RESUMO
Transplant failure is a more and more frequent cause of end stage renal failure and dialysis. Patient survival rate after graft failure is very varied according to different reports. Better survival is mainly a consequence of good continuum of care thanks to improved interaction between dialysis and transplant center. Diabetic and elderly patients, as well as patients affected by cardiovascular disease are the subjects at higher risk: if judged clinically adequate to enter the waiting list, they should be retransplanted as soon as possible. Dialysis survival of patients with failed kidney transplant is strictly linked to adequate dialysis dose. Second transplant survival rate is higher in the case of a living donor and if the first transplant survived longer. Good immunologic match is also a condition linked to higher graft and patient survival rate. High body mass index, smoking and severe cardiovascular comorbidity should be avoided. Whether to keep low immunosuppression levels after first graft failure and whether to excise the failed kidney, even though it shows no clinical problems, are issues still under debate. Low-dose immunosuppression is not recommended since it may result in higher rate of infectious and neoplastic diseases. The failed kidney should be removed not only in the case of clinical disease, but also when the retained failed kidney is associated with chronic inflammation, as shown by high C-reactive protein levels and erythropoietin resistance.