Management of Patients with a Failed Kidney Transplant: What Should We Do?

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2021 Feb 10

PMID 33564409

Citations 13

Authors

Marco Fiorentino

Pasquale Gallo

Marica Giliberti

Vincenza Colucci

Antonio Schena

Giovanni Stallone

Loreto Gesualdo

Giuseppe Castellano

Affiliations

Soon will be listed here.

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.

Citing Articles

Chronic kidney disease management in patients with a failing graft: a comparative study with incident non-transplant hemodialysis patients.

Silva A, Marques M, Rodrigues L, Santos L, Romaozinho C, Caramelo F Ren Fail. 2025; 47(1):2447791.

PMID: 39801455 PMC: 11731143. DOI: 10.1080/0886022X.2024.2447791.

Supportive care in transplantation: A patient-centered care model to better support kidney transplant candidates and recipients.

Slominska A, Loban K, Kinsella E, Ho J, Sandal S World J Transplant. 2024; 14(4):97474.

PMID: 39697448 PMC: 11438939. DOI: 10.5500/wjt.v14.i4.97474.

Losing Much More Than a Transplant: A Qualitative Study of Kidney Transplant Recipients' Experiences of Graft Failure.

Slominska A, Kinsella E, El-Wazze S, Gaudio K, Shamseddin M, Bugeja A Kidney Int Rep. 2024; 9(10):2937-2945.

PMID: 39430187 PMC: 11489391. DOI: 10.1016/j.ekir.2024.07.011.

Delayed graft function has comparable associations with early outcomes in primary and repeat transplant among deceased-donor kidney transplant recipients.

Stoy D, Muth B, Astor B, Mandelbrot D, Parajuli S J Nephrol. 2024; .

PMID: 39363124 DOI: 10.1007/s40620-024-02104-5.

Clinical relevance of HLA-DQ eplet mismatch and maintenance immunosuppression with risk of allosensitization after kidney transplant failure.

Tran J, Alrajhi I, Chang D, Sherwood K, Keown P, Gill J Front Genet. 2024; 15:1383220.

PMID: 38638120 PMC: 11024336. DOI: 10.3389/fgene.2024.1383220.

References

Verresen L, Vanrenterghem Y, Waer M, Hauglustaine D, Michielsen P . Corticosteroid withdrawal syndrome in dialysis patients. Nephrol Dial Transplant. 1988; 3(4):476-7. DOI: 10.1093/oxfordjournals.ndt.a091703. View

van Leeuwen M, Webster A, McCredie M, Stewart J, McDonald S, Amin J . Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study. BMJ. 2010; 340:c570. PMC: 2820609. DOI: 10.1136/bmj.c570. View

Pham P, Pham P . Immunosuppressive management of dialysis patients with recently failed transplants. Semin Dial. 2011; 24(3):307-13. DOI: 10.1111/j.1525-139X.2011.00864.x. View

Bunthof K, Hazzan M, Hilbrands L . Review: Management of patients with kidney allograft failure. Transplant Rev (Orlando). 2018; 32(3):178-186. DOI: 10.1016/j.trre.2018.03.001. View

Scornik J, Kriesche H . Human leukocyte antigen sensitization after transplant loss: timing of antibody detection and implications for prevention. Hum Immunol. 2011; 72(5):398-401. DOI: 10.1016/j.humimm.2011.02.018. View

Varas J, Perez-Saez M, Ramos R, Merello J, de Francisco A, Luno J . Returning to haemodialysis after kidney allograft failure: a survival study with propensity score matching. Nephrol Dial Transplant. 2018; 34(4):667-672. DOI: 10.1093/ndt/gfy215. View

Davies S . Peritoneal dialysis in the patient with a failing renal allograft. Perit Dial Int. 2002; 21 Suppl 3:S280-4. View

Ojo A, Hanson J, Meier-Kriesche H, Okechukwu C, Wolfe R, Leichtman A . Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001; 12(3):589-597. DOI: 10.1681/ASN.V123589. View

Yeates K, Zhu N, Vonesh E, Trpeski L, Blake P, Fenton S . Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transplant. 2012; 27(9):3568-75. DOI: 10.1093/ndt/gfr674. View

10.

Takase H, Contti M, Nga H, Bravin A, Valiatti M, El-Dib R . Nephrectomy Versus Embolization of Non-Functioning Renal Graft: A Systematic Review with a Proportional Meta-Analysis. Ann Transplant. 2018; 23:207-217. PMC: 6248024. View

11.

Del Bello A, Congy-Jolivet N, Sallusto F, Guilbeau-Frugier C, Cardeau-Desangles I, Fort M . Donor-specific antibodies after ceasing immunosuppressive therapy, with or without an allograft nephrectomy. Clin J Am Soc Nephrol. 2012; 7(8):1310-9. PMC: 3408115. DOI: 10.2215/CJN.00260112. View

12.

Perl J, Dong J, Rose C, Jassal S, Gill J . Is dialysis modality a factor in the survival of patients initiating dialysis after kidney transplant failure?. Perit Dial Int. 2013; 33(6):618-28. PMC: 3862091. DOI: 10.3747/pdi.2012.00280. View

13.

Cooper B, Branley P, Bulfone L, Collins J, Craig J, Fraenkel M . A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med. 2010; 363(7):609-19. DOI: 10.1056/NEJMoa1000552. View

14.

McDonald S, Marshall M, Johnson D, Polkinghorne K . Relationship between dialysis modality and mortality. J Am Soc Nephrol. 2008; 20(1):155-63. PMC: 2615722. DOI: 10.1681/ASN.2007111188. View

15.

Bargman J, Thorpe K, Churchill D . Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol. 2001; 12(10):2158-2162. DOI: 10.1681/ASN.V12102158. View

16.

Laham G, Pujol G, Vilches A, Cusumano A, Diaz C . Nonprogrammed Vascular Access Is Associated With Greater Mortality in Patients Who Return to Hemodialysis With a Failing Renal Graft. Transplantation. 2017; 101(10):2606-2611. DOI: 10.1097/TP.0000000000001751. View

17.

Ahmad N, Ahmed K, Mamode N . Does nephrectomy of failed allograft influence graft survival after re-transplantation?. Nephrol Dial Transplant. 2008; 24(2):639-42. DOI: 10.1093/ndt/gfn567. View

18.

SHEMIN D, Bostom A, Laliberty P, Dworkin L . Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis. 2001; 38(1):85-90. DOI: 10.1053/ajkd.2001.25198. View

19.

Heaphy E, Poggio E, Flechner S, Goldfarb D, Askar M, Fatica R . Risk factors for retransplant kidney recipients: relisting and outcomes from patients' primary transplant. Am J Transplant. 2014; 14(6):1356-67. DOI: 10.1111/ajt.12690. View

20.

Meier-Kriesche H, Schold J, Srinivas T, Kaplan B . Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant. 2004; 4(3):378-83. DOI: 10.1111/j.1600-6143.2004.00332.x. View