Immunosuppression Withdrawal After Kidney Transplantation

Abstract

Introduction: Achieving immunosuppression minimization or withdrawal without rejection is a goal in tolerant patients. Methods: Review of 10 prospective trials (2000–2024) evaluating structured immunosuppression reduction in stable kidney transplant recipients. Results: Complete withdrawal succeeded in <10% of unselected patients, causing acute rejection in 40%. In operationally tolerant patients (biopsy-proven, donor-specific hyporesponsiveness), withdrawal was safe in selected trials. Biomarkers (gene expression, urine cells) predict tolerance. Discussion: Current evidence does not support routine withdrawal outside research protocols. Conclusion: Immunosuppression minimization (single-drug therapy) may be feasible in low-risk patients.