Management of patients with a failed kidney transplant: what should we do?
Autor: | Pasquale Gallo, Giuseppe Castellano, Marica Giliberti, Vincenza Colucci, Antonio Schena, Marco Fiorentino, Loreto Gesualdo, Giovanni Stallone |
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Rok vydání: | 2020 |
Předmět: |
allosensitization
medicine.medical_specialty Allosensitization graft failure medicine.medical_treatment Population 030232 urology & nephrology Disease 030230 surgery allograft nephrectomy retransplantation 03 medical and health sciences 0302 clinical medicine medicine AcademicSubjects/MED00340 Intensive care medicine education Dialysis CKJ Reviews Transplantation education.field_of_study immunosuppression business.industry Immunosuppression Nephrectomy surgical procedures operative Nephrology dialysis Hemodialysis business |
Zdroj: | Clinical Kidney Journal |
ISSN: | 2048-8513 |
Popis: | The number of kidney transplant recipients returning to dialysis after graft failure is steadily increasing over time. Patients with a failed kidney transplant have been shown to have a significant increase in mortality compared with patients with a functioning graft or patients initiating dialysis for the first time. Moreover, the risk for infectious complications, cardiovascular disease and malignancy is greater than in the dialysis population due to the frequent maintenance of low-dose immunosuppression, which is required to reduce the risk of allosensitization, particularly in patients with the prospect of retransplantation from a living donor. The management of these patients present several controversial opinions and clinical guidelines are lacking. This article aims to review the leading evidence on the main issues in the management of patients with failed transplant, including the ideal timing and modality of dialysis reinitiation, the indications for an allograft nephrectomy or the correct management of immunosuppression during graft failure. In summary, retransplantation is a feasible option that should be considered in patients with graft failure and may help to minimize the morbidity and mortality risk associated with dialysis reinitiation. |
Databáze: | OpenAIRE |
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