The Failing Kidney Allograft
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Abstract
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.
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References
United States Renal Data System. 2022 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2022.
สมาคมปลูกถ่ายอวัยวะแห่งประเทศไทย. รายงานการปลูกถ่ายอวัยวะประจำปี พ.ศ. 2565. กรุงเทพมหานคร: บริษัท ปริ้นท์แอนด์มอร์ จำกัด;2566.
Kaplan B, Meier-Kriesche HU. Death after graft loss: an important late study endpoint in kidney transplantation. Am J Transplant 2002;2(10):970–4. doi: 10.1034/j.1600-6143.2002.21015.x.
Rao PS, Schaubel DE, Jia X, Li S, Port FK, Saran R. Survival on dialysis post-kidney transplant failure: results from the Scientific Registry of Transplant Recipients. Am J Kidney Dis 2007;49(2):294–300. doi: 10.1053/j.ajkd.2006.11.022.
Perl J, Zhang J, Gillespie B, Wikstrom B, Fort J, Hasegawa T, et al. Reduced survival and quality of life following return to dialysis after transplant failure: the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2012;27(12):4464–72. doi: 10.1093/ndt/gfs386.
Davis S, Mohan S. Managing Patients with Failing Kidney Allograft: Many Questions Remain. Clin J Am Soc Nephrol 2022;17(3):444–51. doi: 10.2215/CJN.14620920.
Josephson MA, Becker Y, Budde K, Kasiske BL, Kiberd BA, Loupy A, et al. Challenges in the management of the kidney allograft: from decline to failure: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2023;104(6):1076–91. doi: 10.1016/j.kint.2023.05.010.
Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S, et al. OPTN/SRTR 2018 Annual Data Report: Kidney. Am J Transplant 2020;20 Suppl s1:20–130. doi: 10.1111/ajt.15672.
Fiorentino M, Gallo P, Giliberti M, Colucci V, Schena A, Stallone G, et al. Management of patients with a failed kidney transplant: what should we do? Clin Kidney J 2021;14(1):98–106. doi: 10.1093/ckj/sfaa094.
Lubetzky M, Tantisattamo E, Molnar MZ, Lentine KL, Basu A, Parsons RF, et al. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients. Am J Transplant 2021;21(9):2937–49. doi: 10.1111/ajt.16717.
Scornik JC, Kriesche HU. Human leukocyte antigen sensitization after transplant loss: timing of antibody detection and implications for prevention. Hum Immunol 2011;72(5):398–401. doi: 10.1016/j.humimm.2011.02.018.
Nimmo A, McIntyre S, Turner DM, Henderson LK, Battle RK. The Impact of Withdrawal of Maintenance Immunosuppression and Graft Nephrectomy on HLA Sensitization and Calculated Chance of Future Transplant. Transplant Direct 2018;4(12):e409. doi: 10.1097/TXD.0000000000000848.
Casey MJ, Wen X, Kayler LK, Aiyer R, Scornik JC, Meier-Kriesche HU. Prolonged immunosuppression preserves nonsensitization status after kidney transplant failure. Transplantation 2014;98(3):306–11. doi: 10.1097/TP.0000000000000057.
Freist M, Bertrand D, Bailly E, Lambert C, Rouzaire PO, Lemal R, et al. Management of Immunosuppression After Kidney Transplant Failure: Effect on Patient Sensitization. Transplant Proc 2021;53(3):962–9. doi: 10.1016/j.transproceed.2020.10.009.
Martin K, Cantwell L, Barraclough KA, Lian M, Masterson R, Hughes PD, et al. Prolonged immunosuppression does not improve risk of sensitization or likelihood of retransplantation after kidney transplant graft failure. Transpl Int 2021;34(11): 2353–62. doi: 10.1111/tri.13998.
Alhamad T, Lubetzky M, Lentine KL, Edusei E, Parsons R, Pavlakis M, et al. Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers. Am J Transplant 2021;21(9):3034–42. doi: 10.1111/ajt.16523.
Knoll G, Campbell P, Chasse M, Fergusson D, Ramsay T, Karnabi P, et al. Immunosuppressant Medication Use in Patients with Kidney Allograft Failure: A Prospective Multicenter Canadian Cohort Study. J Am Soc Nephrol 2022;33(6):1182–92. doi: 10.1681/ASN.2021121642.
Schulte K, Vollmer C, Klasen V, Brasen JH, Puchel J, Borzikowsky C, et al. Late conversion from tacrolimus to a belatacept-based immuno-suppression regime in kidney transplant recipients improves renal function, acid-base derangement and mineral-bone metabolism. J Nephrol 2017;30(4):607–15. doi: 10.1007/s40620-017-0411-0.
Badell IR, Bray RA, Elbein R, Chami AS, Easley KA, Pastan SO, et al. Belatacept in Kidney Transplant Recipients With Failed Allografts for the Prevention of Humoral Sensitization: A Pilot Randomized Controlled Trial. Transplantation 2021;105(12):e395–e6. doi: 10.1097/TP.0000000000003852.
Jassal SV, Lok CE, Walele A, Bargman JM. Continued transplant immunosuppression may prolong survival after return to peritoneal dialysis: results of a decision analysis. Am J Kidney Dis 2002;40(1):178–83. doi: 10.1053/ajkd.2002.33927.
Gregoor PJ, Kramer P, Weimar W, van Saase JL. Infections after renal allograft failure in patients with or without low-dose maintenance immunosuppression. Transplantation 1997;63(10):1528–30. doi: 10.1097/00007890-199705270-00028.
Johnston O, Zalunardo N, Rose C, Gill JS. Prevention of sepsis during the transition to dialysis may improve the survival of transplant failure patients. J Am Soc Nephrol 2007;18(4):1331–7. doi: 10.1681/ASN.2006091017.
Woodside KJ, Schirm ZW, Noon KA, Huml AM, Padiyar A, Sanchez EQ, et al. Fever, infection, and rejection after kidney transplant failure. Transplantation 2014;97(6):648–53. doi: 10.1097/01.TP.0000437558.75574.9c.
van Leeuwen MT, Webster AC, McCredie MR, Stewart JH, McDonald SP, Amin J, et al. Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study. BMJ 2010;340:c570. doi: 10.1136/bmj.c570.
British Transplant Society: Management of the failing kidney transplant. https://bts.org.uk/wp-content/uploads/ 2016/09/13_BTS_Failing_Graft-1.pdf. Accessed December 5, 2023.
Ghyselen L, Naesens M. Indications, risks and impact of failed allograft nephrectomy. Transplant Rev (Orlando) 2019;33(1):48–54. doi: 10.1016/j.trre.2018.08.001.
Akbari A, Hussain N, Karpinski J, Knoll GA. Chronic kidney disease management: comparison between renal transplant recipients and nontransplant patients with chronic kidney disease. Nephron Clin Pract 2007;107(1):c7–13. doi: 10.1159/000105138.
Leal R, Pardinhas C, Martinho A, Sa HO, Figueiredo A, Alves R. Challenges in the Management of the Patient with a Failing Kidney Graft: A Narrative Review. J Clin Med 2022;11(20). doi: 10.3390/jcm11206108.
Kidney Disease: Improving Global Outcomes CKDMBDUWG. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (2011) 2017;7(1):1–59. doi: 10.1016/j.kisu.2017.04.001.
Lopez-Gomez JM, Perez-Flores I, Jofre R, Carretero D, Rodriguez-Benitez P, Villaverde M, et al. Presence of a failed kidney transplant in patients who are on hemodialysis is associated with chronic inflammatory state and erythropoietin resistance. J Am Soc Nephrol 2004;15(9):2494–501. doi: 10.1097/01.ASN.0000137879.97445.6E.
Chadban SJ, Ahn C, Axelrod DA, Foster BJ, Kasiske BL, Kher V, et al. KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation 2020;104(4S1 Suppl 1):S11–S103. doi: 10.1097/ TP.0000000000003136.
Chan MR, Oza-Gajera B, Chapla K, Djamali AX, Muth BL, Turk J, et al. Initial vascular access type in patients with a failed renal transplant. Clin J Am Soc Nephrol 2014;9(7):1225–31. doi: 10.2215/CJN.12461213.
Zhang JC, Al-Jaishi A, Perl J, Garg AX, Moist LM. Hemodialysis Arteriovenous Vascular Access Creation After Kidney Transplant Failure. Am J Kidney Dis 2015;66(4):646–54. doi: 10.1053/j.ajkd.2015.03.031.
Molnar MZ, Streja E, Kovesdy CP, Hoshino J, Hatamizadeh P, Glassock RJ, et al. Estimated glomerular filtration rate at reinitiation of dialysis and mortality in failed kidney transplant recipients. Nephrol Dial Transplant 2012;27(7):2913–21. doi: 10.1093/ndt/gfs004.
Perl J, Hasan O, Bargman JM, Jiang D, Na Y, Gill JS, et al. Impact of dialysis modality on survival after kidney transplant failure. Clin J Am Soc Nephrol 2011;6(3):582–90. doi: 10.2215/CJN.06640810.
Schold JD, Augustine JJ, Huml AM, O’Toole J, Sedor JR, Poggio ED. Modest rates and wide variation in timely access to repeat kidney transplantation in the United States. Am J Transplant 2020;20(3):769–78. doi: 10.1111/ajt.15646.
Johnston O, Rose CL, Gill JS, Gill JS. Risks and benefits of preemptive second kidney transplantation. Transplantation 2013;95(5):705–10. doi: 10.1097/TP.0b013e31827a938f.
Wong G, Chua S, Chadban SJ, Clayton P, Pilmore H, Hughes PD, et al. Waiting Time Between Failure of First Graft and Second Kidney Transplant and Graft and Patient Survival. Transplantation 2016;100(8):1767–75. doi: 10.1097/TP.0000000000000953.
