Temporary discontinuation of immunosuppressive treatment and renal graft rejection. Experience of a center in Venezuela.
In some Latin American countries, discontinuation of treatment when immunosuppressive drugs are unavailable can cause late renal graft loss. This retrospective study reports the frequency and consequences of interrupted treatment at a single center in Venezuela. In 2005 and 2006, we evaluated the medical records of and interviewed 303 patients (181 males) followed for more than one year after renal transplantation done between 1973 and 2005. Noncompliance for>1 week was reported by 124 patients; 107 (86.3%) instances were due to unavailability of immunosuppressive drugs at the institution (institutional noncompliance), and the remainder were due to voluntary noncompliance. Acute rejection episodes were about three times as frequent among voluntary noncompliers as institutional noncompliers, probably because voluntary noncompliance lasted longer (mean 42.7+/-standard deviation of 14.1 days) than institutional noncompliance (18.5+/-11.2 days, P<0.001). Graft loss occurred in 63.6% (7/11) of the episodes of voluntary noncompliance and in 33.3% (10/30) of the episodes of institutional noncompliance. Institutional noncompliance represents a preventable cause of graft loss in some transplantation programs in developing countries.
Herrera
José
J
Renal Service, Hospital Universitario de Maracaibo, Maracaibo, Estado Zulia, Venezuela.
Chávez
Maribel
M
Rodríguez-Iturbe
Bernardo
B
D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000600:supply & distribution*; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data; D014687:Venezuela
D007166:Immunosuppressive Agents