Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2015; 4(2): 148-159
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.148
Management of patients with a failed kidney transplant: Dialysis reinitiation, immunosuppression weaning, and transplantectomy
Phuong-Thu Pham, Matthew Everly, Arman Faravardeh, Phuong-Chi Pham
Phuong-Thu Pham, Arman Faravardeh, Department of Medicine, Nephrology Division, Kidney Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Matthew Everly, Terasaki Foundation Laboratory, Los Angeles, CA 90025, United States
Phuong-Chi Pham, Department of Medicine, Division of Nephrology and Hypertension, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
Author contributions: All authors contributed to this paper.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Phuong-Thu Pham, MD, Department of Medicine, Nephrology Division, Kidney Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States. ppham@mednet.ucla.edu
Telephone: +1-310-7941757
Received: June 15, 2014
Peer-review started: June 15, 2014
First decision: July 10, 2014
Revised: January 24, 2015
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: May 6, 2015
Processing time: 327 Days and 13 Hours
Core Tip

Core tip: The number of patients with a failed allograft returning to dialysis increases over time. Studies suggest that such patients are at increased morbidity and mortality risks compared with their transplant-naïve, incident dialysis patients. This review provides a critical literature overview of the risks and benefits of early vs late dialysis re-initiation, immunosuppression weaning, and transplantectomy in patients with a failed allograft. Based on currently available literature, suggested guidelines for the management of this unique patient population are presented.