Kidney Week 2025 Early Program - Care of Kidney Transplant Candidates and Recipients-What to Do with a Failing Transplant

Video Transcription

Video Summary

Dr. Murakami discusses caring for patients with a failing kidney allograft, emphasizing individualized immunosuppression management by balancing benefits (preserving function, avoiding sensitization for retransplant) against risks (infection, cancer). Strategy depends on retransplant likelihood, urine output, and infection risk, with options to maintain, reduce, or stop agents and taper steroids. She highlights the transplant trajectory and symptom burden as eGFR declines, noting many patients are older and frailer at graft failure. Decisions about dialysis, retransplant, or conservative management require shared decision-making and better clinic structures. Outcomes after return to dialysis are poor; KDIGO recommends symptom-based dialysis start. Supportive/conservative care should be a real option.

Asset Subtitle

Naoka Murakami

Meta Tag

Module TRX

Speaker Naoka Murakami

Keywords

failing kidney allograft management

immunosuppression tapering strategy

retransplant sensitization risk

dialysis initiation KDIGO symptom-based

supportive conservative care in graft failure