Abstract: SA-PO012
Immunosuppression in the Failing Allograft: To Wean or Not to Wean?
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Lubetzky, Michelle L., Division of Nephrology and Hypertension, New York, New York, United States
- Friedlander, Rex, The Rogosin Institute, New York, New York, United States
- Dadhania, Darshana, Weill Cornell Medical College, New York, New York, United States
Background
Sensitization is frequent after failed allograft yet there are no clear management strategies for tapering of immunosuppression.
Methods
We performed cross-sectional chart review of patients who were re-listed for repeat kidney transplant after either failed/failing allograft and subdivided them based upon their most recent calculated panel reactive antibody (cPRA) into two groups, LOW PRA, cPRA of <10% (n=18) or HIGH PRA, cPRA 100% (n=20).
Results
Table 1 describes the baseline characteristics. More patients in the 100% cPRA group had >1 prior transplant (35% versus 5.5%, p=0.05), but there was no difference in other sensitizing events or acute rejection episodes between the groups. All patients in the HIGH cPRA had failed allografts, while 8 patients in the LOW PRA group were pre-emptive and had functioning grafts (p<0.001). In the HIGH CPRA group, 30% had 0 CPRA at time of graft failure and the CPRA significantly increased in this cohort at follow up (Figure1; p<0.001), most of which (75%) were taken off immunosuppression during that time.
Conclusion
Graft failure leading to subsequent tapering of immunosuppression may be a risk factor for increase in CPRA while awaiting re-transplant. There is a need for a more standardized approach to weaning immunosuppression to avoid sensitization.