Immediate and Gradual Withdrawal of Immunosuppression After Kidney Graft Loss Lead to Similar Outcomes

The management of immunosuppression in dialysis patients with a failed kidney transplant remains a pending question, and different approaches to immunosuppression weaning have been proposed. We conducted a retrospective study of patients who experienced a graft failure, and compared the rates of immune and non-immune events, according to different modalities of immunosuppression withdrawal. Two hundred and eighteen patients were included. During the follow-up (45 (20-80) months post-graft failure), 53 patients (24.3%) experienced an intolerance syndrome. The time between graft failure and the occurrence of intolerance syndrome was 6 (3-13) months. Immunosuppression withdrawal was associated with the occurrence of intolerance syndrome. However, regarding the immunosuppression withdrawal modality, only a steroid cessation during the first 3 months post graft failure was independently associated with an earlier occurrence of intolerance syndrome [HR = 1.91, 95%CI (1.08-3.38), p = 0.025], while a longer time between transplantation to graft failure was independently associated with a delayed occurrence of intolerance syndrome [HR = 0.99, 95%CI (0.98-0.99), p = 0.009]. The immunosuppression withdrawal modality after graft failure didn't have an impact on infections and cardiovascular complications. Although discontinuation of immunosuppression strongly influences the occurrence of intolerance syndrome, immunosuppression withdrawal modality itself does not appear to.