A prominent high mortality cause of renal failure is now allograft failure. Patients approach dialysis burdened by years of immunosuppression, advanced CV disease, but become sensitized and untransplantable if immunosuppression is withdrawn. Strategies for management of this population of patients are lacking.
Patients who return to dialysis after a failed renal transplant have a markedly increased risk for death and other adverse outcomes. The retained allograft serves as a nidus for excess inflammation that could contribute to cardiovascular and other clinical events. Other than repeat transplant, few effective options exist for reducing the risk of premature mortality. Observational data suggest a possible benefit of allograft ...more »
Patients who return to dialysis after a failed renal transplant have a markedly increased risk for death and other adverse outcomes. The retained allograft serves as a nidus for excess inflammation that could contribute to cardiovascular and other clinical events. Other than repeat transplant, few effective options exist for reducing the risk of premature mortality. Observational data suggest a possible benefit of allograft nephrectomy, but those studies are limited by selection bias and potential residual confounding. A randomized controlled trial of elective allograft nephrectomy on the risks of death, other clinically relevant events & resource utilization in patients returning to dialysis after allograft failure would provide the evidence needed to determine whether this would be a therapeutic option for these high-risk patients. Other therapeutic approaches could be layered on to such a trial using a factorial design as well.
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