Outcome of patients without any immunosuppressive therapy after renal allograft failure

Continuation of low-dose maintenance immunosuppressive therapy in end-stage renal allografts (ESRAs) that are left in situ is controversial. We studied the outcome of 85 patients (mean age 33.3 +/- 13.4 and range of 12-56 years) on hemodialysis with ESRAs, and without immunosuppressive therapy in our center from July 1991 to July 2003. Twelve (14.1%) study patients underwent allograft nephrectomy within a mean interval of 44.5 months after graft failure. The rest of the patients remained stable without fever, hematuria, graft tenderness, or localized edema during a mean interval of 46.5 +/- 45.2 months of follow-up. These results are promising and suggest that maintenance immuno-suppressive therapy in patients with ESRAs and on dialysis may not be necessary to avoid allograft nephrectomy. Prospective studies are warranted to substantiate these results.