Abstract: FR-PO1229
To Stop or Not to Stop Immunosuppression: Outcomes of 215 Critically Ill Kidney Transplant Recipients over 14 Years
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Author
- Ville, Simon, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
Background
Management of immunosuppressive therapy (IS) in critically ill kidney transplant recipients (KTR) remains unstandardized.
Methods
Single-center retrospective cohort of all 215 consecutive KTR admitted to a tertiary ICU between January 2009 and January 2023. Factors associated with ICU mortality were assessed using multivariable logistic regression adjusted for age, Charlson Comorbidity Index, and SAPS II score.
Results
IS was modified in 89% of patients receiving at least one agent at baseline; complete discontinuation occurred in 68%. ICU mortality was 16.7% (n=36); 3-month mortality was 24.7%. In multivariable analysis, complete IS discontinuation was independently associated with ICU mortality (OR 3.79 [1.17–17.0], p=0.044), confirmed in sensitivity analysis restricted to CNI/antimetabolite patients (OR 4.20 [1.11–21.4], p=0.050). A consistent trend was observed for CNI discontinuation alone (OR 3.24 [0.95–15.0], p=0.085). Complete IS discontinuation was not associated with de novo anti-HLA immunization (29.7% vs 24.3%, p=0.656), de novo DSA (9.6% vs 10.8%, p>0.999), or graft rejection (6.1% vs 9.8%, p=0.511).
Conclusion
Complete IS discontinuation in critically ill KTR is independently associated with increased ICU mortality. These data support a strategy of selective antimetabolite withdrawal with CNI maintenance, potentially leveraging CNI anti-inflammatory properties to attenuate the hyperinflammatory phase of critical illness.
Figure 1. Forest plot illustrating the association between immunosuppressive therapy management and ICU mortality across primary and sensitivity analyses. All models were adjusted for age, Charlson Comorbidity Index, and SAPS II score, except the antimetabolite discontinuation analysis which was adjusted for age and SAPS II score only. Arrows indicate confidence intervals truncated at the display limit. CNI: calcineurin inhibitor; IS: immunosuppressive therapy; SA: sensitivity analysis; SAPS: Simplified Acute Physiology Score.