{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T16:16:43Z","timestamp":1783095403662,"version":"3.54.6"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>\n                    The management of immunosuppression in dialysis patients with a failed kidney transplant remains a pending question, and different approaches to immunosuppression weaning have been proposed. We conducted a retrospective study of patients who experienced a graft failure, and compared the rates of immune and non-immune events, according to different modalities of immunosuppression withdrawal. Two hundred and eighteen patients were included. During the follow-up (45 (20\u201380) months post-graft failure), 53 patients (24.3%) experienced an intolerance syndrome. The time between graft failure and the occurrence of intolerance syndrome was 6 (3\u201313) months. Immunosuppression withdrawal was associated with the occurrence of intolerance syndrome. However, regarding the immunosuppression withdrawal modality, only a steroid cessation during the first 3 months post graft failure was independently associated with an earlier occurrence of intolerance syndrome [HR = 1.91, 95%CI (1.08\u20133.38),\n                    <jats:italic>p<\/jats:italic>\n                    = 0.025], while a longer time between transplantation to graft failure was independently associated with a delayed occurrence of intolerance syndrome [HR = 0.99, 95%CI (0.98\u20130.99),\n                    <jats:italic>p<\/jats:italic>\n                    = 0.009]. The immunosuppression withdrawal modality after graft failure didn\u2019t have an impact on infections and cardiovascular complications. Although discontinuation of immunosuppression strongly influences the occurrence of intolerance syndrome, immunosuppression withdrawal modality itself does not appear to.\n                  <\/jats:p>","DOI":"10.3389\/ti.2026.15642","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:10:27Z","timestamp":1771567827000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Immediate and Gradual Withdrawal of Immunosuppression After Kidney Graft Loss Lead to Similar Outcomes"],"prefix":"10.3389","volume":"39","author":[{"given":"Asmaa","family":"Nabil","sequence":"first","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU de Toulouse","place":["Toulouse, France"]},{"name":"Centre Hospitalier et Universitaire, Universit\u00e9 Paul Sabatier Toulouse III","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Congy-Jolivet","sequence":"additional","affiliation":[{"name":"Centre Hospitalier et Universitaire, Universit\u00e9 Paul Sabatier Toulouse III","place":["Toulouse, France"]},{"name":"Laboratory of Immunology, Biology Department, Centre Hospitalier et Universitaire (CHU) de Toulouse","place":["Toulouse, France"]},{"name":"Institute of Metabolic and Cardiovascular Diseases (I2MC), Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM) U1297, University of Toulouse 3","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amandine","family":"Darres","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU de Toulouse","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Guy","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU de Toulouse","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Marion","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU de Toulouse","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Milhes","sequence":"additional","affiliation":[{"name":"Laboratory of Immunology, Biology Department, Centre Hospitalier et Universitaire (CHU) de Toulouse","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Prudhomme","sequence":"additional","affiliation":[{"name":"Centre Hospitalier et Universitaire, Universit\u00e9 Paul Sabatier Toulouse III","place":["Toulouse, France"]},{"name":"Department of Urology and Renal Transplantation, CHU de Toulouse","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nassim","family":"Kamar","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU de Toulouse","place":["Toulouse, France"]},{"name":"Centre Hospitalier et Universitaire, Universit\u00e9 Paul Sabatier Toulouse III","place":["Toulouse, France"]},{"name":"Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1043-CNRS 5282","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Del Bello","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU de Toulouse","place":["Toulouse, France"]},{"name":"Centre Hospitalier et Universitaire, Universit\u00e9 Paul Sabatier Toulouse III","place":["Toulouse, France"]},{"name":"Institute of Metabolic and Cardiovascular Diseases (I2MC), Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM) U1297, University of Toulouse 3","place":["Toulouse, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1056\/NEJMra1802677","article-title":"Antibody-Mediated Rejection of Solid-Organ Allografts. New England Journal of Medicine","volume":"379","author":"Loupy","year":"2018","journal-title":"Massachussetts Med Soc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/ajt.16982","article-title":"OPTN\/SRTR 2020 Annual Data Report: Kidney","volume":"22","author":"Lentine","year":"2022","journal-title":"Am J Transplant"},{"key":"B3","doi-asserted-by":"publisher","first-page":"S19","DOI":"10.1016\/j.ajt.2024.01.012","article-title":"OPTN\/SRTR 2022 Annual Data Report: Kidney","volume":"24","author":"Lentine","year":"2024","journal-title":"Am J Transplant"},{"key":"B4","unstructured":"Agence De La Biom\u00e9decine\n          \n          \n          2025"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1016\/J.AJT.2023.07.025","article-title":"A Rational Approach to Guide Cost-Effective De Novo Donor-Specific Antibody Surveillance with Tacrolimus Immunosuppression","volume":"23","author":"Wiebe","year":"2023","journal-title":"Am J Transpl"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1016\/J.EKIR.2024.02.1394","article-title":"Utility of Routine Post Kidney Transplant Anti-HLA Antibody Screening","volume":"9","author":"Salhi","year":"2024","journal-title":"Kidney Int Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1097\/TP.0B013E3182612921","article-title":"Independent of Nephrectomy, Weaning Immunosuppression Leads to Late Sensitization After Kidney Transplant Failure","volume":"94","author":"Augustine","year":"2012","journal-title":"Transplantation"},{"key":"B8","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1097\/TP.0B013E3181949E37","article-title":"Donor-Directed HLA Antibodies Before and After Transplantectomy Detected by the Luminex Single Antigen Assay","volume":"87","author":"Billen","year":"2009","journal-title":"Transplantation"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.2215\/CJN.00260112","article-title":"Donor-Specific Antibodies After Ceasing Immunosuppressive Therapy, with or Without an Allograft Nephrectomy","volume":"7","author":"Del Bello","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/TP.0000000000000426","article-title":"Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant","volume":"98","author":"Andrews","year":"2014","journal-title":"Transplantation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1111\/j.1600-6143.2007.01884.x","article-title":"Nephrectomy After Transplant Failure: Current Practice and Outcomes","volume":"7","author":"Johnston","year":"2007","journal-title":"Am J Transplant"},{"key":"B12","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1097\/01.TP.0000437558.75574.9C","article-title":"Fever, Infection, and Rejection After Kidney Transplant Failure","volume":"97","author":"Woodside","year":"2014","journal-title":"Transplantation"},{"key":"B13","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1111\/j.1525-139X.2011.00864.x","article-title":"Immunosuppressive Management of Dialysis Patients with Recently Failed Transplants","volume":"24","author":"Pham","year":"2011","journal-title":"Semin Dial"},{"key":"B14","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1111\/tri.13088","article-title":"Graft Intolerance Syndrome Requiring Graft Nephrectomy After Late Kidney Graft Failure: Can It Be Predicted?","volume":"31","author":"Bunthof","year":"2018","journal-title":"A Retrospective Cohort Study. Transpl Int"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2486","DOI":"10.1097\/TP.0000000000004625","article-title":"The Role of Allograft Nephrectomy in the Failing Kidney Transplant","volume":"107","author":"Budhiraja","year":"2023","journal-title":"Transplantation"},{"key":"B16","doi-asserted-by":"publisher","first-page":"174","DOI":"10.12659\/AOT.883887","article-title":"Transplant Nephrectomy: What Are the Surgical Risks?","volume":"18","author":"Alberts","year":"2013","journal-title":"Ann Transpl"},{"key":"B17","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1111\/tri.13442","article-title":"Allosensitization After Transplant Failure: The Role of Graft Nephrectomy and Immunosuppression \u2013 A Retrospective Study","volume":"32","author":"Lucisano","year":"2019","journal-title":"Transpl Int"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1681\/ASN.2015040373","article-title":"Variation in Cancer Incidence Among Patients With Esrd During Kidney Function and Nonfunction Intervals","volume":"27","author":"Yanik","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1681\/ASN.2021121642","article-title":"Immunosuppressant Medication Use in Patients With Kidney Allograft Failure: A Prospective Multi-Center Canadian Cohort Study","volume":"33","author":"Knoll","year":"2022","journal-title":"J Am Soc Nephrol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1034\/J.1399-0012.2001.150606.X","article-title":"Immunosuppression Should Be Stopped in Patients with Renal Allograft Failure","volume":"15","author":"Smak Gregoor","year":"2001","journal-title":"Clin Transpl"},{"key":"B21","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1136\/BMJ.C570","article-title":"Effect of Reduced Immunosuppression After Kidney Transplant Failure on Risk of Cancer: Population Based Retrospective Cohort Study","volume":"340","author":"Van Leeuwen","year":"2010","journal-title":"BMJ (Online)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1681\/ASN.2014090894","article-title":"Immune Sensitization and Mortality in Wait-Listed Kidney Transplant Candidates","volume":"27","author":"Sapir-Pichhadze","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2353","DOI":"10.1111\/TRI.13998","article-title":"Prolonged Immunosuppression Does Not Improve Risk of Sensitization or Likelihood of Retransplantation After Kidney Transplant Graft Failure","volume":"34","author":"Martin","year":"2021","journal-title":"Transpl Int"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e409","DOI":"10.1097\/TXD.0000000000000848","article-title":"The Impact of Withdrawal of Maintenance Immunosuppression and Graft Nephrectomy on HLA Sensitization and Calculated Chance of Future Transplant","volume":"4","author":"Nimmo","year":"2018","journal-title":"Transpl Direct"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/BIOMEDICINES8040072","article-title":"Immunosuppression with Calcineurin Inhibitor After Renal Transplant Failure Inhibits Allosensitization","volume":"8","author":"del Moral Cuesta","year":"2020","journal-title":"Biomedicines"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2937","DOI":"10.1111\/AJT.16717","article-title":"The Failing Kidney Allograft: A Review and Recommendations for the Care and Management of a Complex Group of Patients","volume":"21","author":"Lubetzky","year":"2021","journal-title":"Am J Transplant"},{"key":"B27","doi-asserted-by":"publisher","first-page":"444","DOI":"10.2215\/CJN.14620920","article-title":"Managing Patients with Failing Kidney Allograft Many Questions Remain","volume":"17","author":"Davis","year":"2022","journal-title":"Clin J Am Soc Nephrol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.1056\/NEJMRA064928","article-title":"Infection in solid-organ Transplant Recipients","volume":"357","author":"Fishman","year":"2007","journal-title":"N Engl J Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"E1302","DOI":"10.1093\/CID\/CIAA1189","article-title":"Immunosuppressive Agents and Infectious Risk in Transplantation: Managing the \u201cNet State of Immunosuppression.\u201d","volume":"73","author":"Roberts","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1097\/ALN.0000000000000113","article-title":"Myocardial Injury After Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes","volume":"120","author":"Botto","year":"2014","journal-title":"Anesthesiology"},{"key":"B31","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1159\/000342626","article-title":"Care of the Patient After Renal Allograft Failure: Managing the Present and Planning for the Future","volume":"36","author":"Fuquay","year":"2012","journal-title":"Am J Nephrol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2437","DOI":"10.1111\/j.1600-6143.2012.04101.x","article-title":"Kidney Function and Risk of Cardiovascular Disease and Mortality in Kidney Transplant Recipients: The FAVORIT Trial","volume":"12","author":"Weiner","year":"2012","journal-title":"Am J Transplant"},{"key":"B33","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1053\/j.ajkd.2006.11.022","article-title":"Survival on Dialysis Post-kidney Transplant Failure: Results from the Scientific Registry of Transplant Recipients","volume":"49","author":"Rao","year":"2007","journal-title":"Am J Kidney Dis"},{"key":"B34","doi-asserted-by":"publisher","first-page":"4464","DOI":"10.1093\/NDT\/GFS386","article-title":"Reduced Survival and Quality of Life Following Return to Dialysis After Transplant Failure: The Dialysis Outcomes and Practice Patterns Study","volume":"27","author":"Perl","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1093\/ndt\/gfu205","article-title":"Risk of Death Following Kidney Allograft Failure: A Systematic Review and meta-analysis of Cohort Studies","volume":"29","author":"Kabani","year":"2014","journal-title":"Nephrol Dial Transplant"},{"key":"B36","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.urology.2011.02.068","article-title":"Transplant Nephrectomy After Allograft Failure Is Associated with Allosensitization","volume":"78","author":"Knight","year":"2011","journal-title":"Urology"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1038\/ki.2014.106","article-title":"Impact of Donor Mismatches at Individual HLA-A, -B, -C, -DR, and -DQ Loci on the Development of HLA-specific Antibodies in Patients Listed for Repeat Renal Transplantation","volume":"86","author":"Kosmoliaptsis","year":"2014","journal-title":"Kidney Int"},{"key":"B38","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/J.TRIM.2009.12.005","article-title":"Detection of Donor-Specific HLA Antibodies Before and After Removal of a Rejected Kidney Transplant","volume":"22","author":"Marrari","year":"2010","journal-title":"Transpl Immunol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1053\/j.ajkd.2005.04.024","article-title":"Intolerance Syndrome in Failed Renal Allografts: Incidence and Efficacy of Percutaneous Embolization","volume":"46","author":"Delgado","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e15160","DOI":"10.1111\/ctr.15160","article-title":"Evolution of HLA-Sensitization According to Immunosuppressive Therapy Management Among Kidney Transplant Patients Returning to Dialysis Between 2008 and 2019: A French Retrospective Study","volume":"38","author":"Ferrari","year":"2024","journal-title":"Clin Transpl"},{"key":"B41","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1007\/s40620-022-01458-y","article-title":"Revisiting Maintenance Immunosuppression in Patients with Renal Transplant Failure: Early Weaning of Immunosuppression Versus Prolonged Maintenance\u2014Systematic Review and Meta-Analysis","volume":"36","author":"Elgenidy","year":"2023","journal-title":"J Nephrol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"2483386","DOI":"10.1080\/0886022X.2025.2483386","article-title":"Prolonging Calcineurin Inhibitor Therapy Post Kidney Allograft Failure: A Prospective Study","volume":"47","author":"Leal","year":"2025","journal-title":"Ren Fail"},{"key":"B43","doi-asserted-by":"publisher","first-page":"e14558","DOI":"10.1111\/CTR.14558","article-title":"Factors Affecting Sensitization Following Kidney Allograft Failure","volume":"36","author":"Garg","year":"2022","journal-title":"Clin Transpl"},{"key":"B44","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/S1081-1206(10)61380-4","article-title":"Effects of Long-Term Low-Dose Corticosteroid Therapy on Humoral Immunity","volume":"97","author":"Fedor","year":"2006","journal-title":"Ann Allergy Asthma & Immunol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1146\/ANNUREV.IMMUNOL.18.1.309","article-title":"Glucocorticoids in T Cell Development and Function","volume":"18","author":"Ashwell","year":"2000","journal-title":"Annu Rev Immunol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2701","DOI":"10.1084\/JEM.20190738","article-title":"Selective Inhibition of Low-affinity Memory CD8+ T Cells by Corticosteroids","volume":"216","author":"Tokunaga","year":"2019","journal-title":"J Exp Med"},{"key":"B47","doi-asserted-by":"publisher","first-page":"104590","DOI":"10.1016\/J.AMSU.2022.104590","article-title":"Too Much of a Good Thing: Immune Reconstitution Inflammatory Syndrome in a Patient with Still\u2019s Disease","volume":"82","author":"Batool","year":"2022","journal-title":"Ann Med Surg"}],"container-title":["Transplant International"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.15642\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:10:30Z","timestamp":1771567830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.15642\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":47,"alternative-id":["10.3389\/ti.2026.15642"],"URL":"https:\/\/doi.org\/10.3389\/ti.2026.15642","relation":{},"ISSN":["1432-2277"],"issn-type":[{"value":"1432-2277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]},"article-number":"15642"}}