{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:15:54Z","timestamp":1791598554760,"version":"4.3.4"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"name":"CIHR","award":["PJT 191952"],"award-info":[{"award-number":["PJT 191952"]}],"id":[{"id":"https:\/\/ror.org\/01gavpb45","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This qualitative study explored patient, caregiver, and provider perceived barriers to retransplantation after kidney allograft loss.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>We identified four medical and nonmedical barriers to retransplantation and four additional barriers to pursuing living donor retransplantation.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>System-, transplant center\u2013, provider-, and patient-level approaches to address these barriers are highlighted.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many kidney transplant recipients experience graft loss, and retransplantation offers a significant survival benefit when compared with waitlisted patients. Yet, trends related to preemptive relisting\/retransplantation are suboptimal. Little empirical evidence has explored barriers to kidney retransplantation. We aimed to identify the predominant barriers to retransplantation after graft loss and factors that hinder the pursuit of living kidney donor (LKD) retransplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a qualitative study that used an interpretive descriptive design. Participants included patients with a history of graft loss, caregivers who supported them, and transplant nephrologists, recruited using purposive and snowball sampling techniques. Data collection entailed semistructured interviews that were coded, and an inductive thematic analysis was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We synthesized the perspectives of 23 patients, 23 caregivers, and 11 transplant nephrologists representing 11 Canadian transplant programs. Through our analysis, we identified four key barriers to retransplantation: high antibody sensitization resulting in scarcity of compatible donors; prevalence of comorbidities leading to ineligibility or wait list withdrawal; history of nonadherence among the recipients leading to ineligibility or delays in transplant referral and reevaluation; and delayed referrals and poor coordination of retransplant workup. Additional barriers to LKD retransplantation included patient preference for deceased donor transplantation that was unlikely to change after graft loss; perceived smaller pool of eligible LKDs felt to have been exhausted with the first transplant; the psychological burden of unresolved issues related to previous LKD transplant loss; and overall structural barriers to living kidney donation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This analysis highlights both medical and nonmedical barriers to retransplantation and that the pursuit of retransplantation entails persistent as well as additional and compounding challenges. A list of implications that arise from these findings is presented. Given the well-established benefits of kidney transplantation and that graft loss remains a leading cause of dialysis initiation, these findings have important implications for the nephrology community.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000001162","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T16:00:56Z","timestamp":1784736056000},"page":"1783-1795","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["A Qualitative Study of Patients, Caregivers, and Providers on Barriers to Kidney Retransplantation following Graft Loss"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1005-3525","authenticated-orcid":false,"given":"Anita Marie","family":"Slominska","sequence":"first","affiliation":[{"name":"MEDIC Program, Research Institute of the McGill University Health Centre, Montreal, Quebec"},{"name":"Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2471-4038","authenticated-orcid":false,"given":"Mathilde","family":"Gouin-Bonenfant","sequence":"additional","affiliation":[{"name":"MEDIC Program, Research Institute of the McGill University Health Centre, Montreal, Quebec"},{"name":"Department of Medicine, Graduate Program in Clinical and Translational Research, McGill University, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Katz","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0266-017X","authenticated-orcid":false,"given":"Kathleen","family":"Gaudio","sequence":"additional","affiliation":[{"name":"MEDIC Program, Research Institute of the McGill University Health Centre, Montreal, Quebec"},{"name":"Department of Medicine, Graduate Program in Clinical and Translational Research, McGill University, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Sterling-Eilok","sequence":"additional","affiliation":[{"name":"MEDIC Program, Research Institute of the McGill University Health Centre, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8921-4869","authenticated-orcid":false,"given":"Saly","family":"El Wazze","sequence":"additional","affiliation":[{"name":"MEDIC Program, Research Institute of the McGill University Health Centre, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7157-4894","authenticated-orcid":false,"given":"M. Khaled","family":"Shamseddin","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4106-0451","authenticated-orcid":false,"given":"Ann","family":"Bugeja","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8437-0556","authenticated-orcid":false,"given":"Marie-Chantal","family":"Fortin","sequence":"additional","affiliation":[{"name":"Centre de Recherche du Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al QC, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8342-9093","authenticated-orcid":false,"given":"Julie","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0129-7091","authenticated-orcid":false,"given":"Ngan N.","family":"Lam","sequence":"additional","affiliation":[{"name":"Divisions of Transplant Medicine and Nephrology, Cumming School of Medicine, University of Calgary, Calgary, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Cantarovich","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7306-7957","authenticated-orcid":false,"given":"Elizabeth Anne","family":"Kinsella","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-0598","authenticated-orcid":false,"given":"Shaifali","family":"Sandal","sequence":"additional","affiliation":[{"name":"MEDIC Program, Research Institute of the McGill University Health Centre, Montreal, Quebec"},{"name":"Department of Medicine, Graduate Program in Clinical and Translational Research, McGill University, Montreal, Quebec"},{"name":"Division of Nephrology, Department of Medicine, McGill University, Montreal, 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