1994 Volume 27 Issue 2 Pages 89-94
Prognosis and complications after returning to hemodialysis were studied in 89 patients with a rejected kidney allograft as a result of chronic rejection. The cumulative patient survival rate 1, 5 and 10 years after re-institution of hemodialysis was 92%, 83% and 77%, respectively. Within 3 months after re-instituting hemodialysis, 6 of 21 recipients died of complications related to immunosuppressive therapy, including sepsis, gastrointestinal bleeding and perforation. Therewere, 13 later deaths due to hemodialysis complications, such as heart failure, cerebrovascular hemorrhage, cancer and colon perforation. These findings show that early re-institution of hemodialysis and rapid reduction of immunosuppressive drugs are necessary to prevent the progression of immune deficiency and to reduce mortality to a minimum. After returning to hemodialysis, cyclosporine, azathioprine and mizoribine were rapidly withdrawn, and the dose of prednisolone was tapered to 5mg/day. Following the reduction of immunosuppressive drugs, symptoms resembling those of acute rejection, including high fever, hematuria, graft swelling and tenderness, appeared in 15 recipients in whom consequent graftectomy had been performed. Among 50 survivors with a rejected graft, prednisolone was administered at a dose of less than 5mg/day in 19 and discontinued completely in 24 without development of graft necrosis. There has been no difference between the long-term patient survival of recipients with a rejected graft and those who underwent graftectomy.
