title: Care of the patient after renal allograft failure: managing the present and planning for the future.
abstract: The number of patients with end-stage renal disease undergoing kidney transplantation - both cadaveric and living-donor - continues to rise. With long-term graft survival relatively fixed, this trend means that increasing numbers of patients are returning to dialysis after graft loss. Most will never be retransplanted, which introduces a host of clinical questions regarding optimal management of this unique patient population. In this paper, we explore data that informs astute care of the patient requiring dialysis after graft loss. We address new data about the increased clinical risk and the optimal dialysis modality in renal allograft loss, explore new approaches to immunosuppression and transfusion management, and examine the risks and benefits of allograft nephrectomy and timing thereof. While there are no randomized clinical trials in this field, rapidly evolving data will aid the clinician whose practice includes patients who have been transplanted and are returning to dialysis.
authors.affiliation: Division of Kidney Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colo. 80045, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Fuquay
authors.forename: Isaac
authors.initials: I
authors.lastname: Teitelbaum
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D009392:Nephrectomy / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy*; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D014184:Transplantation, Homologous