title: Immunosuppression should be stopped in patients with renal allograft failure.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt, 3000 CA Rotterdam, the Netherlands. smakgregoor@inw1.azr.nl
authors.forename: P J
authors.initials: PJ
authors.lastname: Smak Gregoor
authors.forename: R
authors.initials: R
authors.lastname: Zietse
authors.forename: J L
authors.initials: JL
authors.lastname: van Saase
authors.forename: C T
authors.initials: CT
authors.lastname: op de Hoek
authors.forename: J N
authors.initials: JN
authors.lastname: IJzermans
authors.forename: A T
authors.initials: AT
authors.lastname: Lavrijssen
authors.forename: G M
authors.initials: GM
authors.lastname: de Jong
authors.forename: P
authors.initials: P
authors.lastname: Kramer
authors.forename: W
authors.initials: W
authors.lastname: Weimar
mesh_terms: 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