Infections after renal allograft failure in patients with or without low-dose maintenance immunosuppression

Transplantation. 1997 May 27;63(10):1528-30. doi: 10.1097/00007890-199705270-00028.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Dose-Response Relationship, Drug
  • Female
  • Graft Rejection / complications
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology*
  • Male
  • Middle Aged
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / etiology*

Substances

  • Immunosuppressive Agents