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

Table 3 Transplantectomy: Potential risks and benefits and impact on a repeat transplant

	Comments
Potential benefits
A failing graft is a focus of a chronic inflammatory state
May reduce mortality rates	Variable results, further studies are needed
Potential adverse effects
Residual kidney function may allow less stringent fluid restriction
Surgery-related morbidity and mortality	Morbidity 17%-60% in most series reported
	Mortality 1.5%-14% in most series reported
Allosensitization and the potential for future prolonged wait-times for a compatible crossmatch kidney
Impact on a repeat transplant
Mixed reports due to potential confounding factors
Differences among studies in:
Immunosuppression withdrawal protocols
Recipient and donor demographics
Era of transplantation
Indications for transplantectomy
Time on dialysis prior to a repeat transplant
Causes of prior graft loss
Allosensitization associated with blood transfusion
Pre-existing DSA with or without complement-fixing DSA (see text)
HLA matching of subsequent graft
Donor type (living vs deceased)
Others

DSA: Donor-specific antibody.