{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T22:08:46Z","timestamp":1782943726692,"version":"3.54.5"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,10,11]],"date-time":"2013-10-11T00:00:00Z","timestamp":1381449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Little data exist to guide the management of immunosuppression after renal graft failure. More aggressive tapering of immunosuppressive medications may reduce the risk of infection, but may increase the risk of rejection and sensitization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To document current practices in the<jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>, we emailed a questionnaire to medical and surgical transplant directors as identified by the United Network for Organ Sharing (<jats:styled-content style=\"fixed-case\">UNOS<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Emails were sent to 221 programs, of which 93 (42.1%) responded. About 24.7% of respondents reported adjusting immunosuppression according to a standard protocol; 75.3% said practices are physician dependent. The majority said that 80 or 100% of patients are off all immunosuppression one\u00a0yr after returning to dialysis. The most important factors cited in deciding whether to stop immunosuppression were plans to retransplant (40.2%) and signs and symptoms of rejection (37.0%). When asked which immunosuppressive medications are continued indefinitely, 21.5% responded prednisone and 71.0% said none. Respondents most commonly said they performed graft nephrectomy only if there are signs and symptoms of rejection (47.3%) or if signs and symptoms of rejection fail to respond to steroids (34.4%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the absence of good data to guide decisions on immunosuppression in patients with failed allografts, practices in the<jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>vary greatly. More data are needed to determine which policies lead to the best outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.12254","type":"journal-article","created":{"date-parts":[[2013,10,14]],"date-time":"2013-10-14T11:06:14Z","timestamp":1381748774000},"page":"895-900","source":"Crossref","is-referenced-by-count":34,"title":["Immunosuppression after renal allograft failure: a survey of<scp>US<\/scp>practices"],"prefix":"10.1111","volume":"27","author":[{"given":"George P.","family":"Bayliss","sequence":"first","affiliation":[{"name":"Department of Medicine Rhode Island Hospital Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reginald Y.","family":"Gohh","sequence":"additional","affiliation":[{"name":"Department of Medicine Rhode Island Hospital Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E.","family":"Morrissey","sequence":"additional","affiliation":[{"name":"Department of Surgery Rhode Island Hospital Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Rodrigue","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier A.","family":"Mandelbrot","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,10,11]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"U.S.Renal Data System USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End\u2010Stage Renal Disease in the United States.Bethesda MD:National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases 2011."},{"key":"e_1_2_6_3_1","unstructured":"OrganProcurement andTransplantationNetwork(OPTN)andScientificRegistry ofTransplantRecipients(SRTR).OPTN\/SRTR 2010 Annual Data Report.Rockville MD:Department of Health and Human Services Health Resources and Services Administration Healthcare Systems Bureau Division of Transplantation 2011."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-6143.2002.21015.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2002.00640.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199201000-00009"},{"key":"e_1_2_6_7_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1399-0012.1996.tb00429.x","article-title":"Renal retransplants: effect of primary allograft nephrectomy on early function, acute rejection and outcome","volume":"10","author":"Douzdjian V","year":"1996","journal-title":"Clin Transplant"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00260112"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2007.01884.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2009050480"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000137879.97445.6E"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn567"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-0012.2001.150606.x"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2011.00864.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31824ad60a"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000140969.43761.1F"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V12102158"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2001.25198"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fctr.12254","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.12254","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T17:00:00Z","timestamp":1746032400000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.12254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,11]]},"references-count":17,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2013,11]]}},"alternative-id":["10.1111\/ctr.12254"],"URL":"https:\/\/doi.org\/10.1111\/ctr.12254","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10,11]]}}}