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Lubetzky M, Chauhan K, Alrata L, Dubrawka C, Abuazzam F, Abdulkhalek S, Abdulhadi T, Yaseen Alsabbagh D, Singh N, Lentine KL, Tanriover B, Alhamad T. Management of Failing Kidney and Pancreas Transplantations. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:476-482. [PMID: 39232618 DOI: 10.1053/j.akdh.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 09/06/2024]
Abstract
Survival rates for allografts have improved over the last 2 decades, yet failing allografts remains a challenge in the field of transplant. The risks of mortality and morbidity associated with failed allografts are compounded by infectious complications and metabolic abnormalities, emphasizing the need for a standardized approach to management. Management of failing allografts lacks consensus, highlighting the need for unified protocols to guide treatment protocols and minimize risks with postdialysis initiation. The decision to wean off immunosuppression depends on various factors, including living donor availability and infectious risks, necessitating improved coordination of care and a standard guideline. Treatment of failed pancreas focuses on glycemic control, with insulin as the mainstay, while considering surgical interventions such as graft pancreatectomy in advanced symptomatic cases. Navigating the complexities of failed allograft management demands a multidisciplinary approach and standardized stepwise protocol. Addressing the gaps in management plans for failing allografts and employing a systematic approach to transplant decisions will enhance patient outcomes and facilitate informed decision-making.
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Affiliation(s)
- Michelle Lubetzky
- Division of Nephrology, Department of Medicine, University of Texas in Austin, TX
| | - Krutika Chauhan
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, MO
| | - Louai Alrata
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, MO
| | - Casey Dubrawka
- Department of Pharmacy, Barnes Jewish Hospital, St. Louis, MO
| | - Farah Abuazzam
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, MO
| | - Samer Abdulkhalek
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, MO
| | - Tarek Abdulhadi
- Department of Medicine, Jamaica Hospital Medical Center, Queens, NY
| | - Dema Yaseen Alsabbagh
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, MO
| | - Neeraj Singh
- Division of Nephrology, Department of Medicine, Louisiana State University in Shreveport, LA
| | - Krista L Lentine
- Division of Nephrology, Department of Medicine, Saint Louis University, MO
| | - Bekir Tanriover
- Division of Nephrology, Department of Medicine, University of Arizona College of Medicine, AZ
| | - Tarek Alhamad
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, MO.
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Erratum: Medical and Surgical Management of the Failed Pancreas Transplant: Erratum. Transplant Direct 2024; 10:e1614. [PMID: 38380352 PMCID: PMC10878543 DOI: 10.1097/txd.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
[This corrects the article DOI: 10.1097/TXD.0000000000001543.].
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