INFECTIONS AFTER RENAL-ALLOGRAFT FAILURE IN PATIENTS WITH OR WITHOUT LOW-DOSE MAINTENANCE IMMUNOSUPPRESSION

Background. Failed renal allografts are sometimes left in situ for add itional clearance and urine production during hemodialysis or peritone al dialysis, and low-dose immunosuppressive medication is often contin ued in such patients. We compared the morbidity and mortality due to i nfections between patients with (group A) or without (group B) low-dos e immunosuppression (i.e., transplantectomy). Methods. In a hospital-b ased cohort study, we analyzed data from patient files. We evaluated 3 7 patients who received 42 kidney transplantations between May 1975 an d 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 gr oup 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 inf ections were found in group A; no lethal infections were found in grou p B. Conclusions. The increase in serious and life-threatening infecti ons associated with even low-dose immunosuppression argues in favor of discontinuation of these drugs. The removal of failed renal allograft s should be considered.