The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

Michelle Lubetzky, Ekamol Tantisattamo, Miklos Z. Molnar, Krista L. Lentine, Arpita Basu, Ronald F. Parsons, Kenneth J. Woodside, Martha Pavlakis, Christopher D. Blosser, Neeraj Singh, Beatrice P. Concepcion, Deborah Adey, Gaurav Gupta, Arman Faravardeh, Edward Kraus, Song Ong, Leonardo V. Riella, John Friedewald, Alex Wiseman, Amtul AalaDarshana M. Dadhania, Tarek Alhamad

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations


The return to dialysis after allograft failure is associated with increased morbidity and mortality. This transition is made more complex by the rising numbers of patients who seek repeat transplantation and therefore may have indications for remaining on low levels of immunosuppression, despite the potential increased morbidity. Management strategies vary across providers, driven by limited data on how to transition off immunosuppression as the allograft fails and a paucity of randomized controlled trials to support one approach over another. In this review, we summarize the current data available for management and care of the failing allograft. Additionally, we discuss a suggested plan for immunosuppression weaning based upon the availability of re-transplantation and residual allograft function. We propose a shared-care model in which there is improved coordination between transplant providers and general nephrologists so that immunosuppression management and preparation for renal replacement therapy and/or repeat transplantation can be conducted with the goal of improved outcomes and decreased morbidity in this vulnerable patient group.

Original languageEnglish
Pages (from-to)2937-2949
Number of pages13
JournalAmerican Journal of Transplantation
Issue number9
StatePublished - Sep 2021


  • clinical research/practice
  • immunosuppression/immune modulation
  • immunosuppressive regimens
  • kidney transplantation/nephrology
  • retransplantation


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