Graft Intolerance Syndrome Complicates Retransplantation

Patients with non-functioning renal grafts constitute approximately 4% of patients with incident dialysis. Complete withdrawal of immunosuppression has been associated with a higher risk of HLA sensitization and renal graft intolerance syndrome (GIS).

We conducted a retrospective observational study of 63 patients with renal graft failure (from January 2012 to December 2022). Immediate graft losses due to vascular thrombosis or technical complications were excluded. We analyzed demographic and clinical characteristics, as well as the evolution of GIS. A comparative study was performed with patients who did not develop GIS (non-GIS).

Twenty-three patients (36.5%) developed GIS. The most common presentation was anemia (73.9%), followed by renal graft pain (65.2%). Seventeen patients (74%) required renal graft embolization. GIS was associated with a higher degree of sensitization. We did not find differences in prior HLA sensitization, causes of graft failure, history of acute rejection, or doses/levels of immunosuppression after graft failure, although rejections were more severe in the GIS group. Patients with GIS had a lower rate of retransplantation after graft failure (4.3% vs 25%, P = .02). Graft failure within the first 2 years after transplantation was the main predictive factor for GIS (hazard ratio = 2.740, 95% confidence interval = 1.06-7.06, P = .03).

GIS was more prevalent in patients who experienced graft failure within the first 2 years. Despite increased immunosuppression, a significant percentage required graft embolization. GIS was associated with an increase in HLA sensitization and a lower likelihood of retransplantation.