Continuing immunuesuppression after failed transplant...

[rsudock]

I thought I would share this with you folks because my doctor (Dr. Joshua Augustine) actually just wrote a paper and is in the process of getting it published. (Neil and I are part of the subjects in the study!)

He basically is making a case for keeping folks on transplant meds even after their transplant fails. This will help patients PRA stay lower and lower the need to take out a rejected kidney. He also sites other issues patients may have while stopping immunosuppression...I will see if I can get a copy of the study and posted here....

stay tuned...
R

[Deanne]

Interesting..... I think the word is getting out about this. I'm in the evaluation phase for transplant and at the education class part of it, they stressed that even if the transplant failed, I should count on staying on a level of immunesuppressants probably for the rest of my life to try to maintain a low PRA.

[okarol]

The idea of removing a failed transplant has come up because the PRA can improve quite a bit. Taking the immunos makes sense too.

[bette1]

After my first failed transplant I stayed on prednisone for 4 years.  The failed kidney continued to make urine and that helped me quite a bit. 

[monrein]

I stopped my immunos (except prednisone) to give my body a rest from the heavy duty meds.  However my pra was always 0%, even after 23 years with first trx.  On the other hand that first trx had to be removed 2 months after 2nd trx.

[lawphi]

Wake Forest prefers to maintain immunosuppression with a failed graft.  I just figured it was the gold standard. Can't wait to see the study.  He should include a picture. 

Wake would not take out Ham's 13 year old graft unless it is absolutely necessary.  They did remove Ham's first kidney a day after it clotted. 

[Jie]

If the transplanted kidney does not work anymore, it will make more sense to remove it than continue to take immu. drugs. It really is a risks/benefits issue. Continuing taking the drugs will have great risks too.

[monrein]

Mine became necrotic apparently, cyclosporine toxicity was the cause of the decline in the first place but after the new trx, it seemed to suffer a lack of adequate blood flow and caused much pain and distress.  The new kidney was a trooper though and despite fever and pain my creatinine stayed within normal limits...very confusing for the docs to figure out what was going on. 

[bette1]

My failed transplant from 1994 is still inside me.  I asked my transplant team about it and they said it would shrivel up.  I actually have 4 kidneys in my body.  I would rather not have them removed if it is at all possible.  Who wants another surgery? 

Why would they have to be removed if they aren't causing any problems?

[cariad]

If the transplanted kidney does not work anymore, it will make more sense to remove it than continue to take immu. drugs. It really is a risks/benefits issue. Continuing taking the drugs will have great risks too.

I disagree. I stayed on Myfortic after my GFR went down to end-stage levels. A nephrectomy is a painful and shocking procedure for the system and taking microscopic doses of Myfortic to preserve PRA was far preferable. If they know it is not working at all, take it out during the transplant but don't subject a patient to yet another operation.

Bette, I still have the first transplant, too. I forget what the surgeon said to me about that - something was off and they were thinking they would have to take it out, but since my first donor is still alive, they were able to test his blood against mine and if I remember correctly, there is no evidence of my system creating any antibodies to that kidney, or attacking it in any way. So it stays.

[monrein]

I would have had 4 also if no problems had arisen.  My team doesn't mess with sleeping dogs either.