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Abstract: FR-PO853

Immunosuppression Practices in Failing Renal Allografts: A South Asian Perspective

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Bathini, Srikanth, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
  • Jha, Vivekanand, The George Institute for Global Health, New Delhi, Delhi, India
Background

Immunosuppression practices in failed grafts vary across the world. While the available evidence is not robust, multiple factors complicate the decisions. We conducted a survey to understand these practices in South Asia.

Methods

We distributed a web-based survey to identify the patterns and factors influencing immunosuppression use through a mailing list of over 2000 transplant teams. We collected data on factors affecting their practices in failing renal allografts.

Results

We received 190 valid responses. 88.9% individualized the decision to wean immunosuppression(IS) while 11.1% used a standard protocol.
63.8% first withdrew antimetabolite whereas CNI was most likely to be withdrawn next at 58.9%. 90% continued steroids. 26.3% made a CNI to mTOR inhibitor switch.
Factors considered in changing (IS) included ongoing rejection (77.8%), infections (72.6%), & re-transplant prospects (71.1%).
Ongoing rejection/graft intolerance (45.3%) and steroid-resistant rejection (17.4%),were the major indications for nephrectomy.

Conclusion

Immunosuppression(IS) practices in failed grafts across South Asia are varied and are guided by individual choices but not a standardized protocol. Ongoing rejection, & re-transplant prospects prompt continuation of IS, and graft intolerance was the most common indication for graft nephrectomy.

Factors Considered in Contuining/Stopping Immunosuppression
Factors Considered in Contuining/Stopping ImmunosuppressionPercentage of Respondents
Ongoing Features of Rejection77.8
History of Infections72.6
Plans to Re-Transplant71.1
Urine Output48.4
History of BK Nephropathy46.3
History of Rejection39.5
Panel Reactive Antibody Status37.4
Refractory Anemia with Raised CRP33.6
Kidney Disease Recurrence31.1
Cost of Medication24.2

Respondents were asked to choose as many factors as they would consider before deciding to stop/continue immunosuppression.