TY - JOUR
T1 - The failing kidney allograft
T2 - A review and recommendations for the care and management of a complex group of patients
AU - Lubetzky, Michelle
AU - Tantisattamo, Ekamol
AU - Molnar, Miklos Z.
AU - Lentine, Krista L.
AU - Basu, Arpita
AU - Parsons, Ronald F.
AU - Woodside, Kenneth J.
AU - Pavlakis, Martha
AU - Blosser, Christopher D.
AU - Singh, Neeraj
AU - Concepcion, Beatrice P.
AU - Adey, Deborah
AU - Gupta, Gaurav
AU - Faravardeh, Arman
AU - Kraus, Edward
AU - Ong, Song
AU - Riella, Leonardo V.
AU - Friedewald, John
AU - Wiseman, Alex
AU - Aala, Amtul
AU - Dadhania, Darshana M.
AU - Alhamad, Tarek
N1 - Funding Information:
We would like to thank both the KPCOP executive committee and the AST Education committee for their insightful feedback and review of this manuscript.
Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - clinical research/practice
KW - immunosuppression/immune modulation
KW - immunosuppressive regimens
KW - kidney transplantation/nephrology
KW - retransplantation
UR - http://www.scopus.com/inward/record.url?scp=85110440614&partnerID=8YFLogxK
U2 - 10.1111/ajt.16717
DO - 10.1111/ajt.16717
M3 - Review article
C2 - 34115439
AN - SCOPUS:85110440614
SN - 1600-6135
VL - 21
SP - 2937
EP - 2949
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 9
ER -