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May 1976

Discontinuance of Immunosuppression-Reply

Author Affiliations

Los Angeles

Arch Surg. 1976;111(5):614. doi:10.1001/archsurg.1976.01360230114030

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In Reply.—We are not advocating the treatment of transplant recipients without immunosuppression. On the contrary, we have been impressed by the general readiness with which our recipients initiate rejection: frequently, rejection occurs as we attempt to taper the corticosteroid dose, or after therapy had to be stopped for a short time. Unusually (six patients in 203), immunosuppressive drugs were unintentionally stopped for a very long time without rejection. One patient, the only recipient of a cadaver graft, has since rejected his kidney. The rejection was preceded by a viral illness, and was only partially reversible. One patient died of hypoxic brain damage. As of their last clinic visits, four patients are 20, 51, 62, and 90 months posttransplant, respectively, without immunosuppressants or graft rejection. We think it is arguable whether these patients should be taking immunosuppressant drugs or not; either alternative carries risks. Any decision ought to be carefully

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