title: Immunosuppression in the failing and failed transplant kidney: optimizing outcomes.
abstract: There is little data to guide clinicians on the optimal management of immunosuppression in patients whose kidney transplant has failed and who have returned to dialysis. Nor is there robust data on whether to perform a transplant nephrectomy. Finally, management of late stage chronic kidney disease, including deciding on dialysis initiation, modality and access planning, must occur simultaneously with efforts aimed at preserving the failing kidney and residual renal function for as long as possible. In this article, we will review the evidence on these topics and suggest areas for improvement.
authors.affiliation: Department of Medicine, Rhode Island Hospital, Providence, RI, USA Alpert Medical School, Brown University, Providence, RI, USA Oregon Kidney and Hypertension Clinic, Portland, OR, USA.
authors.forename: Claire T
authors.initials: CT
authors.lastname: Kassakian
authors.affiliation: Alpert Medical School, Brown University, Providence, RI, USA Department of Surgery, Rhode Island Hospital, Providence, RI, USA.
authors.forename: Saad
authors.initials: S
authors.lastname: Ajmal
authors.affiliation: Department of Medicine, Rhode Island Hospital, Providence, RI, USA Alpert Medical School, Brown University, Providence, RI, USA Transplant Center, Rhode Island Hospital, Providence, RI, USA.
authors.forename: Reginald Y
authors.initials: RY
authors.lastname: Gohh
authors.affiliation: Alpert Medical School, Brown University, Providence, RI, USA Department of Surgery, Rhode Island Hospital, Providence, RI, USA Transplant Center, Rhode Island Hospital, Providence, RI, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Morrissey
authors.affiliation: Department of Medicine, Rhode Island Hospital, Providence, RI, USA Alpert Medical School, Brown University, Providence, RI, USA Transplant Center, Rhode Island Hospital, Providence, RI, USA.
authors.forename: George P
authors.initials: GP
authors.lastname: Bayliss
mesh_terms: D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000592:standards*; D007674:Kidney Diseases / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects*; D006435:Renal Dialysis
keywords: immunosuppression; infection; nephrectomy; transplant failure