[Infections following kidney transplantation under threefold or fourfold immunosuppressive treatment]

To determine, whether the infection rate after renal transplantation is influenced by the intensity of immunosuppressive treatment, the postoperative course of 100 consecutive renal transplantations in 64 men and 36 women (mean age 44.1 [18-72] years) was investigated prospectively. 87 patients received threefold basal immunosuppression with low-dose ciclosporin, azathioprine and prednisolone. In 13 risk patients (retransplantation and [or] high panel-reactive antibody titres), poly- or monoclonal antibodies were administered additionally to prevent rejection. Steroid-resistant rejection crises had to be treated with poly- or monoclonal antibodies in 15 patients. Postoperatively there were 10 patients with systemic infections (5 with cytomegalovirus, 4 with herpes simplex virus and 1 with Pneumocystis carinii). The infection rate with three- or fourfold immunosuppression did not differ significantly (5.4% vs. 9.1%). However, infections occurred more frequently after additional antirejection treatment with poly- or monoclonal antibodies (33%). It is concluded from these results that fourfold basal immunosuppression treatment with poly- or monoclonal antibodies is not associated with an increased risk of perioperative infections.