Division of Nephrology, Department of Medicine, University of Texas in Austin, TX.
Division of Nephrology, Department of Medicine, Washington University in St. Louis, MO.
Adv Kidney Dis Health. 2024 Sep;31(5):476-482. doi: 10.1053/j.akdh.2024.07.001.
Survival rates for allografts have improved over the last 2 decades, yet failing allografts remains a challenge in the field of transplant. The risks of mortality and morbidity associated with failed allografts are compounded by infectious complications and metabolic abnormalities, emphasizing the need for a standardized approach to management. Management of failing allografts lacks consensus, highlighting the need for unified protocols to guide treatment protocols and minimize risks with postdialysis initiation. The decision to wean off immunosuppression depends on various factors, including living donor availability and infectious risks, necessitating improved coordination of care and a standard guideline. Treatment of failed pancreas focuses on glycemic control, with insulin as the mainstay, while considering surgical interventions such as graft pancreatectomy in advanced symptomatic cases. Navigating the complexities of failed allograft management demands a multidisciplinary approach and standardized stepwise protocol. Addressing the gaps in management plans for failing allografts and employing a systematic approach to transplant decisions will enhance patient outcomes and facilitate informed decision-making.
在过去的 20 年中，同种异体移植物的存活率有所提高，但同种异体移植物的失败仍然是移植领域的一个挑战。与同种异体移植物失败相关的死亡率和发病率的风险因感染并发症和代谢异常而加剧，强调需要标准化的管理方法。同种异体移植物失败的管理缺乏共识，突出了需要统一的方案来指导治疗方案，并在开始透析后最小化风险。免疫抑制脱除的决定取决于多种因素，包括活体供者的可用性和感染风险，这需要改善护理的协调，并制定标准指南。失败的胰腺移植物的治疗侧重于血糖控制，以胰岛素为主要治疗手段，同时考虑在晚期有症状的病例中进行手术干预，如移植胰腺切除术。处理失败的同种异体移植物管理的复杂性需要多学科的方法和标准化的逐步方案。解决失败的同种异体移植物管理计划中的差距，并采用系统的移植决策方法，将提高患者的预后并促进知情决策。
