Table 1.

Summary of key knowledge gaps in the optimal clinical management of patients with failing allografts

	Key Knowledge Gaps
Immunosuppression	Potential benefit, timing, and strategy of introducing calcineurin inhibitor–avoidance protocols that would prolong the life of a failing allograft
	Timing for reduction of immunosuppression in patients with failing allografts and evidence of ongoing chronic rejection
	Immunosuppression withdrawal strategy after allograft failure and initiation of KRT to minimize the risk of sensitization
	Factors to consider for personalization of the risk/benefit ratio of continued immunosuppression (e.g., infectious risk versus decreased sensitization) in patients on dialysis with different expected intervals before a subsequent transplant
	Determining when the potential benefit of a transplant nephrectomy outweighs the potential risks
Transitions of care	Timing of initiation of discussion for the transition to dialysis in the absence of a living donor
	Timing of modality counseling and appropriate access placement, especially for those patients who are not candidates for a subsequent transplant
	Optimal strategy to offer either preemptive listing while encouraging seeking a living donor
	Timing of preemptive transplantation when available as an option
	Transition of care from transplant clinic to CKD clinic
	Consideration for, and timing of, palliative care referral for patients who are not candidates for a subsequent transplant