Immunosuppression should be stopped in patients with renal allograft failure.
Patients returning to haemodialysis or peritoneal dialysis after a failed kidney transplantation sometimes have a renal allograft left in situ for some urine production. Low-dose immunosuppressive medication is often continued in such patients. To evaluate the morbidity and mortality between patients in time periods with (group A) or without (group B) low-dose maintenance immunosuppression, the present study was initiated. In a multi-centre cohort study we analysed data from patient files, which showed failure after at least 3 months graft function between 10 August 1972 and 4 April 1996, including 197 kidney transplantations. A total of 1.7 versus 0.51 infections per patient year was found in groups A and B, respectively (odds ratio [OR]: 3.4, 95% confidence interval [CI]: 2.5-4.5). There was an increased mortality in group A compared to group B (OR 3.4, 95% CI: 1.8-6.3), both from infectious disease (OR 2.8, 95% CI: 1.1-7.0), and cardiovascular disease (OR 4.9, 95% CI: 1.8-13.5). Continuation of immunosuppressive medication did not lead to fewer rejections (defined as a painful, tender graft and/or haematuria and/or low-grade non-infectious fever). Transplantectomy-related morbidity and mortality were acceptable. The increase in morbidity and mortality associated with low-dose maintenance immunosuppression argues in favour of stopping these medicaments when failed renal allograft patients return to dialysis.
Smak Gregoor
P J
PJ
Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt, 3000 CA Rotterdam, the Netherlands. smakgregoor@inw1.azr.nl
Zietse
R
R
van Saase
J L
JL
op de Hoek
C T
CT
IJzermans
J N
JN
Lavrijssen
A T
AT
de Jong
G M
GM
Kramer
P
P
Weimar
W
W
D000328:Adult; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy; D007239:Infections / Q000209:etiology; D016030:Kidney Transplantation; D008297:Male; D006435:Renal Dialysis; D014184:Transplantation, Homologous; D020246:Venous Thrombosis / Q000209:etiology