Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.148
Peer-review started: June 15, 2014
First decision: July 10, 2014
Revised: January 24, 2015
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: May 6, 2015
Core tip: The number of patients with a failed allograft returning to dialysis increases over time. Studies suggest that such patients are at increased morbidity and mortality risks compared with their transplant-naïve, incident dialysis patients. This review provides a critical literature overview of the risks and benefits of early vs late dialysis re-initiation, immunosuppression weaning, and transplantectomy in patients with a failed allograft. Based on currently available literature, suggested guidelines for the management of this unique patient population are presented.