Management of the Patient with a Failed Renal Transplant

The management of the failed renal transplant depends upon the clinical circumstances. In most instances of failure secondary to acute rejection or structural lesions, transplant nephrectomy is necessary. When failure is due to chronic rejection, grafts often can be left in place and removed only for the indications of fever, pain, swelling, infection, or refractory hypertension. Once dialysis has been reinstituted, immunosuppression should be tapered in accordance with standard principles; this often does not result in the need to remove the failed allograft so long as it is clinically quiet. The presence of a nonfunctioning graft does not preclude retransplantation. With the use of cyclosporine, the results of retransplantation are beginning to look similar to the statistics for first transplants. The quality of life in patients who have failed transplantation has not been definitely proven to be worse than that of patients on dialysis or those who have a functioning graft. However, patients with a failed transplant will need emotional support in their readjustment to dialysis.