Patient with a failed allograft: how to manage immunosuppression, whether or not perform graft nephrectomy?

Abstract

There is reported increase of sensitization after allograft nephrectomy. Removal of failing graft might either lead to de novo immunization to donor HLA antigens (early nephrectomy) or reveal the presence of antibodies that were absorbed by the failing graft while still in place (late nephrectomy). DSAs are the risk factor for acute and chronic antibody mediated rejection and decreased graft survival. DSAs limit opportunity for renal retransplantation. Acute rejection and chronic inflammatory syndrome are accepted indications for graft nephrectomy. In repeat transplant candidates — continuation of immunosuppression and avoidance graft nephrectomy may prevent allosensitization and increases chance for retransplantation. Decision should be individalized according to risks and benefits of immunosuppression continuation and retaining failed graft in terms of patient’s medical status, comorbiditis, life expectancy and chance for retransplantation. Results of presented studies have not clearly poroved that allograft nephrectomy has a negative effect on retransplantation outcome. Using highly sesitive microbead-based Luminex antibody-binding assay with single antigens is recommended in renal retransplantation candidates.