[Definitive removal of immunosuppressors]

Abstract

There's no controlled and prospective studies which show the safest and most effective way to reduce or suspend immunosuppression drugs dosage, and only few groups have published their own protocols. There are reasons to discontinue the immunosuppression therapy; the high incidence of infections is the most important. However, a fast withdrawal is not free of problems, like are residual renal function decline and graft intolerance signs, which could take to nephrectomy, a high risk intervention. Most recommended guidelines for immunosuppression use are: - Antimetabolites immediately cancellation and corticoesteroids slow drop (level C recommendation). - Calcineurin inhibitors could be discontinued but if residual renal function is still significant, it is recommended to maintain a low dosage over three to six months; then, withdrawal may be done slowly (level C recommendation). We have not found information supporting the immunosuppression use beyond six months.