Journal
CLINICAL TRANSPLANTATION
Volume 38, Issue 1, Pages -Publisher
WILEY
DOI: 10.1111/ctr.15160
Keywords
graft nephrectomy; HLA; immunosuppressive therapy; kidney graft failure; kidney transplantation; sensitization
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Continuation of immunosuppressive therapy after kidney allograft failure is associated with less change in HLA-sensitization and does not increase patient mortality.
Background: The optimal management of immunosuppressive therapy (IT) after kidney allograft failure (KAF) remains controversial. Although maintaining IT may reduce HLA-sensitization and improve access to retransplantation, it may also increase the rate of immunosuppression-related complications. The overall impact on patient mortality is unknown. The main objective of this study was to compare the evolution of HLA-sensitization 6 months after KAF according to IT management.Methods: Individual clinical and health care data were extracted from the French national end-stage kidney disease registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Patients aged > 18 years returning to dialysis after KAF between January 2008 and December 2019 in Lorraine were included. Patients were classified into two groups, IT continuation or IT discontinuation. HLA-sensitization was defined as an increase in incompatible graft rate (IGR) between KAF and 6 months post-KAF (change to a higher predefined category (0%-5%), (5%-20%), (20%-50%), (50%-85%), (85%-95%), (95%-98%), (98%-100%)). Secondary outcome was patient survival according to IT management.Results: A total of 121 patients were included, 35 (29%) of whom continued IT. HLAsensitization after KAF tended to be higher in the IT discontinuation group (57% vs. 38% in the IT continuation group, p = .07). In multivariate analysis, IT continuation was associated with a lower increase in IGR (OR .37, 95% CI [.14; .93]). IT management was not associated with patient mortality.Conclusions: Continuation of IT after KAF was associated with less change in IGR and was not associated with excess mortality.
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