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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1996  |  Volume : 7  |  Issue : 3  |  Page : 317-318
How Long Should a Patient with Kidney Transplant Continue on Immunosuppressive Drugs ?


Department of Nephrology, Al Thawra Hospital, Faculty of Medicine, Sana'a University, Yemen

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How to cite this article:
Sheiban AKA. How Long Should a Patient with Kidney Transplant Continue on Immunosuppressive Drugs ?. Saudi J Kidney Dis Transpl 1996;7:317-8

How to cite this URL:
Sheiban AKA. How Long Should a Patient with Kidney Transplant Continue on Immunosuppressive Drugs ?. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2019 Aug 25];7:317-8. Available from: http://www.sjkdt.org/text.asp?1996/7/3/317/39499
To the Editor,

In the late post-transplant period, patient and allograft survival are both critically dependent on the degree of immunosuppression and on the long-term side effects of the agents used to achieve this immunosuppression. In general, too much immunosuppression leads to an increase in patient mortality whereas inadequate immunosuppression can lead to an inordinately high rate of allograft failure [1] .

We report a Yemeni male, aged 35 years, who developed chronic renal failure at the age of 23 years, and underwent a living non­related renal transplantation in Russia in 1984. The patient was maintained on triple drug immunosuppressive therapy comprising of prednisone lOmg/day, azathioprine 150mg/ day, and cyclosporin 100 mg/day. He was also on anti-hypertensive medications (hydralazine and atenolol) and attended follow-up regularly. Between April and July 1994, Yemen experienced one of its most disastrous civil wars. During the war, the whole country suffered an acute shortage of all types of drugs. This led our patient to undertake self reduction of all the drugs. Consequently, he took nothing except 2.5 mg of prednisone either daily or every other day. This was continued for a period of 2 months and 12 days before he attended the follow-up clinic on the 19th of August 1994.

Clinical examination revealed a satisfactory general condition and no abnormality was detected in his cardiovascular, gastrointestinal or urological systems, but we noted that his blood pressure was uncontrolled, 150/100 mm Hg, and there was a 6 kg weight loss. The laboratory investigations were all within the normal range: CBC, kidney function tests, electrolytes, liver function tests, blood sugar and urine culture.

The patient was strongly advised to start using the triple immunosuppressive treatment again. However, he refused all medications and continued to take only prednisone in a dose of 2.5 mg daily. Since then, he is on regular follow-up and nearly 16 months later, he has remained well with normal graft function.

The experience on morbidity and mortality in recipients of long-term (> 5 years) renal allografts has shown that hepatic dysfunction, sepsis and cardiac disease each account for about 20% of the overall mortality, while malignancy, particularly lymphoma and acute leukemias, account for an increasing proportion of deaths. Each of these complications probably is related in part at least, to the use of chronic immunosuppression [2] . Currently, the best approach to preventing complications in the late post-transplant period is to maintain a vigilant, comprehensive program of on­going medical care. The minimal amount of immunosuppression required to prevent allograft rejection should be used while adhering to the principle that it is better to lose the graft than to lose the patient [1]

The above case report raises a question as to how long a transplant recipient continue to take immunosuppressive drugs? We feel that 10 years may be a long-enough-period for the human immune system to accept the transplanted graft and safely live with it, and all that may be required subsequently is a small daily dose of prednisone as has been observed in our reported patient. However, extreme caution should be exercised before embarking on this regime.

 
   References Top

1.Gray JR, Kasiske BC. Patient and renal allograft survival in the late post transplant period. Semin Nephrol 1992;12(4):343-52.  Back to cited text no. 1    
2.Ramos, Tilney, Ravenscraft. Clinical aspects of renal transplantation. The kidney brener Rector. 1991;2:2394.  Back to cited text no. 2    

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Correspondence Address:
Abdul-Karim A Sheiban
Department of Nephrology, Al Thawra Hospital, Faculty of Medicine, Sana'a University
Yemen
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PMID: 18417952

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