The number of patients returning to dialysis after graft failure increases with graft vintage. The United Network for Organ Sharing and Organ Procurement and Transplantation Network (UNOS/OPTN) database demonstrated that among primary transplant recipients performed between 2008-2015, approximately one in five patients lost their graft by 5 years post-transplantation. More importantly, patients who require dialysis reinitiation after a failed transplant have been shown to have higher mortality rates compared with those with a functioning allograft as well as transplant-naïve incident dialysis patients, particularly in the first several months or first year of dialysis therapy. Whether early vs late reinitiation of dialysis, continuation vs. discontinuation of immunosuppression, or other factors define patient survival remains to be elucidated.
The current research topic aims to address various unanswered clinical questions encountered in the management of patients with a failed transplant and how various aspects of medical care can be optimized, including but not limited to:
1) Timing and criteria for re-referral for a repeat transplant
2) Optimal management of dialysis access following a successful kidney transplant and with failing graft
3) Timing of dialysis reinitiation after a failed transplant: dialysis modality, early vs. late reinitiation of dialysis and impact on patient survival
4) Continuation of immunosuppression vs. immunosuppression weaning after graft failure. Pros: Preservation of residual graft function, prevention of graft intolerance syndrome and graft nephrectomy, minimization of allosensitization. Cons: Increased infectious, cardiovascular, and malignancy risks. Metabolic complications (diabetes, hypertension, hyperlipidemia)
5) Allograft nephrectomy vs. No nephrectomy after graft failure (morbidity and mortality associated with the surgical procedure, impact on patient survival, allosensitization risk)
This editorial initiative of particular relevance is led by Prof. Thu Pham, Specialty Chief Editor of the Kidney Transplantation section, together with Associate Editor Prof. Chi Pham.
The number of patients returning to dialysis after graft failure increases with graft vintage. The United Network for Organ Sharing and Organ Procurement and Transplantation Network (UNOS/OPTN) database demonstrated that among primary transplant recipients performed between 2008-2015, approximately one in five patients lost their graft by 5 years post-transplantation. More importantly, patients who require dialysis reinitiation after a failed transplant have been shown to have higher mortality rates compared with those with a functioning allograft as well as transplant-naïve incident dialysis patients, particularly in the first several months or first year of dialysis therapy. Whether early vs late reinitiation of dialysis, continuation vs. discontinuation of immunosuppression, or other factors define patient survival remains to be elucidated.
The current research topic aims to address various unanswered clinical questions encountered in the management of patients with a failed transplant and how various aspects of medical care can be optimized, including but not limited to:
1) Timing and criteria for re-referral for a repeat transplant
2) Optimal management of dialysis access following a successful kidney transplant and with failing graft
3) Timing of dialysis reinitiation after a failed transplant: dialysis modality, early vs. late reinitiation of dialysis and impact on patient survival
4) Continuation of immunosuppression vs. immunosuppression weaning after graft failure. Pros: Preservation of residual graft function, prevention of graft intolerance syndrome and graft nephrectomy, minimization of allosensitization. Cons: Increased infectious, cardiovascular, and malignancy risks. Metabolic complications (diabetes, hypertension, hyperlipidemia)
5) Allograft nephrectomy vs. No nephrectomy after graft failure (morbidity and mortality associated with the surgical procedure, impact on patient survival, allosensitization risk)
This editorial initiative of particular relevance is led by Prof. Thu Pham, Specialty Chief Editor of the Kidney Transplantation section, together with Associate Editor Prof. Chi Pham.