*Purpose: Approximately 5,000 US kidney transplant recipients return to dialysis each year due to allograft failure. Understanding how kidney allograft failure and transitioning to chronic dialysis affects patients emotionally, and their perceptions of the care that they received during the transition can identify avenues for improved care for patients.

*Methods: Semi-structured interviews were conducted at a single center with 29 adult patients who had developed allograft failure and returned to dialysis within the last 5 years. Thematic analysis was used to code the transcripts and identify emerging themes.

*Results: Five themes emerged about patients’ transition from allograft failure to chronic dialysis: 1) Patient context: the acuity of allograft decline, symptoms that accompanied decline, frequency of interactions with the heath care system, and personal understanding of reasons for graft failure varied among patients. 2) Impact on quality of life: allograft failure had a negative impact on quality of life such as interference with daily life activities, and loss of independence. (3) Emotional response: patients reported feelings of shock, sadness, hopelessness, frustration, disappointment and anxiety, (4) Coping: they felt well-supported emotionally by their family, friends and providers. They expressed desire that the diagnosis of allograft failure be delivered with compassion along with a thorough discussion of the cause of allograft loss. They expressed appreciation when this occurred. (5) Health system context: mental health resources were considered helpful. Poor care coordination after allograft failure leading to confusion in immunosuppression medication tapering and infectious complications as well as limitations in insurance coverage were perceived as harmful.

*Conclusions: Kidney allograft failure is a devastating experience to patients and their families. Ensuring compassionate communication between patients and providers, readily available mental health resources and care coordination, and social work support to navigate health insurance challenges during the transition from allograft failure to chronic dialysis may improve the patient experience.

« Back to 2021 American Transplant Congress