Organ Transplantation Research Today is a free monthly online journal that collates and summarizes the latest research about Organ Transplantation, including details on risks, prognosis, procedure, surgery.

The failed renal transplant: in or out?

Bennett WM

With the increased number of renal transplants being performed in the United States, there are also increasing numbers of early and long-term allograft failures. Patients with failed allografts require reentry into the end-stage renal disease (ESRD) system. If an allograft is producing little in the way of morbidity, it seems reasonable to continue the patient on low-dose immunosuppressive therapy to avoid sensitization while leaving the allograft in. This is particularly true if the allograft is providing enough renal function to keep the patient off dialysis. However, if the patient is having serious morbidity that may be due to the retained, failed kidney transplant, it may be necessary to remove the allograft kidney, which often shows ongoing inflammation. This may restore erythropoietin responsiveness and contribute to the overall benefit of the patient. The optimal protocol for withdrawal of immunosuppression in this circumstance has not been established by any scientific studies, and the effect of allograft nephrectomy on sensitization status and the ability to receive a crossmatch-negative retransplant are controversial. The author's personal approach is presented.

Published 6 June 2005 in Semin Dial, 18(3): 188-9.
Full-text of this article is available online (may require subscription).

© 2004-2008 Organ Transplantation Research Today. All Rights Reserved.