Patients' Perceptions of Kidney Transplant Failure and Return to Dialysis

Despite improvements in kidney transplant care, most allografts ultimately fail. Allograft failure is associated with an increased risk of adverse outcomes, including death and reduced quality of life. Little is known about patients' perceptions of the care received during the transition from graft failure back to dialysis, a critical knowledge gap that hinders optimal patient-centered care.

Qualitative study using semistructured interviews.

Interviews were conducted among 29 adult patients who experienced kidney allograft failure and returned to dialysis within the past 5 years in a large academic medical center.

Interviews were recorded, transcribed, and analyzed using thematic analysis until thematic saturation was achieved. We utilized stress and coping theory to understand processes that patients use to manage ongoing life challenges and stressors associated with transplant failure and return to dialysis.

Five themes emerged: (1) Graft failure is a negative experience regardless of patient context, (2) Graft failure leads to emotional distress, (3) Patients mitigate the negative impact of graft failure through coping, (4) The health system plays a crucial role, and (5) Graft failure adversely affects quality of life.

Generalizability may be limited due to the single-center study design.

Kidney allograft failure is a devastating experience for patients. Patients expressed the need for empathetic care and effective provider communication. Mental health resources and improved care coordination with general nephrologists could support patient transition and quality of life. These findings advocate for a comprehensive, patient-centered approach in managing the medical and psychosocial dimensions of kidney transplant failure.