Infections after renal allograft failure in patients with or without low-dose maintenance immunosuppression.
BACKGROUND
Failed renal allografts are sometimes left in situ for additional clearance and urine production during hemodialysis or peritoneal dialysis, and low-dose immunosuppressive medication is often continued in such patients. We compared the morbidity and mortality due to infections between patients with (group A) or without (group B) low-dose immunosuppression (i.e., transplantectomy).


METHODS
In a hospital-based cohort study, we analyzed data from patient files. We evaluated 37 patients who received 42 kidney transplantations between May 1975 and November 1995.


RESULTS
A total of 2.28 vs. 0.68 infections/patient-year were found in groups A and B, respectively. The odds ratio of one or two infections developing for patients in group A compared with group B was 14.2 (95% confidence interval, 1.4-143.4; P<0.025) and 4.3 (95% confidence interval, 1.1-17.3; P<0.04). A total of five lethal infections were found in group A; no lethal infections were found in group B.


CONCLUSIONS
The increase in serious and life-threatening infections associated with even low-dose immunosuppression argues in favor of discontinuation of these drugs. The removal of failed renal allografts should be considered.
Gregoor
P J
PJ
Department of Internal Medicine and Nephrology, St. Clara Hospital, Rotterdam, the Netherlands.
Kramer
P
P
Weimar
W
W
van Saase
J L
JL
D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*
D007166:Immunosuppressive Agents