Immunosuppressant Medications Use in Patients with Transplant Failure: A Canadian Multi-Centre Prospective Study

G. Knoll¹, M. Chassé², D. Fergusson³, A. A. House⁴, O. Johnston⁵, R. Mainra⁶, D. Baran⁷, D. Treleaven⁸, l. senecal⁹, L. Tibbles¹⁰, M. Hebert¹¹, M. Karpinski¹², T. Campbell¹³, T. Ramsay¹⁴, J. Kim¹⁵, I. Houde¹⁶, C. White¹⁷, J. Perl¹⁵, P. Karnabi¹⁸, J. Gill⁵

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 May 8, 2025.

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