Dr HELENA XIANG1, DR DHARMENAAN PALAMUTHUSINGAM1,2, DR SOPHIE HARMOS3, DR ROSS FRANCIS2,4,5, DR KATHARINE HEGERTY2,4, DR CARMEL HAWLEY4,5,6, DR MONICA SUET YING NG1,2,7
1Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston, Australia, 2Faculty of Medicine, University of Queensland, Herston , Australia, 3Renal Medicine, Auckland City Hospital, Auckland, New Zealand, 4Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Australia, 5Translational Research Institute, Woolloongabba, Australia, 6Centre for Kidney Disease Research, University of Queensland, Woolloongabba, Australia, 7Conjoint Internal Medicine Laboratory, Chemical Pathology, Pathology Queensland, Herston, Australia
Biography:
Bio to come
Aim:
To characterise patterns in Australia and Aotearoa New Zealand regarding immunosuppressive medication management and graft nephrectomy after kidney transplant failure.
Background:
There is limited guidance on immunosuppressive medication management after graft failure. While these medications are no longer required to maintain graft function, stopping them can lead to complications including graft intolerance syndrome/ sensitisation. Understanding practice patterns is important to inform the interpretation of outcome data from registry studies.
Methods:
STAG-ANZ is a survey of 22 questions administered to kidney specialists and advanced trainees across Australia and New Zealand. Immunosuppression and graft nephrectomy practices were assessed by determining current immunosuppression medications of patients with graft failure followed by clinical scenarios to explore how/if management changed depending on re-transplantability, frailty and existing complications of immunosuppression.
Results:
After 6 months, the survey received 64 responses, with 47 complete responses. Forty percent of respondents worked in centres performing kidney transplants. Additionally, 52% reported caring for patients eligible for re-transplantation who were receiving minimal or no immunosuppressive therapy. In cases of graft failure for patients suitable for re-transplantation, more respondents initially preferred reducing antimetabolite use over adjusting calcineurin inhibitor or prednisone doses. Almost 70% would be comfortable with patients not receiving antiproliferative agents. For patients not suitable for re-transplantation, 47% would stop antimetabolites first. The majority of respondents expressed comfort with these patients not receiving calcineurin inhibitors (57%) or antiproliferative agents (79%). Across the cases presented, an average of 24% of respondents indicated they would refer patients for graft nephrectomy.
Conclusion:
The survey highlights variability in managing immunosuppression after kidney graft failure, underscoring the need for further evidence to guide clinicians and improve patient outcomes.
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