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Multicenter Study
. 2023 Sep 15:36:11775.
doi: 10.3389/ti.2023.11775. eCollection 2023.

Impact of Calcineurin Inhibitor-Based Immunosuppression Maintenance During the Dialysis Period After Kidney Transplant Failure on the Next Kidney Graft Outcome: A Retrospective Multicenter Study With Propensity Score Analysis

Juliette Noelle  1 , Valentin Mayet #  1 , Céline Lambert  2 , Lionel Couzi  3 , Bertrand Chauveau  4 , Antoine Thierry  5 , Laure Ecotière  5 , Dominique Bertrand  6 , Charlotte Laurent  6 , Richard Lemal  7 , Clarisse Grèze  1 , Marine Freist  1   8 , Anne-Elisabeth Heng  9 , Paul-Olivier Rouzaire  7   10 , Cyril Garrouste  9   10
Affiliations
Multicenter Study

Impact of Calcineurin Inhibitor-Based Immunosuppression Maintenance During the Dialysis Period After Kidney Transplant Failure on the Next Kidney Graft Outcome: A Retrospective Multicenter Study With Propensity Score Analysis

Juliette Noelle et al. Transpl Int. .

Abstract

The impact of immunosuppressive therapy (IS) strategies after kidney transplant failure (KTF) on potential future new grafts is poorly established. We assessed the potential benefit of calcineurin inhibitor (CNI)-based IS maintenance throughout the dialysis period on the outcome of the second kidney transplant (KT). We identified 407 patients who underwent a second KT between January 2008 and December 2018 at four French KT centers. Inverse probability of treatment weighting was used to control for potential confounding. We included 205 patients with similar baseline characteristics at KTF: a total of 53 received at least CNIs on the retransplant day (G-CNI), and 152 did not receive any IS (G-STOP). On the retransplant date, G-STOP patients experienced a longer pretransplant dialysis time, were more often hyperimmunized, and underwent more expanded-criteria donor KTs than G-CNI patients. During the second KT follow-up period, rejection episodes were similar in both groups. The 10-year survival rates without death and dialysis were 98.7% and 59.5% in G-CNI and G-STOP patients, respectively. In the multivariable analysis, CNI-based IS maintenance was associated with better survival (hazard ratio: 0.08; 95% confidence interval: 0.01-0.58, p = 0.01). CNI-based IS maintenance throughout the dialysis period after KTF may improve retransplantation outcomes.

Keywords: calcineurin inhibitor maintenance; immunosuppression; kidney retransplant; kidney transplant failure; waiting list.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

None
Graphical abstract
FIGURE 1
FIGURE 1
Flow chart of the study. CNI, calcineurin inhibitor; cPRA, calculated panel reactive antibody; G-CNI, group with immunosuppressive therapy maintenance; G-STOP, group with discontinued immunosuppressive therapy.
FIGURE 2
FIGURE 2
Overall second kidney transplant survival (without death or kidney transplant failure) in patients with immunosuppressive therapy maintenance until the second graft (G-CNI) or discontinued therapy (G-STOP). Data are presented after the inverse probability of treatment weighting.
FIGURE 3
FIGURE 3
Adverse events between the two kidney transplants (A) and after the second transplant (B) in patients with immunosuppressive therapy maintenance (G-CNI) or discontinued therapy (G-STOP). Data are presented after the inverse probability of treatment weighting. MACE, major cardiovascular event; NMSC, non-melanoma skin cancer.
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References

    1. Agence de la biomédecine. Organs - Kidney Transplant (2023). Available from: https://rams.agence-biomedecine.fr/greffe-renale-0 (Accessed August 11, 2023).
    1. USRDS Annual Data Report. 2022 Annual Data Report (2022). Available from: https://adr.usrds.org/ (Accessed August 11, 2023).
    1. Eurotransplant. Statistics Report Library (2023). Available from: https://statistics.eurotransplant.org/index.php?search_type=waiting+list... (Accessed August 11, 2023).
    1. The UK Kidney Association. 23rd Annual Report - Data to 31/12/2019 (2019). Available from: https://ukkidney.org/audit-research/annual-report/23rd-annual-report-dat... (Accessed August 11, 2023).
    1. Agence de la biomédecine. Table R4. Demographic Characteristics of Patients Registered According to Their Future on the Kidney Transplant Waiting List in 2021 (2022). Available from: https://rams.agence-biomedecine.fr/media/2606 (Accessed August 11, 2023).

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