Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers

Kidney allograft failure and return to dialysis carries a high risk of morbidity. A practice survey was developed by the AST Kidney Pancreas Community of Practice workgroup and distributed electronically to the AST members. There were 104 responders that represented 92 kidney transplant centers. Most survey respondents were transplant nephrologists at academic centers. The most common approach to immunosuppression management was to withdraw the anti-metabolite first (73%), while 12% responded they would withdraw calcineurin inhibitor first. More than 60% reported that the availability of a living donor is the most important factor in the decision to taper immunosuppression, followed by the risk of infection, risk of sensitization, frailty, and side effects of medications. More than half of respondents reported that embolization was either not available or offered to less than 10% as an option for surgical intervention. More than half reported that ≤50% of failed allograft patients were re-listed before dialysis, and less than a quarter of transplant nephrologists perform frequent follow-ups with their failed allograft patients after dialysis. This survey demonstrates a heterogeneity in the care of patients with a failing allograft and the need for more evidence to guide improvements in clinical practice related to transition of care.