Management of patients with a failed kidney transplant: Dialysis reinitiation, immunosuppression weaning, and transplantectomy

Table 1 Continuation of immunosuppression after a failed transplant

Potential beneficial effects	Potential adverse effects
Preservation of residual kidney function	Metabolic complications (diabetes, hypertension, dyslipidemia)
Decreased incidence of graft intolerance syndrome and the need for allograft nephrectomy	Steroid-associated adverse effects (e.g., diabetes, cataracts, myopathy, and avascular necrosis among others)
Minimization of allosensitization	Cardiovascular complications
Avoidance of overt acute rejection	Increased susceptibility to infection
Prevention of adrenal insufficiency syndrome	Malignancy (especially skin cancers, Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and lip cancers)
Prevention of reactivation of systemic disease (e.g., systemic lupus erythematosus, vasculitis)	Costs (particularly when data supporting continued immunosuppression are lacking)