Treatment of renal transplant failure.
BACKGROUND
Among graft failures beyond months, we performed progressive reduction and complete withdrawal of immunosuppressive drugs and steroids over a period of 6 months.


METHODS
We analyzed the treatment and complications associated with all late allograft failures in 34 patients (8.19%) out of 415 patients transplanted from November 1996 to November 2006.


RESULTS
In 21 patients (61.8%), the progressive reduction of immunosuppressive treatment was effective and well tolerated; however, in 13 patients (38.2%) there was rejection of the allograft at 10.74 +/- 8.95 months (0.77-34.80) after the failure. With the reintroduction of these drugs, the rejection was controlled in seven patients, but in the other six we had to embolize the allograft, which had to be repeated in one case. Embolization was well tolerated, but in one case there was migration of one coil to the femoral artery. One patient treated with drug withdrawal experienced emphysematous pyelonephritis after repeated urinary infections, requiring a nephrectomy. Thirteen (38.2%) of the patients with late failures have been admitted for a second transplant; five of them showed HLA sensitization.


CONCLUSIONS
Conservative treatment with progressive withdrawal of immunosuppression was effective and well tolerated in two-thirds of the patients with late renal allograft failure, but one-third of the patients rejected the graft and needed allograft embolization. Infection of the graft and HLA sensitization can complicate the course of these patients.
Morales
A
A
Service de Nefrología, Hospital Universitario Dr Peset, Valencia, Spain. amoralesg@senefro.or
Gavela
E
E
Kanter
J
J
Beltrán
S
S
Sancho
A
A
Escudero
V
V
Crespo
J
J
Pallardó
L M
LM
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001783:Blood Flow Velocity; D004334:Drug Administration Schedule; D004621:Embolization, Therapeutic; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000628:therapy* / Q000652:urine; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D009392:Nephrectomy; D012079:Renal Circulation; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000276:immunology; D014552:Urinary Tract Infections / Q000209:etiology / Q000601:surgery
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents