Factors influencing long-term outcome after kidney transplantation

Abstract

SummaryMany factors influence the long-term outcome of kidney transplantation, which is defined very schematically by patient death or renal dysfunction leading to graft loss. The most important of these factors is most likely the quality of the transplant itself, with kidneys from living donors showing a positive impact, while kidneys from expanded criteria donors show deleterious impacts. Various clinicopathological scores exist to predict mid-to long-term outcomes and avoid the transplantation of kidneys displaying inferior results. The key factors related to the recipient include their age as well as disease recurrence, HLA matching, HLA immunization, ethnic background, time on dialysis, and cardiovascular comorbidities. Renal function, defined based on estimated GFR and/or proteinuria values, is a result of all these factors. Delayed graft function has a detrimental long-term impact, as does the level of renal function impairment either in stable condition or in case of progressing dysfunction. Finally, although current immunosuppression regimes are highly efficient in preventing acute rejection, the burden of specific (diabetes, nephrotoxicity) and nonspecific (infection and cancer) side effects has significant negative long-term consequences that may well be worse in the future because of the increasing ages of both donors and recipients. The development of safer immunosuppression strategies is therefore crucial to improve long-term outcomes.

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

“…A szérumkreatinin-értékek gyorsabb normalizálódása (2. ábra) inkább az indukciós kezelésnek köszönhető. A hosszú távú eredmények már jelentős részben függnek a veseműködés azonnali megindulásától (immediate graft function), a korai akut rejectiók elmaradásától, a társbetegségek (például hypertonia, diabetes) megfelelő kezelésétől, a gyógyszermel-lékhatások lehetséges kiküszöbölésétől és a betegek hozzáállásától (adherencia, gyógyszerszedés) is [33]. Ezért Debrecenben is megszerveztük a betegek járóbeteg-ellá-tása keretében a dietetikai és pszichológiai tanácsadást, továbbá a betegek úgynevezett sorstárs közösségét, amelynek egyik célja a betegedukáció belső szervezése és problémamegoldó csoport kialakítása.…”

Long- and short-term outcomes in renal allografts with deceased donors: A large recipient and donor genome-wide association study

“…However, both late allograft loss and increased mortality among transplant recipients remain key challenges for the transplant community. There are a wide number of factors that are known to influence long‐term transplant outcome, including donor factors such as age and comorbidity, recipient factors such as comorbidity and response to immunosuppression, as well as allograft ischemic time, the degree of HLA mismatch, and the development of donor‐specific antibodies 3, 4, 5. However, a comprehensive understanding of the pathophysiology of graft failure has remained elusive, with the observed variation in patient outcomes still inadequately explained by our current understanding of risk factors.…”

Evaluation of Morbidity and Patient and Graft Survival in Kidney Transplant Recipients: Experience of Dokuz Eylul University Hospital

“…Bu başarıda cerrahi yöntemlerdeki gelişmeler ve etkin antimikrobiyal ilaçların kullanımının da payı büyüktür. Bağışıklık sistemini baskılayıcı tedaviler ve cerrahi yöntemlerdeki olumlu gelişmelerin kaydedilmesi kısa dönem greft sağkalımında belirgin artışa yol açarken, uzun dönem greft sağkalımında dramatik bir artış saptanmamıştır (10). Dokuz Eylül Üniversitesi Hastanesi'nde ilk böbrek nakli Nisan 1992 tarihinde kadavra vericiden yapılmıştır.…”