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FamilyPhysician
FamilyPhysician, MD, MBA
Category: General
Satisfied Customers: 12816
Experience:  Primary care physician for transplant patients
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My 33 year old son received my kidney (his mother) when he

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My 33 year old son received my kidney (his mother) when he was 14 years old. Today he revealed to me that he has stopped taking his cyclosporine, the anti-rejection, immune suppressing drug. He said he has not taken it in 2 months! I am very frightened and made him promise that he would resume taking the drug. He says that there are a very few people whose antigens have such a close match that they do not have to take the drug. He was diagnosed with renal dysplasia when he was 4 years old. He had one non-working kidney removed at that time and then when he was 14 received my kidney. Is this true? How long does it take for rejection to begin? His creatinine has remained the same, about 1.3. He is not good about having regular blood work or seeing his nephrologist. He is married and is the father of a 1 year old with another on the way. He says he feels good.  Please advise.
Thank you for your question:

Non-compliance with immune suppressant medications (such as cyclosporine) is a major risk factor for rejection. This rejection could be acute (sudden) or chronic. In either case, his chance of keeping the kidney and remaining healthy without anti-rejection medications is very poor.

The fact that he has not had any sudden problems, does NOT mean that he will not have problems next week, next month or next year. In medicine, I try to avoid "always" and "never", but I can assure you that the risk if VERY high that he will loose this kidney, and end up on dialysis sooner or later.

He needs to discuss he concerns (side effects, costs, inconvenience etc) about this medication with his transplant nephrologist.

Here are some studies that look at the unfortunately common problem of non-compliance
http://www.ncbi.nlm.nih.gov/pubmed/11982618
http://www.ncbi.nlm.nih.gov/pubmed/20847093
http://www.ncbi.nlm.nih.gov/pubmed/20584734
http://www.ncbi.nlm.nih.gov/pubmed/21077956
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Customer: replied 4 years ago.
I would like you to respond to the information that he has about people who have very close antigens and don't seem to require the drugs. I'd like to know if that ever happens. What is the percentage. HOW LONG BEFORE REJECTION ON THE AVERAGE BEGINS WHEN MEDICINE IS NOT TAKEN?
While it is "possible", it is not common and not something that should be attempted without close medical supervision.
http://abcnews.go.com/Health/post-transplant-regimen-eliminate-immunosuppressants/story?id=14673242#.T906nr8VyRA

http://www.nih.gov/news/health/may2010/niaid-25.htm

Making the assumption, that since he has not lost the kidney in 2 months, is a dangerous approach. This is something that really needs medical supervision, and he needs to be aware of the risks.

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