{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:10:25Z","timestamp":1783350625510,"version":"3.54.6"},"reference-count":18,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T00:00:00Z","timestamp":1596672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Immunosuppressive regimens are delivered without direct measure of the net state of immunosuppression. Besides therapeutic drug monitoring, adjustments in immunosuppressive medications are largely event\u2010driven.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied the clinical phenotype of immunosuppression reduction (ISR) among kidney transplant recipients from 2005 to 2012. Patients were grouped into: no ISR, ISR for infection, or ISR for intolerance. Outcome measures were rejection, rejection\u2010free survival, and IFTA\u2010free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>1114 adult kidney transplant recipients were included: 57% had no ISR, 16% had ISR for infection, and 27% had ISR for intolerance. ISR for infection was mainly on MMF, while ISR for intolerance was mainly on FK. ISR was associated with higher rates of acute rejection. The Kaplan\u2010Meier analysis showed increased prevalence of rejection among patients with ISR due to infection (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.003) or intolerance (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.05). The risk of interstitial fibrosis and tubular atrophy was increased in patients with ISR due to infection (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.001) or intolerance (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.018).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Immunosuppression reduction is associated with increased prevalence of rejection. The clinical phenotype of ISR is dominated by IFTA remote from the\u00a0onset of ISR. Solely focusing on acute rejection may underestimate effects of ISR on long\u2010term graft function and survival.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14047","type":"journal-article","created":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T03:54:41Z","timestamp":1595217281000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Phenotype of immunosuppression reduction after kidney transplantation"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7411-7154","authenticated-orcid":false,"given":"Maria Aurora","family":"Posadas Salas","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Medical University of South Carolina Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7273-4589","authenticated-orcid":false,"given":"David","family":"Taber","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery Medical University of South Carolina Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0960-2644","authenticated-orcid":false,"given":"Karim","family":"Soliman","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Medicine Medical University of South Carolina Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Nwadike","sequence":"additional","affiliation":[{"name":"Department of Medicine Lake City Medical Center Lake City FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titte","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Department of Medicine University Hospitals Cleveland Medical Center Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/86882"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.2000.tb05988.x"},{"issue":"1","key":"e_1_2_9_4_1","first-page":"Cd004759","article-title":"Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients","author":"Hill P","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-017-0553-2"},{"issue":"4","key":"e_1_2_9_6_1","first-page":"367","article-title":"Induction immunosuppression in high\u2010risk kidney transplant 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