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Kidney Week

Abstract: FR-PO1168

Kidney Recipients with Allograft Failure, Transition of Care (KRAFT): Practice Survey

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Alhamad, Tarek, Washington University in St. Louis, St. Louis, Missouri, United States
  • Lubetzky, Michelle L., Division of Nephrology and Hypertension, New York, New York, United States
  • Edusei, Emmanuel Y., Weill Cornell Medicine, New York, New York, United States
  • Blosser, Christopher D., University of Washington, Seattle, Washington, United States
  • Singh, Neeraj, LSU Health Sciences Center, Shreveport, Louisiana, United States
  • Concepcion, Beatrice P., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Riella, Leonardo V., Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • Gupta, Gaurav, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Tantisattamo, Ekamol, University of California, Irvine School of Medicine, Irvine, California, United States
  • Adey, Deborah B., University of California, San Francisco, San Francisco, California, United States
  • Friedewald, John J., Northwestern University, Chicago, Illinois, United States
  • Wiseman, Alexander C., University of Colorado at Denver and Health Sciences Center, Denver, Colorado, United States
  • Pavlakis, Martha, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Parsons, Ronald, Emory University School of Medicine, Atlanta, Georgia, United States
  • Woodside, Kenneth J., University of Michigan , Ann Arbor, Michigan, United States
  • Rice, James C., University of San Diego, San Diego, California, United States
  • Kraus, Edward S., Johns Hopkins University, Baltimore, Maryland, United States
  • Dadhania, Darshana, Weill Cornell Medicine, New York, New York, United States
Background

Sensitization after failed allograft in the setting of withdrawal of immunouspression makes re-transplantation increasingly difficult. We sought to understand how different centers and clinical care providers approach withdrawal of immunosuppression in a failing kidney allograft through a survey of US kidney transplant centers.

Methods

After approval from IRB and the AST Education Committee, a survey about practices related to withdrawal of immunosupression was distributed electronically to members of the AST members between Nov 2018 and May 2019.

Results

There were 101 responders with a response rate of 31%. Most survey respondents were Transplant Nephrologists (80.4%) at academic medical centers (90.2%). The most common approach to withdrawal of immunosuppression was withdrawal of the anti-metabolite first; with 64.2 % respodning they would withdraw antimetabolite first, 24% with no unified protocol, and 9.4% responding they would stop CNI first. Most providers would stop immunosupression over a time frame of 2-6 months (38.9%), although 24.1% responded they would keep a low dose of prednisone, and 20.4% had no unified protocol. Approach to tapering of immunosuppression did differ based upon whether or not practitioners felt the patient would be re-transplanted shortly. While most practitioners, 96.6% felt development of sensitization was of intermediate or most importance in the decision to taper immunosuppression there were many concerns of risk of infections, malignancy and patient age which were factors in the decision to taper or continue immunosuppression. Overall, 57.4% providers felt there was a need for standardized approach to taper immunosuppression in the failing allograft.

Conclusion

In a sample of US Kidney Transplant centers, we found a wide range of approaches to withdrawal of immunosuppression in a failed kidney transplant with no unified protocols in quarter of the respondents. Efforts to standardize clinical practice are warranted to tailor immunosuppression withdrawal according to the availability of a second kidney transplant and patient comorbidities.