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.