{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:16:52Z","timestamp":1783487812396,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Retransplantation is becoming more common. Allosensitization represents an increasing issue, as it prolongs the time on the waiting list and worsens the outcome of a second transplant. The optimal maintenance immunosuppression (IS) after graft failure remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective single-center study including kidney retransplant recipients (KRTRs) who underwent a retransplantation in the University Hospital of Zurich between 2012 and 2023. We analyzed which factors and especially which kind of maintenance IS after graft failure could affect allosensitization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In our cohort, 191\/1,040 (16%) were retransplantations. Of the included KRTRs, 27\/129 (20%) were living donations (LDs). The median waiting time for deceased donations (DDs) was 4 years. The burden of IS decreased from graft failure to retransplantation (triple IS 54 vs. 12%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05), while the allosensitization increased [number of HLA-antibodies (Ab) MFI &amp;gt; 1,000\/patient 5.8 vs. 12.45,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt; 0.001]. In the univariate analysis transplant, nephrectomy was associated with a higher calculated panel reactive Ab (cPRA): 90 vs. 29 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.0001). At retransplantation, intake of calcineurin inhibitor (CNI) was associated with lower cPRA (27% vs. 78% no CNI,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001), as was intake of antimetabolite [23% for azathioprine, 20% for mycophenolic acid (MPA), and 88% for no antimetabolite,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001] and of prednisone (PDN) (24% vs. 66% no PDN,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02). First retransplantation was also associated with a lower cPRA when compared to a second or a third retransplantation (41% vs. 78% vs. 88%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02). In the multivariable analysis, only the intake of antimetabolite remained associated with cPRA &amp;lt;85% at retransplantation. Surprisingly, we could find a weak correlation between cPRA and waiting time to retransplantation (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.25,\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The intake of antimetabolite at retransplantation showed a protective effect against allosensitization. Waiting time to retransplantation had only a weak correlation with allosensitization over the whole cPRA spectrum in this Swiss cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1850824","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:51:01Z","timestamp":1783486261000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The potential role of antimetabolite in preventing allosensitization before kidney retransplantation"],"prefix":"10.3389","volume":"17","author":[{"given":"Madeleine","family":"Thommen","sequence":"first","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Weidmann","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dusan","family":"Harmacek","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seraina","family":"von Moos","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Cantonal Hospital of Lucerne","place":["Lucerne, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Westphal","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"H\u00fcbel","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britta","family":"George","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]},{"name":"University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mallone","sequence":"additional","affiliation":[{"name":"Department of Immunology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Frischknecht","sequence":"additional","affiliation":[{"name":"Department of Immunology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Immunology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schachtner","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]},{"name":"University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Rho","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-068769","article-title":"Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and 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