Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers

Alhamad, Tarek; Lubetzky, Michelle; Lentine, Krista L.; Edusei, Emmanuel; Parsons, Ronald F.; Pavlakis, Martha; Woodside, Kenneth J.; Adey, Deborah; Blosser, Christopher D.; Concepcion, Beatrice P.; Friedewald, John; Wiseman, Alexander C.; Singh, Neeraj; Chang, Su‐Hsin; Gupta, Gaurav; Molnár, Miklós; Basu, Arpita; Kraus, Edward S.; Ong, Song; Faravardeh, Arman; Tantisattamo, Ekamol; Riella, Leonardo V.; Rice, J. C.; Dadhania, Darshana

doi:10.1111/ajt.16523

Cited by 29 publications

(51 citation statements)

References 26 publications

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“…Forty percent responded that being listed for a re‐transplantation was the single most important factor for continuing immunosuppression 7 . A more recent survey that was performed by the KRAFT workgroup in 2019 that included 101 respondents and found that the most common approach was withdrawal of the antimetabolite first (64.2%), whereas 9.4% would stop the CNI first, and 24% reported no unified protocol 8 . Overall, 57.4% providers felt that there was a need for a standardized approach to taper immunosuppression in the failing allograft 8 .…”

Section: Current Physician Perspectives On Immunosuppression Withdrawalmentioning

confidence: 99%

“…A more recent survey that was performed by the KRAFT workgroup in 2019 that included 101 respondents and found that the most common approach was withdrawal of the antimetabolite first (64.2%), whereas 9.4% would stop the CNI first, and 24% reported no unified protocol 8 . Overall, 57.4% providers felt that there was a need for a standardized approach to taper immunosuppression in the failing allograft 8 . Comparing the 2012 and 2019 surveys, the percentage of providers that would stop the CNI first decreased from 38% to 9.4% 7 .…”

Section: Current Physician Perspectives On Immunosuppression Withdrawalmentioning

confidence: 99%

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The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

Lubetzky

Tantisattamo

Molnar

et al. 2021

American Journal of Transplantation

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The return to dialysis after allograft failure is associated with increased morbidity and mortality. This transition is made more complex by the rising numbers of patients who seek repeat transplantation and therefore may have indications for remaining on low levels of immunosuppression, despite the potential increased morbidity. Management strategies vary across providers, driven by limited data on how to transition off How to cite this article: Lubetzky M, Tantisattamo E, Molnar MZ, et al. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients.

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Section: Current Physician Perspectives On Immunosuppression Withdrawalmentioning

confidence: 99%

Section: Current Physician Perspectives On Immunosuppression Withdrawalmentioning

confidence: 99%

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

Lubetzky

Tantisattamo

Molnar

et al. 2021

American Journal of Transplantation

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“…Although there are non-invasive investigations to determine the possibility of acute kidney allograft rejection such as donor-derived cell-free DNA, allograft biopsy should be performed to confirm the diagnosis unless there is a contraindication for the biopsy. We also consider withholding rejection treatment in the patients with progressively declining allograft function toward failing kidney allograft and maintenance immunosuppressive medications should be carefully managed; although there is no consensus guideline for immunosuppressive medication management in this setting [20].…”

Section: Acute Rejection Treatmentmentioning

confidence: 99%

Kidney Transplantation during the COVID-19 Pandemic: From Past through Present Time of Emerging Vaccine

Jittirat¹,

Eguchi²,

Tanphaichitr³

et al. 2021

OBM ICM

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The novel coronavirus disease 2019 (COVID-19) pandemic has significantly impacted kidney transplantation worldwide. The rate of kidney transplantation decreased during the peak of the COVID-19 pandemic, especially living donor kidney transplantation. Kidney transplant recipients are at high risk of developing severe complications from COVID-19 due to underlying comorbidities and immunosuppressed status. Management of immunosuppression, including the induction therapy and maintenance immunosuppressive regimen, has been modified at many transplant centers during the pandemic. In severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) infected kidney transplant recipients, the immunosuppression is usually reduced. The acute rejection treatment is usually individualized based on the risks and benefits. Several COVID-19 therapies have received emergency use authorization to prevent the progression of COVID-19 severity. Use of oral antiviral therapies is faced with challenges in terms of drug-drug interaction, drug efficacy, and lack of data in the transplant population. For COVID-19 prophylaxis in kidney transplant recipients, the effectiveness of COVID-19 vaccines is lower compared to the general population. Pre-exposure prophylaxis with a long-acting antibody combination may be an adjunct strategy for vaccination in kidney transplant recipients or those for whom COVID-19 vaccination is not contraindicated. Post-exposure prophylaxis remains to be studied. Further studies are necessary to establish standard guidelines of immunosuppressive management in kidney transplant recipients diagnosed with COVID-19 and to better understand the outcomes and adverse drug reactions of the therapeutic and prophylactic modalities including vaccination in this high-risk population.

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“…A recent survey of US kidney transplant centers showed overwhelming agreement regarding the need to standardize management of immunosuppression in patients with failing kidney allografts 4 . Centers reported that availability of a living donor is the most important factor in the decisions regarding overall approach.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting sensitization following kidney allograft failure

Garg

Viney

Burger

et al. 2022

Clinical Transplantation

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Introduction Management of immunosuppression in a kidney transplant recipient with a failed allograft is complex; continuation carries infectious and metabolic risks, and discontinuation can lead to sensitization. Methods We evaluated risk factors for sensitization in 89 kidney or simultaneous kidney‐pancreas recipients, whose kidney transplant failed after January, 2013 and who were subsequently re‐evaluated for kidney transplantation. Results Among recipients with pre graft failure cPRA < 50%, calcineurin inhibitor (CNI) continuation (OR .11, P = .003) and steroid continuation (OR .17, P = .04) were associated with significantly lower odds of developing an absolute increase in cPRA of ≥50%. Each additional HLA mismatch was associated with OR of 2.16 (P = .02). CNI use was associated with OR of .09 (P = .001) for increase in cPRA to ≥80% if pre graft failure cPRA was <50%, and OR of .08 (P = .02) for increase in cPRA to ≥98% if pre graft cPRA was <80%. Anti‐metabolites were continued more often among recipients who had a <50% increase (P = .006); however, the association was lost on multivariate analyses. Weaning off immunosuppression and higher number of HLA mismatches are associated with greater likelihood of sensitization. Conclusion While both CNI and steroid continuation conferred some protection against increase in cPRA, CNI continuation was the only factor protecting against becoming highly sensitized.

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Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers

Cited by 29 publications

References 26 publications

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

Kidney Transplantation during the COVID-19 Pandemic: From Past through Present Time of Emerging Vaccine

Factors affecting sensitization following kidney allograft failure

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