Elizabeth Kendrick ^*

• David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, United States

While long term function of renal transplants has improved over time, duration of transplant function is still likely to be outstripped by the recipient's lifespan. Therefore transplant recipients will likely again face management for CKD and transition to renal replacement therapy. While traditional metrics of transplant outcome end at death with a functioning graft or graft failure, it has been show that death rates are considerably increased after loss of graft function and contributing causes and potential interventions have not been as widely explored. In particular, the initial 3 to 6 month period after graft loss and return to dialysis is associated with a risk of death as much as 3-fold that of those with continued graft function 1-2 . Patient survival after graft loss is poor with 40% of patients surviving 10 years versus 75% of patients with a functioning allograft. Therefore, loss of renal graft function has a more profound impact on patient outcomes than just the need to return to dialysis. Contributing factors to poor outcomes after graft loss are felt to include the loss of the survival benefit of a functioning graft as well as the adverse cardiovascular effects of the cumulative length of ESRD, complications of long term immunosuppression, and other comorbid factors such as diabetes. Therefore transplant recipients with failing allografts are facing a transition fraught with potential risk of death or other serious complications. They face complex issues including management of immunosuppression and decisions in regards to ESRD management