The failed renal transplant: in or out?

Abstract:

:With the increased number of renal transplants being performed in the United States, there are also increasing numbers of early and long-term allograft failures. Patients with failed allografts require reentry into the end-stage renal disease (ESRD) system. If an allograft is producing little in the way of morbidity, it seems reasonable to continue the patient on low-dose immunosuppressive therapy to avoid sensitization while leaving the allograft in. This is particularly true if the allograft is providing enough renal function to keep the patient off dialysis. However, if the patient is having serious morbidity that may be due to the retained, failed kidney transplant, it may be necessary to remove the allograft kidney, which often shows ongoing inflammation. This may restore erythropoietin responsiveness and contribute to the overall benefit of the patient. The optimal protocol for withdrawal of immunosuppression in this circumstance has not been established by any scientific studies, and the effect of allograft nephrectomy on sensitization status and the ability to receive a crossmatch-negative retransplant are controversial. The author's personal approach is presented.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

Bennett WM

doi

10.1111/j.1525-139X.2005.18306.x

subject

Has Abstract

pub_date

2005-05-01 00:00:00

pages

188-9

issue

3

eissn

0894-0959

issn

1525-139X

pii

SDI18306

journal_volume

18

pub_type

社论,评审
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