Christophe Mariat, from Saint-Étienne, France, and Chair of the ERA DESCaRTES Working Group, takes us through the complex topic of adapting anti-rejection treatment in the context of a failing renal graft. He shares valuable insights on renal graft survival rates, strategies for adjusting immunosuppressive treatments when the kidney starts failing, and the adaptations needed in antirejection strategies once dialysis is resumed.