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Review
. 2020 Jul 13;14(1):98-106.
doi: 10.1093/ckj/sfaa094. eCollection 2021 Jan.

Management of patients with a failed kidney transplant: what should we do?

Marco Fiorentino  1 , Pasquale Gallo  1 , Marica Giliberti  1 , Vincenza Colucci  1 , Antonio Schena  1 , Giovanni Stallone  2 , Loreto Gesualdo  1 , Giuseppe Castellano  2
Affiliations
Review

Management of patients with a failed kidney transplant: what should we do?

Marco Fiorentino et al. Clin Kidney J. .

Abstract

The number of kidney transplant recipients returning to dialysis after graft failure is steadily increasing over time. Patients with a failed kidney transplant have been shown to have a significant increase in mortality compared with patients with a functioning graft or patients initiating dialysis for the first time. Moreover, the risk for infectious complications, cardiovascular disease and malignancy is greater than in the dialysis population due to the frequent maintenance of low-dose immunosuppression, which is required to reduce the risk of allosensitization, particularly in patients with the prospect of retransplantation from a living donor. The management of these patients present several controversial opinions and clinical guidelines are lacking. This article aims to review the leading evidence on the main issues in the management of patients with failed transplant, including the ideal timing and modality of dialysis reinitiation, the indications for an allograft nephrectomy or the correct management of immunosuppression during graft failure. In summary, retransplantation is a feasible option that should be considered in patients with graft failure and may help to minimize the morbidity and mortality risk associated with dialysis reinitiation.

Keywords: allograft nephrectomy; allosensitization; dialysis; graft failure; immunosuppression; retransplantation.

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Figures

FIGURE 1
FIGURE 1
Suggested algorithm for the management of immunosuppressive therapy after kidney transplant failure. *Contraindications to maintaining immunosuppressive therapy: metabolic (diabetes, hypertension), cardiovascular complications, susceptibility to infections, malignant neoplasia, steroid-associated adverse effects
See this image and copyright information in PMC

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