Factors affecting sensitization following kidney allograft failure

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Managing immunosuppression in kidney transplant recipients with failed allografts presents a complex challenge.
• Continuing immunosuppression carries risks of infection and metabolic complications.
• Discontinuing immunosuppression can lead to increased sensitization, complicating future transplantation.

Purpose of the Study:

• To evaluate risk factors for sensitization in kidney or simultaneous kidney-pancreas transplant recipients with a failed allograft.
• To identify factors associated with an increased calculated panel reactive antibody (cPRA) level post-graft failure.

Main Methods:

• A study of 89 kidney or simultaneous kidney-pancreas recipients whose kidney transplants failed after January 2013.
• Analysis of risk factors including calcineurin inhibitor (CNI) and steroid continuation, HLA mismatches, and anti-metabolite use.
• Evaluation of changes in cPRA levels before and after graft failure.

Main Results:

• Among recipients with pre-graft failure cPRA <50%, CNI and steroid continuation were associated with significantly lower odds of a ≥50% increase in cPRA.
• Each additional HLA mismatch increased the odds of sensitization.
• CNI continuation was protective against becoming highly sensitized (cPRA ≥80% or ≥98%).

Conclusions:

• Continuation of both CNI and steroids may offer some protection against increased cPRA.
• CNI continuation was the sole factor identified as protective against becoming highly sensitized.
• Weaning immunosuppression and a higher number of HLA mismatches are associated with a greater likelihood of sensitization.