It is estimated that patients with failed transplants currently constitute approximately 4% of the incident dialysis population. With increasing number of kidney transplant recipients (KTRs) it is inevitable that, despite improvements in graft survival, failing grafts will become progressively more common. While some patients will be retransplanted, increasing age and comorbidity mean that most KTRs whose transplants fail will never return to the transplant list.These are the first guidelines on this subject published by the British Transplantation Society. This document aims to provide a comprehensive summary of all aspects of the management of the failing kidney transplant, including outcome data. Guidelines for the management of patients with failing grafts are inevitably similar in many respects to those for general KTRs which have been previously published. This document should be read in conjunction with these existing guidelines, but will focus on areas with special relevance to KTRs with poor renal function.