Novel options for failing allograft in kidney transplanted patients to avoid or defer dialysis therapy.
Curr Opin Nephrol Hypertens
; 29(1): 80-91, 2020 01.
Article
em En
| MEDLINE
| ID: mdl-31743241
ABSTRACT
PURPOSE OF REVIEW Despite improvement in short-term renal allograft survival in recent years, renal transplant recipients (RTR) have poorer long-term allograft outcomes. Allograft function slowly declines with periods of stable function similar to natural progression of chronic kidney disease in nontransplant population. Nearly all RTR transitions to failing renal allograft (FRG) period and require transition to dialysis. Conservative chronic kidney disease management before transition to end-stage renal disease is an increasingly important topic; however, there is limited data in RTR regarding how to delay dialysis initiation with conservative management. RECENT FINDINGS:
Since immunological and nonimmunological factors unique to RTR contribute to decline in allograft function, therapies to slow progression of FRG should take both sets of factors into account. Renal replacement therapy either incremental dialysis or rekidney transplantation should be explored. This required taking benefits and risks of continuing immunosuppressive medications into account when allograft nephrectomy may be necessary.SUMMARY:
FRG may benefit from various interventions to slow progression of worsening allograft function. Until there are stronger evidence to guide interventions to preserve renal function, extrapolating evidence from nontransplant patients and clinical judgment are necessary. The goal is to provide individualized care for conservative management of RTR with FRG.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diálise Renal
/
Transplante de Rim
/
Insuficiência Renal Crônica
Limite:
Humans
Idioma:
En
Revista:
Curr Opin Nephrol Hypertens
Assunto da revista:
ANGIOLOGIA
/
NEFROLOGIA
Ano de publicação:
2020
Tipo de documento:
Article