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Lubetzky M, Tantisattamo E, Molnar MZ, Lentine KL, Basu A, Parsons RF, Woodside KJ, Pavlakis M, Blosser CD, Singh N, Concepcion BP, Adey D, Gupta G, Faravardeh A, Kraus E, Ong S, Riella LV, Friedewald J, Wiseman A, Aala A, Dadhania DM, Alhamad T. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients. Am J Transplant 2021; 21:2937-2949. [PMID: 34115439 DOI: 10.1111/ajt.16717] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/23/2021] [Accepted: 05/20/2021] [Indexed: 01/25/2023]
Abstract
The return to dialysis after allograft failure is associated with increased morbidity and mortality. This transition is made more complex by the rising numbers of patients who seek repeat transplantation and therefore may have indications for remaining on low levels of immunosuppression, despite the potential increased morbidity. Management strategies vary across providers, driven by limited data on how to transition off immunosuppression as the allograft fails and a paucity of randomized controlled trials to support one approach over another. In this review, we summarize the current data available for management and care of the failing allograft. Additionally, we discuss a suggested plan for immunosuppression weaning based upon the availability of re-transplantation and residual allograft function. We propose a shared-care model in which there is improved coordination between transplant providers and general nephrologists so that immunosuppression management and preparation for renal replacement therapy and/or repeat transplantation can be conducted with the goal of improved outcomes and decreased morbidity in this vulnerable patient group.
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Affiliation(s)
- Michelle Lubetzky
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Ekamol Tantisattamo
- Division of Nephrology, University of California Irvine, Orange, California, USA
| | - Miklos Z Molnar
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, USA
| | - Krista L Lentine
- Internal Medicine-Nephrology, Saint Louis University, St. Louis, Missouri, USA
| | - Arpita Basu
- Division of Transplantation, Emory University, Atlanta, Georgia, USA
| | - Ronald F Parsons
- Division of Transplantation, Emory University, Atlanta, Georgia, USA
| | - Kenneth J Woodside
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha Pavlakis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christopher D Blosser
- Division of Nephrology, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Neeraj Singh
- Division of Nephrology, Willis Knighton Health System, Shreveport, Louisiana, USA
| | | | - Deborah Adey
- Division of Nephrology, University of California San Francisco, San Francisco, California, USA
| | - Gaurav Gupta
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Arman Faravardeh
- SHARP Kidney and Pancreas Transplant Center, San Diego, California, USA
| | - Edward Kraus
- Department of Medicine, Johns Hopkins, Baltimore, Maryland, USA
| | - Song Ong
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leonardo V Riella
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Friedewald
- Division of Medicine and Surgery, Northwestern University, Chicago, Illinois, USA
| | - Alex Wiseman
- Division of Nephrology, University of Colorado, Denver, Colorado, USA
| | - Amtul Aala
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Darshana M Dadhania
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Tarek Alhamad
- Division of Nephrology, Washington University in St. Louis, St. Louis, Michigan, USA
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Abstract
Kidney transplantation is recognised as the gold standard treatment of end-stage renal disease in most children, with excellent graft survival rates. When graft failure occurs, renal transplant recipients (RTRs) have the option of removal of the transplant (graft nephrectomy [GN]), or leaving the failed transplant in situ. The aims of this review are to discuss the indications for GN, surgical techniques, outcomes after GN (including risks of allosensitisation and the impact on subsequent transplants), and the possible role of routine GN in the asymptomatic RTR with a failed renal allograft. Literature in both the pediatric and adult renal transplant fields is reviewed. We also discuss how future research in this area could advance our knowledge of which patients to select for GN, and the most appropriate surgical approach.
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Affiliation(s)
- Benedict L. Phillips
- Department of Nephrology and Transplantation, Guy’s Hospital and the Evelina London Children’s Hospital, London, UK
| | - Chris J. Callaghan
- Department of Nephrology and Transplantation, Guy’s Hospital and the Evelina London Children’s Hospital, London, UK
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3
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Al Badaai G, Pernin V, Garrigue V, Monnin V, Murez T, Fadli SED, Molinari N, Thuret R, Iborra F, Mourad G. Renal graft intolerance syndrome in late graft failure patients: efficacy and safety of embolization as first-line treatment compared to surgical removal. Transpl Int 2017; 30:484-493. [DOI: 10.1111/tri.12927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/22/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ghalib Al Badaai
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Vincent Pernin
- Department of Nephrology, Dialysis and Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Valérie Garrigue
- Department of Nephrology, Dialysis and Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Valérie Monnin
- Department of Vascular Radiology; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Thibaut Murez
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Saad Ed Dine Fadli
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Nicolas Molinari
- Department of Medical Information; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Rodolphe Thuret
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - François Iborra
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Georges Mourad
- Department of Nephrology, Dialysis and Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
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4
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Matignon M, Leibler C, Moranne O, Salomon L, Charron D, Lang P, Jacquelinet C, Suberbielle C, Grimbert P. Anti-HLA sensitization after kidney allograft nephrectomy: changes one year post-surgery and beneficial effect of intravenous immunoglobulin. Clin Transplant 2016; 30:731-40. [DOI: 10.1111/ctr.12743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Marie Matignon
- Nephrology and Renal Transplantation and CIC-BT 504 Department; Henri Mondor Hospital; APHP; Créteil France
- INSERM U955; Paris Est University; Créteil France
| | - Claire Leibler
- Nephrology and Renal Transplantation and CIC-BT 504 Department; Henri Mondor Hospital; APHP; Créteil France
- INSERM U955; Paris Est University; Créteil France
| | - Olivier Moranne
- Nephrology & Public Health Department; CHU Nice; Nice France
| | - Laurent Salomon
- Urology Department; Henri Mondor Hospital; APHP; Paris Est University; Créteil France
| | - Dominique Charron
- Histocompatibility and Immunology Department; Saint Louis Hospital; AP-HP; Paris France
| | - Philippe Lang
- Nephrology and Renal Transplantation and CIC-BT 504 Department; Henri Mondor Hospital; APHP; Créteil France
- INSERM U955; Paris Est University; Créteil France
| | | | - Caroline Suberbielle
- Histocompatibility and Immunology Department; Saint Louis Hospital; AP-HP; Paris France
| | - Philippe Grimbert
- Nephrology and Renal Transplantation and CIC-BT 504 Department; Henri Mondor Hospital; APHP; Créteil France
- INSERM U955; Paris Est University; Créteil France
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Yanagida H, Tabata N, Sugimoto K, Izu A, Wada N, Sakata N, Okada M, Takemura T. Non-invasive renal artery embolization for renal dysplasia accompanied by hypertension. Pediatr Int 2014; 56:107-9. [PMID: 24548196 DOI: 10.1111/ped.12226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 05/23/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022]
Abstract
Renovascular hypertension caused by renal dysplasia often is resistant to drug therapy. For a 14-year-old girl with such refractory hypertension, a non-invasive right renal ablation by embolization with anhydrous ethanol using a shepherd 's-crook' balloon catheter, was done. Blood pressure then rapidly normalized. Apart from mild fever after the procedure, no adverse effects occurred. In patients with mild renal artery stenosis and hypertension resistant to anti-hypertensive drug therapy, renal artery embolization may be a useful option.
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Affiliation(s)
- Hidehiko Yanagida
- Department of Pediatrics, Kinki University Faculty of Medicine, Osaka, Japan
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