CKD complications in kidney-transplanted patients going back to dialysis: impact on patients outcomes

Aniort, Julien; Kaysi, Saleh; Garrouste, Cyril; Abdel‐Kader, Mahmoud H.; Isnard, M.; Aguilera, Didier; Ali, Youssef; Bouiller, M.; Mulliez, Aurélien; Heng, Anne Elisabeth

doi:10.1007/s40620-017-0449-z

Cited by 8 publications

(2 citation statements)

References 25 publications

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“…Reports also indicate these patients are less likely to undergo appropriate dialysis planning and more often initiate dialysis with a central venous catheter (14). This is particularly troubling given evidence that early referral for patients with native kidney disease is associated with significantly improved clinical care at the start of dialysis and improved longer-term outcomes—a trend that does not appear to extend to transplant nephrologists and their patients with failing allografts (43). Appropriate planning, including modality counseling and the use of peritoneal dialysis, has also been shown to be associated with improved early outcomes for individuals with a failed allograft (41).…”

Section: Ckd Management and Dialysis Modalitymentioning

confidence: 99%

Managing Patients with Failing Kidney Allograft

Davis

Mohan

2022

CJASN

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Patients who receive a kidney transplant commonly experience failure of their allograft. Transplant failure often comes with complex management decisions, such as when and how to wean immunosuppression and start the transition to a second transplant or to dialysis. These decisions are made in the context of important concerns about competing risks, including sensitization and infection. Unfortunately, the management of the failed allograft is, at present, guided by relatively poor-quality data and, as a result, practice patterns are variable and suboptimal given that patients with failed allografts experience excess morbidity and mortality compared with their transplant-naive counterparts. In this review, we summarize the management strategies through the often-precarious transition from transplant to dialysis, highlighting the paucity of data and the critical gaps in our knowledge that are necessary to inform the optimal care of the patient with a failing kidney transplant.

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Section: Ckd Management and Dialysis Modalitymentioning

confidence: 99%

Managing Patients with Failing Kidney Allograft

Davis

Mohan

2022

CJASN

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“…A comprehensive pre-dialysis evaluation reduces the mortality of incident dialysis patients and increases the chance of receiving an allograft [1,2]. Data suggests that the pre-dialysis treatment might be suboptimal for patients with dialysis after graft loss (DAGL) as compared to incident dialysis patients [3].…”

Section: Introductionmentioning

confidence: 99%

Dialysis after graft loss: a Swiss experience

Bonani

Achermann

Seeger

et al. 2020

Nephrology Dialysis Transplantation

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Background Patients returning to dialysis after graft loss have high early morbidity and mortality. Methods We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded. Results Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft. Conclusion In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.

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