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

## TL;DR

This study compares immediate and gradual immunosuppression withdrawal after kidney transplant failure and finds similar outcomes in terms of infections and cardiovascular complications.

## Contribution

The study identifies that the timing of steroid cessation, not the withdrawal modality, is linked to earlier intolerance syndrome after kidney graft loss.

## Key findings

- Steroid cessation within 3 months post-graft failure is independently associated with earlier intolerance syndrome.
- The immunosuppression withdrawal modality does not impact infections or cardiovascular complications.
- A longer time between transplantation and graft failure delays intolerance syndrome occurrence.

## Abstract

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.

Infographic compares immediate and gradual immunosuppression withdrawal after kidney graft loss. Three panels highlight withdrawal modalities, patient data, immune and non-immune events, and a survival curve showing discontinuation timing impacts intolerance syndrome, not withdrawal approach.