Aim– Allosensitization after renal allograft failure is a major obstacle to re-transplantation.Withdrawal of immunosuppression after allograft failure is associated with sensitization. However, prolonged continuation of immunosuppression increases medical costs and the risk of infectious complications. We hypothesize that gradual instead of rapid withdrawal of immunosuppression, may result in less allosensitization, thereby decreasing the formation of de-novo donor specific antibodies (DSA).
Method-We performed a retrospective chart review of 113 patients listed for renal transplantation after renal allograft failure, from April 2007 to April 2011. 76 patients had documented immunosuppression withdrawal. Data for change in PRA, development of DSA and allograft nephrectomy were recorded. Statistical differences were calculated using Fishers exact test and Wilcoxon's Rank Sum test as appropriate.
Results-Out of 76 patients, 62 had a rapid reduction (group 1) and 14 had a gradual reduction in immunosuppression (group 2). Interestingly, group 1 showed a statistically significant increase in Class I PRA compared to group 2 (mean 63% vs 33%, p =0.03). The increase in Class II PRA was also higher in group 1 than group 2(mean 56% vs 43%), but did not reach statistical significance (p=0.40). Only 14% of patients in group 2 required allograft nephrectomy compared to 39% in group 1 (p= 0.12). Seventy-one of 76 patients were at risk of developing DSA after withdrawal of immunosuppression, as 5 patients had DSA prior to allograft failure. Importantly, 85% (n=60) of these 71 patients developed DSA. More patients in group 1 developed DSA compared to group 2 (88% vs 71%, p=0.2).
Conclusion-Rapid withdrawal of immunosuppression after allograft failure results in statistically higher rise in Class I PRA compared to gradual withdrawal. There was a trend towards a higher rise in Class II PRA, more allograft nephrectomies and development of DSA in patients with rapid withdrawal. However, these did not reach statistical significance. These findings suggest that a gradual withdrawal immunosuppression results in less allosensitization.
To cite this abstract in AMA style:Rao S, Bray R, Perez S, Pastan S, Gebel H, Chami A. Gradual vs Rapid Withdrawal of Immunosuppression after Kidney Allograft Failure Results in Less Allosensitization, Decreased Rate of De-Novo Donor Specific Antibody and Reduced Need for Allograft Nephrectomy [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/gradual-vs-rapid-withdrawal-of-immunosuppression-after-kidney-allograft-failure-results-in-less-allosensitization-decreased-rate-of-de-novo-donor-specific-antibody-and-reduced-need-for-allograft-neph/. Accessed December 6, 2023.
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