Discontinuance of Immunosuppression

Arch Surg. 1976;111(5):614. doi:10.1001/archsurg.1976.01360230114029.
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To the Editor.—Our experience at the University of Wisconsin permits me to agree with Dr Najarian's editorial comments on the article by Owens et al concerning the discontinuance of immunosuppression in renal transplant patients (Arch Surg 110:1450-1451, 1975). We have recently reviewed our immunosuppressive protocol at the University of Wisconsin, after finding that several patients had voluntarily stopped taking the drugs without informing the physician. Eight patients (five living related donor recipients and three cadaver recipients) stopped all immunosuppression against medical advice. This represents a 4% incidence of major lapses in immunosuppression, and is probably lower than the actual incidence. In addition, several other transplantation patients had their immunosuppressive therapy removed by medical advice due to severe infection or leukopenia.

Two of the mixed leukocyte culture (MLC)-nonidentical living related donor recipients underwent severe rejection following cessation of immunosuppressive therapy; this was ultimately fatal to both. This occurred despite the


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