The Failing Kidney Allograft

The number of kidney transplant recipients returning to dialysis after graft failure is steadily increasing. Patients with a failing kidney allograft face a heightened risk of complications from chronic kidney disease (CKD), renal replacement therapy, immunosuppressive drugs, infections, and cardiovascular disease. The management of these patients is highly complex, particularly concerning immunosuppressive drug use. Discontinuing these drugs can lead to chronic rejection, graft intolerance syndrome, or increased sensitization. Currently, management approaches for these patients vary considerably. This article reviews the current knowledge on caring for patients with failing kidney allografts, including the ideal timing and modality of dialysis reinitiation, retransplantation, and the management of immunosuppression during graft failure.