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Kidney recipients with allograft failure,transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers |
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| Authors: | Tarek Alhamad Michelle Lubetzky Krista L. Lentine Emmanuel Edusei Ronald Parsons Martha Pavlakis Kenneth J. Woodside Deborah Adey Christopher D. Blosser Beatrice P. Concepcion John Friedewald Alexander Wiseman Neeraj Singh Su-Hsin Chang Gaurav Gupta Miklos Z. Molnar Arpita Basu Edward Kraus Song Ong Arman Faravardeh Ekamol Tantisattamo Leonardo Riella Jim Rice Darshana M. Dadhania |
| Affiliation: | 1. Washington University in St. Louis, Saint Louis, Missouri, USA;2. New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York, USA;3. Saint Louis University, Saint Louis, Missouri, USA;4. Emory University, Atlanta, Georgia, USA;5. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;6. University of Michigan, Ann Arbor, Michigan, USA;7. University of California San Francisco, San Francisco, California, USA;8. University of Washington and Seattle Children’s Hospital, Seattle, Washington, USA;9. Vanderbilt University Medical Center, Nashville, Tennessee, USA;10. Northwestern University, Chicago, Illinois, USA;11. University of Colorado, Denver, Colorado, USA;12. Willis Knighton Health System, Shreveport, Louisiana, USA;13. Virginia Commonwealth University, Richmond, Virginia, USA;14. University of Utah, Salt Lake City, Utah, USA;15. Johns Hopkins, Baltimore, Maryland, USA;16. University of Alabama at Birmingham, Birmingham, Alabama, USA;17. SHARP Kidney and Pancreas Transplant Center, San Diego, California, USA;18. University of California Irvine, Orange, California, USA;19. Brigham and Women, Boston, California, USA;20. Scripps Heath, San Diego, California, USA |
| Abstract: | Kidney allograft failure and return to dialysis carry a high risk of morbidity. A practice survey was developed by the AST Kidney Pancreas Community of Practice workgroup and distributed electronically to the AST members. There were 104 respondents who represented 92 kidney transplant centers. Most survey respondents were transplant nephrologists at academic centers. The most common approach to immunosuppression management was to withdraw the antimetabolite first (73%), while only 12% responded they would withdraw calcineurin inhibitor (CNI) first. More than 60% reported that the availability of a living donor is the most important factor in their decision to taper immunosuppression, followed by risk of infection, risk of sensitization, frailty, and side effects of medications. More than half of respondents reported that embolization was either not available or offered to less than 10% as an option for surgical intervention. Majority reported that ≤50% of failed allograft patients were re-listed before dialysis, and less than a quarter of transplant nephrologists performed frequent visits with their patients with failed kidney allograft after they return to dialysis. This survey demonstrates heterogeneity in the care of patients with a failing allograft and the need for more evidence to guide improvements in clinical practice related to transition of care. |
| Keywords: | clinical research/practice dialysis immunosuppression/immune modulation kidney failure/injury kidney transplantation/nephrology transitional care |