K MARTIN1, L CANTWELL2, K BARRACLOUGH1,3, M LIAN1,3, R MASTERSON1,3, P HUGHES1,3, K CHOW1,3
1Department of Nephrology, The Royal Melbourne Hospital, 2Victorian Transplantation and Immunogenetics Service, Australian Red Cross Life Blood, 3Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
Aim: To compare different immunosuppression withdrawal periods after kidney transplant graft failure and evaluate the associated clinical risks, sensitisation outcomes and re-transplantation rates.
Background: The optimum approach toward immunosuppression withdrawal following kidney transplant failure is unclear. Prolonged weaning may be associated with reduced sensitisation, lower graft nephrectomy risk and greater likelihood of re-transplantation, but conversely increased risk of infection, malignancy and death.
Methods: We conducted a single centre retrospective analysis of patients experiencing graft failure between 2007-2017, comparing rates of sensitisation, re-transplantation, nephrectomy, infection, malignancy and death between patients who had immunosuppression weaned over <90 days, ≥90 days or ≥180 days.
Results: Patient survival after immunosuppression withdrawal over ≥90 vs. <90 days was 76.7% and 73.3% respectively (p=0.67), with no differences in calculated panel reactive antibody (cPRA) (83.37 vs. 80.06, p=0.58), re-transplantation rate (44/90 (48.9%) vs. 24/45 (53.3%), p=0.63), time to re-transplantation (753 vs. 864 days, p=0.52) or malignancy (29/90 (32.2%) vs. 14/45 (31.1%), p=0.13). More infections (0.80 vs. 0.32 per patient, p=0.01), but a trend toward less nephrectomy (14/90 (15.6%) vs. 13/45 (28.9%), p=0.07) was seen in the ≥90 day cohort. Comparing patients weaned over ≥180 vs. <90 days, no differences were seen in patient survival (80.4% vs. 73.3%, p=0.42), cPRA (85.08 vs. 80.06, p=0.45), re-transplantation (23/46 (50%) vs. 24/45 (53.3%), p=0.45), time to re-transplantation (884 vs. 864 days, p=0.92), or malignancy (18/46 (39.1%) vs. 14/45 (31.1%), p=0.42). There were more infections (0.91 vs. 0.32 per patient, p=0.01) but less nephrectomy (5/46 (10.9%) vs. 13/45 (28.9%), p=0.03).
Conclusions: Prolonged immunosuppression withdrawal does not reduce sensitisation or improve re-transplantation rates, and is associated with more infection but less nephrectomy. Immunosuppression withdrawal should be individually tailored.
Kylie Martin is a final year Nephrology trainee, clinical researcher and formally involved in public health – translating research into meaningful positive health outcomes for Australians. She has conducted numerous retrospective studies on renal outcomes. She has published these findings in peer-reviewed journals and has presented at national and international conferences. She has a particular interest in practice innovation and renal healthcare access.