Patients with a Failed Renal Transplant

Renal transplantation is the best method of renal replacement therapy for patients with end-stage renal disease. On the other hand in the early or late period of transplantation, majority of patients suffer from allograft failure and return to the dialysis. These patients carry the risks of adverse effects of previous immunosuppressive therapy (i.e infections and cancers). Furthermore, worse quality of life and many limitations of dialysis result in psychological problems. The controversial issues in treatment of these patients can be summarized under the headings of : 1- In which stage of allograft failure these patients should return to dialysis? 2- Which is the most appropriate renal replacement therapy after the renal allograft failure? 3- What are the main problems during dialysis practice and how should these problems be managed? 4- How should the immunosupression regimen be managed? 5- What are the indications for transplant nephrectomy? 6- What are the advantages and drawbacks of retransplantation? In this review these problems were discussed.