Abstract: FR-PO853
Immunosuppression Practices in Failing Renal Allografts: A South Asian Perspective
Session Information
- Transplantation: Clinical - Outcomes
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
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63.8% first withdrew antimetabolite whereas CNI was most likely to be withdrawn next at 58.9%. 90% continued steroids. 26.3% made a CNI to mTOR inhibitor switch.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 Immunosuppression | Percentage of Respondents |
| Ongoing Features of Rejection | 77.8 |
| History of Infections | 72.6 |
| Plans to Re-Transplant | 71.1 |
| Urine Output | 48.4 |
| History of BK Nephropathy | 46.3 |
| History of Rejection | 39.5 |
| Panel Reactive Antibody Status | 37.4 |
| Refractory Anemia with Raised CRP | 33.6 |
| Kidney Disease Recurrence | 31.1 |
| Cost of Medication | 24.2 |
Respondents were asked to choose as many factors as they would consider before deciding to stop/continue immunosuppression.