Background: Most patients who failed kidney transplant become sensitized. It is uncertain whether maintaining immunosuppression with or without nephrectomy after the allograft failure will prevent developing sensitization and benefit to the future retransplantation.

Methods: We retrospectively studied total 90 kidney retransplants from 2000 to 2012. PRA were compared at the time of the previous transplant, relist after failed kidney transplant and retransplant in patients who had none immunosuppression (n= 63) and maintained on any tapered immunosuppression which included prednisone, mycophenolate mofetil, and/or calcineurin inhibitors (n=27). They are sub-grouped with and without allograft nephrectomy.

Results: All the groups had significantly increased PRA after failed kidney transplant. PRA was significantly increased from relist to retransplant in all groups. There is a trend that PRA was found increased higher in allograft nephrectomy with none immunosuppression group. In contrast, there is no difference in increasing PRA in immunosuppression maintenance groups with or without nephrectomy.

Conclusions: The tapered immunosuppression maintenance did not successfully achieve prevention of increasing PRA after failed kidney transplant. Immunosuppression maintenance seems to prevent increasing PRA after allograft nephrectomy. Further studies are required to assess the benefits of using higher immunosuppressant maintenance in those suitable retransplant candidates, particularly after allograft nephrectomy to prevent sensitization.

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