft survival after their re-kidney transplantation (re-KT).

*Methods: Using USRDS, we identified 2,107 patients who underwent graft failure and received re-KT between 2007-2018 with Medicare at first transplant and during 180 days before/after graft failure. We used logistic regression to compare the risk of 1-year post-KT acute rejection and Cox regression to compare the risk of patient and graft survival between immunosuppression withdrawal and low-dose immunosuppression defined as continuing 1 or more immunosuppression at 6 months after graft failure.

*Results: Of 2,107 patients, 72.1% discontinued maintenance immunosuppression at 6 months after graft failure and 17.9% continued low-dose immunosuppression. There was no association between immunosuppression withdrawal and acute rejection (aOR=_0.911.44_2.26) and death-censored graft failure (aHR=_0.650.91_1.27). However, patients who discontinued immunosuppression had a lower risk of mortality after re-KT compared with those who continued low-dose immunosuppression (aHR=_0.530.72_0.99).

*Conclusions: Our finding suggests that immunosuppression withdrawal had better survival after re-KT with no evidence of elevated risk of graft failure compared with continuation of low-dose immunosuppression. In addition to the advantages of continuing immunosuppression after graft failure, long-term outcomes should be considered.

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