Grant: Project Grant

Failure of a first kidney transplant affects over 7000 patients per year in Canada and the United States is the fifth most frequent cause for starting dialysis. Transplant failure patients experience a high rate of morbidity and mortality on dialysis and are best treated with a second transplant. However, only 15% of transplant failure patients receive a second transplant. The failed transplant is difficult to remove surgically and therefore patients typically continue treatment with reduced doses of the same immunosuppressant drugs they were prescribed during the time their transplant functioned to prevent development of antibodies that can exclude them from receiving a second transplant and to prevent rejection of the failed transplant. The use of immunosuppressant drugs is associated with infection, cancer and heart disease and therefore defining the optimal strategy to prevent patients from developing antibodies that can limit the opportunity to receive a second transplant is a critical issue. Unfortunately, there are no evidence-based recommendations for the use of immunosuppressant drugs in transplant failure patients and there is wide variation in how patients are treated. This pilot study will determine the feasibility of a large multi-centre trial to determine whether continuing immunosuppressant drugs prevents development of antibodies that can exclude patients from receiving a second transplant without increasing the risk of adverse events. The study will also determine whether laboratory tests that are currently used prior to transplant can be used at the time of transplant failure to inform the optimal treatment of transplant failure patients while they wait for a second transplant. The study will provide critical information for planning a definitive trial with the potential to dramatically improve the care of patients who have failed a first kidney transplant.