Immunosuppression after Renal Transplant Failure.
David Gomez
August 2022
Immunossupresion withdrawl after Tx Failure= HLA sensitization
HLA sensitization = less Re-Tx Potencial
No Guidelines on what to do after Tx Failure
Main Ideas
15% Kidney Tx, lost in the first 5 years
20% Re-Tx
Re-Tx = Reduce Mortality by 45%
quick Data
HLA main Factor for Renal-Tx.
Main HLA influence
Tx in the past, Pregnacies, Blood Trasnfusions.
short info in Renal-Tx
158 Patients
only 77 Patients (Tx Failure 1st and 2nd Tx)
Our Study:
What to do after Tx-Failure
Results
Median Duration of Tx: 10 years.
No CNI(Tacrolimus) + Graft Nephrectomy = Increase of dnDSA 90%
CNI Mainteance = Lower HLA sensitization (by 4x more with IS (Corticoids))
Tacrolimus serum contetracion
3ng/ml = lower dnDSA
Graft nephrectomy = HLA sensitization.
We DID NOT measure CNI levels, in all the patients, we cannot establish a fix dosis to prevent HLA sensitization
limitation
conclusion
& discussion
conclusion
&
discussion
conclusion
Graft Lost is High, mortality after Tx-failure is high.
Graft nephrectomy = Higher HLA sensitization
CNI(Tacrolimus) maintenance after Tx-failure = Reduced HLA sensitization (x4 compared to no IS or Corticoids(prednisolon))
We recommend to maintain IS with Tacrolimus after Graft Failure. To improved the possiblity of Re-Tx, especially when we anticipate a short-medium term Re-Tx
Publication
https://pubmed.ncbi.nlm.nih.gov/32231087/