Allograft nephrectomy: a systematic review of immunological consequences and management of immunosuppressants
In brief
Immunosuppression withdrawal, not nephrectomy, drives sensitization in kidney transplant recipients
A systematic review of studies from 2000-2026 found that stopping or reducing immunosuppressive drugs after graft failure caused marked rises in anti-HLA antibodies, while removing the failed kidney under continued therapy had little independent effect. Consequently, individualized immunosuppression strategies are needed to balance infection risk with the heightened chance of sensitization and possible retransplant complications.
- Journal
- Transplant international : official journal of the European Society for Organ Transplantation (Q1)
- Published
- 3 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Arnaud Del Bello, Anna Goujon, Diana Kassab, Thomas Prudhomme, Alexandre Frontczak, Thibault Culty
- PMID
- 42490882
- DOI
- 10.3389/ti.2026.16661
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 26 July 2026): High-quality evidence in a top journal
- Picked for Surgery (top studies of the week, 26 July 2026).
- Picked for Immunology and Allergy (top studies of the week, 26 July 2026).
- Picked for Infectious Diseases (top studies of the week, 26 July 2026).
- Picked for Nephrology (top studies of the week, 26 July 2026).
- Picked for Transplantation (top studies of the week, 26 July 2026): High-quality evidence in a top journal
- Picked for Urology (top studies of the week, 26 July 2026): Allograft nephrectomy immunological impact and management review
Abstract
Allograft nephrectomy (AN) is a serious complication of kidney transplantation. Beyond surgical morbidity, AN has important immunological implications. We performed a systematic review to synthesize current evidence on the immunological impact of AN and post-allograft failure immunosuppressive strategies. A systematic review was conducted according to PRISMA guidelines. PubMed/Medline® was searched for studies published from 01/2000 to 03/2026 on transplantectomy indications and surgical techniques. Eligible designs included meta-analyses, randomized trials, and prospective or retrospective studies evaluating the immunological impact of AN and/or immunosuppression management before, during, or after graft removal in adult or pediatric kidney transplant recipients returning to dialysis. Consistent evidence indicates that immunosuppression withdrawal is the principal driver of allosensitization after graft failure. Multiple studies demonstrated marked increases in anti-HLA antibodies following the cessation of immunosuppression, regardless of nephrectomy status. When AN was performed under maintained immunosuppression, its independent effect on sensitization and retransplant outcomes appeared limited. Meta-analyses showed comparable survival after retransplantation, although higher PRA levels, delayed graft function, and acute rejection were more frequent in patients with prior nephrectomy. Allosensitization after graft failure is primarily driven by immunosuppression withdrawal/reduction rather than AN itself. Individualized immunosuppressive management balancing immunological and infectious risks is essential.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.