title: [Dialysis reinitiation after kidney transplant failure and preparation for retransplantation].
abstract: With the development of kidney transplantation procedure the number of patients returning to dialysis after losing their graft function is gradually increasing. Early return to dialysis after an unsuccessful kidney transplantation is associated with a worse prognosis. Patients with end stage transplanted kidney failure may be qualified again for the treatment of both peritoneal dialysis or hemodialysis. They represent an increased risk of complications as compared to patients without a history of previous kidney transplantation because they usually have high commorbidity, receive immunosuppressive therapy and during re-qualification to dialysis usually have no efficient vascular access or peritoneal catheter implanted. Graft loss in the early stages after procedure, because of fulminant rejection, vascular thrombosis or lack of primary organ function is associated with immunosuppression withdrawal while leaving a failing kidney is an indication to maintain it in a reduced form. The indication for removal of an inefficient transplant after more than 12 months are: symptoms of its intolerance manifested by acute rejection, pain in the area of the graft, fever, severe anemia, increase of blood pressure and inflammatory markers. Removal of the graft may be associated with a temporary increase in immunization of the patient. Patients meeting the clinical conditions for transplantation should be considered for another kidney transplant as preemptive transplantation or as soon as possible after dialysis start. Although kidney retransplantation results are slightly worse when compared with the first transplant, it still has an advantage over dialysis.
authors.forename: Paweł
authors.initials: P
authors.lastname: Wróbel
authors.forename: Władysław
authors.initials: W
authors.lastname: Sułowicz
mesh_terms: D006084:Graft Rejection; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D006435:Renal Dialysis; D012086:Reoperation