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Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 42-47

Issues and concerns in the management of progressive allograft dysfunction: A narrative review

1 Department of Nephrology, Yashoda Hospital, Secunderabad, Telangana, India
2 Department of Nephrology, Global Hospital, Hyderabad, Telangana, India

Correspondence Address:
Dr. Urmila Anandh
Department of Nephrology, Yashoda Hospitals, Secunderabad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijot.ijot_114_20

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Nephrologists taking care of dialysis patients are increasingly encountering patients returning to dialysis after a failed transplant. These patients have a different pathophysiology and their medical issues differ from transplant-naïve dialysis patients. Prolonged cumulative immunosuppression and long-term exposure to chronic kidney disease (CKD) pathology are major factors responsible for increased complications and mortality. Often, their CKD-related issues are managed suboptimally as the emphasis is mostly on endeavors related to protecting allograft function. Managing their immunosuppression and allograft-related symptomatology poses serious challenges. There is also a dilemma as to whether the failed allograft should be left in situ or not. Considerate and appropriate decisions are required when these kidney allograft failure patients are offered re-transplantation. This review aims to address the major issues faced by transplant nephrologists in managing patients with allograft failure.

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