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NDT Advance Access originally published online on June 3, 2008
Nephrology Dialysis Transplantation 2008 23(9):2738-2742; doi:10.1093/ndt/gfn313
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Coming back to dialysis after kidney transplant failure

Piergiorgio Messa1, Claudio Ponticelli2 and Luisa Berardinelli3

1 Nephrology, Dialysis and Transplant Unit, Ospedale Maggiore Policlinico 2 Istituto Auxologico 3 Surgery and Renal Transplant Unit, Ospedale Maggiore Policlinico, Milan, Italy

Correspondence and offprint requests to: Piergiorgio Messa, Nephrology, Dialysis and Renal Transplant Unit, Ospedale Maggiore Policlinico, Padiglione Corff, Via Della Commenda n.15, 20122 Milan, Italy. Tel: +39-0255034551-2; Fax: +39-0255034550; E-mail: pmessa@policlinico.mi.it

Keywords: dialysis; graft failure; renal transplant

The first 150 words of the full text of this article appear below.



   Preliminary considerations
 
Advances in immunosuppressive therapy in recent decades have led to excellent renal transplant survival rates at 1 year, but the advantages are lower in the long term. As reported by Meier-Kriesche et al. [1], the actual kidney allograft half-life showed only a marginal improvement over the past decade. Recent data from the United States Renal Data System (USRDS) report an almost invariable 4% annual rate of graft failure among renal transplant recipients [2]. Given the continuing expansion of the transplanted patient pool, this figure translates into a progressive increase in the number of transplanted patients re-entering a dialysis programme [3].



   Outcome of patients starting dialysis after graft failure
 
Since the first reports, the mortality rate in patients starting dialysis after graft loss has been reported as variable, though higher than that observed in patients with a functioning graft and basically similar to that observed in patients on dialysis treatment [4–9. . . [Full Text of this Article]



   Special topics
 
When to start dialysis treatment?
What type of dialysis?
How to handle immunosuppressive therapy?
How to handle the failed kidney?
Re-transplantation


   Conclusions
 

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