Management of the failing renal allograft: an updated summary of the guidelines

Abstract

With increasing numbers of renal transplants performed globally, there is also an increase in the incidence of patients with failed transplants. Management of these patients with a failed graft needs special attention, as they represent a unique patient cohort with specific medical issues and high degree of morbidity and mortality. The primary aim should be to prolong the function of the existing graft and plan for eventual return to dialysis or early retransplantation. Minimization of immunosuppression to avoid unnecessary adverse effects while stabilizing cardiovascular risk factors and associated comorbidities is paramount. Individualized decision making is required in terms of graft nephrectomy versus leaving the graft in situ. Furthermore, an informed decision needs to be taken regarding the optimum plan of definitive management in terms of return to dialysis, retransplantation, or conservative management.