AUTHOR=Alhamad Tarek , Murad Haris , Dadhania Darshana M. , Pavlakis Martha , Parajuli Sandesh , Concepcion Beatrice P. , Singh Neeraj , Murakami Naoka , Casey Michael J. , Ji Mengmeng , Lubetzky Michelle , Tantisattamo Ekamol , Alomar Omar , Faravardeh Arman , Blosser Christopher D. , Basu Arpita , Gupta Gaurav , Adler Joel T. , Adey Deborah , Woodside Kenneth J. , Ong Song C. , Parsons Ronald F. , Lentine Krista L. TITLE=The Perspectives of General Nephrologists Toward Transitions of Care and Management of Failing Kidney Transplants JOURNAL=Transplant International VOLUME=36 YEAR=2023 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11172 DOI=10.3389/ti.2023.11172 ISSN=1432-2277 ABSTRACT=

The management of failing kidney allograft and transition of care to general nephrologists (GN) remain a complex process. The Kidney Pancreas Community of Practice (KPCOP) Failing Allograft Workgroup designed and distributed a survey to GN between May and September 2021. Participants were invited via mail and email invitations. There were 103 respondents with primarily adult nephrology practices, of whom 41% had an academic affiliation. More than 60% reported listing for a second kidney as the most important concern in caring for patients with a failing allograft, followed by immunosuppression management (46%) and risk of mortality (38%), while resistant anemia was considered less of a concern. For the initial approach to immunosuppression reduction, 60% stop antimetabolites first, and 26% defer to the transplant nephrologist. Communicating with transplant centers about immunosuppression cessation was reported to occur always by 60%, and sometimes by 29%, while 12% reported making the decision independently. Nephrologists with academic appointments communicate with transplant providers more than private nephrologists (74% vs. 49%, p = 0.015). There are heterogeneous approaches to the care of patients with a failing allograft. Efforts to strengthen transitions of care and to develop practical practice guidelines are needed to improve the outcomes of this vulnerable population.