Davis Scott, Mohan Sumit
Department of Medicine, University of Colorado, Aurora, Colorado.
Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York.
Clin J Am Soc Nephrol. 2022 Mar;17(3):444-451. doi: 10.2215/CJN.14620920. Epub 2021 Mar 10.
Patients who receive a kidney transplant commonly experience failure of their allograft. Transplant failure often comes with complex management decisions, such as when and how to wean immunosuppression and start the transition to a second transplant or to dialysis. These decisions are made in the context of important concerns about competing risks, including sensitization and infection. Unfortunately, the management of the failed allograft is, at present, guided by relatively poor-quality data and, as a result, practice patterns are variable and suboptimal given that patients with failed allografts experience excess morbidity and mortality compared with their transplant-naive counterparts. In this review, we summarize the management strategies through the often-precarious transition from transplant to dialysis, highlighting the paucity of data and the critical gaps in our knowledge that are necessary to inform the optimal care of the patient with a failing kidney transplant.
接受肾移植的患者通常会经历同种异体移植失败。移植失败往往伴随着复杂的管理决策，比如何时以及如何减少免疫抑制，并开始过渡到二次移植或透析。这些决策是在对包括致敏和感染在内的相互竞争风险的重要担忧背景下做出的。不幸的是，目前对失败同种异体移植的管理是基于质量相对较差的数据，因此，鉴于移植失败的患者与未接受过移植的患者相比存在更高的发病率和死亡率，实践模式存在差异且并不理想。在本综述中，我们总结了从移植到透析这一通常不稳定的过渡阶段的管理策略，强调了数据的匮乏以及我们知识中的关键空白，这些对于为移植失败的肾移植患者提供最佳护理至关重要。
