Return in dialysis after transplantation failure

There is an increasing number of patient returning on dialysis after transplantation failure. However, there is a lack of medical publication regarding dialysis after allograft failure. Despite the fact that patients returning on dialysis after transplantation failure have a regular nephrology follow up, un-planned dialysis initiation is frequent so that these patients are exposed to uremic complication. Earlier dialysis initiation is clearly mandatory for patients with allograft failure. A significant proportion of failed transplant patients can be registered on the waiting list for renal transplantation. Therefore, these patients should be evaluated for pre-emptive transplantation. Peritoneal dialysis and haemodialysis are equivalent treatment option for patients returning on dialysis after allograft failure. For no clear reason peritoneal dialysis is underused for failed transplant patients. Whether or not immunosuppressive therapy should be stopped early after dialysis start is still controversial. Further studies regarding failed transplant patients are clearly needed. (C) 2007 Elsevier Masson SAS. All rights reserved.