Abstract: SA-PO517

Weaning Immunosuppression in Patients with Failing Kidney Grafts: When and How?

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Ryu, Hyunjin, Seoul National University Hospital, JongNo-Gu, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, JongNo-Gu, Seoul, Korea (the Republic of)
  • Yu, Mi-yeon, Seoul National University Hospital, JongNo-Gu, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, JongNo-Gu, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, JongNo-Gu, Seoul, Korea (the Republic of)
Background

Immunosuppressant (ISA) weaning protocol in failing allograft has not been established. Maintaining ISA would preserve residual renal function (RRF) and prevent graft intolerance syndrome (GIS) and sensitization, although it would increase risk of infection, malignancy and cardiovascular disease. However, there is no optimal ISA weaning protocol after GF.

Methods

We retrospectively reviewed graft failure (GF) cases after kidney transplantation (KT) in a single center. After excluding 424 patients with age under 19, death within 6 month after KT or 1 month after GF, and lost follow-up, a total of 131 GF patients were analyzed. Maintaining ISA was defined as either ≥10 mg of prednisolone (Pd) or combination treatment including Pd with calcineurin inhibitors or antimetabolites at 6 month after GF. ISA weaning was defined as either all ISA discontinuation or using < 10mg of Pd at 6 month after GF. Duration of low dose steroid usage after GF, which is < 10mg of Pd, were also reviewed. Outcomes were infection-related hospitalization, death, GIS, nephrectomy, and RRF represented as duration of diuretics usage.

Results

Among 131 cases, 34 (26%) were female and mean age at GF was 44.9±11.1 years. At the time of GF, 72 (55%) patients were maintaining ISA but 6 month after, only 22 (16.8%) patients were maintaining ISA. With low dose steroid usage, 60 (45.8%) and 33 (25.2%) patients maintained Pd at 6 and 12 months after GF. There were total 68 events of infection related hospitalization, 11 GIS, 20 graft nephrectomy (9 GIS, and 3 graft kidney cancers), and 17 deaths (8 Cardiovascular disease, 5 infection, 2 malignancy and 1 unknown) during median 216 months (range; 15-375 months) follow up. ISA maintaining significantly lowered patient survival rate (log rank P=0.027) than weaning. Moreover, it was an independent risk factor for mortality even after adjustment (odds ratio of 3.36, 95% CI 1.06-10.64, P=0.04). Infection related hospitalization, GIS and nephrectomy was not affected by ISA weaning protocol. However, low dose steroid maintaining at 6 and 12 months after GF, was protective in RRF preservation (P=0.002 and P<0.001, respectively).

Conclusion

In this study, we suggested that ISA should be maintained less than 6month after GF due to elevated mortality risk. However, lower dose steroid continuation up to 1 year after GF could be advantageous for preserving RRF.