Update in Renal Transplantation

Abstract

Renal transplantation is the treatment of choice for most patients with end-stage renal disease. The shortage of donor organs, however, remains a major obstacle to successful, early transplantation. This shortage has actually worsened despite an increase in living family-related and unrelated donors. On the other hand, over the last 10 years, allograft and recipient survival have significantly improved. This encouraging outcome reflects many factors, particularly a favorable shift in the balance between the efficacy and toxicity of immunosuppressive regimens. As acute rejection and early graft loss have become less common, the focus is increasingly directed toward the prevention and treatment of the long-term complications of renal transplantation. These include suboptimal allograft function, premature death, cardiovascular disease, and bone disease. Thus, a multidisciplinary approach--rather than management of immunological issues alone--is now required to optimize long-term outcomes of renal transplant recipients.

Statin-centric versus low-density lipoprotein-centric approach for atherosclerotic cardiovascular disease prevention: a Singapore perspective

“…However, toxicity due to drug interactions, especially with calcineurin inhibitors, needs to be taken into account. (45) A low starting dose with cautious increments, according to patient tolerability and indication, is recommended.…”

Evaluation of Potential Living Kidney Donors

“…For recipients of a first living donor kidney, current 1-year patient and graft survival probabilities are 98% and 94%, respectively [5]. Improved immunosuppressive medications have decreased early acute rejection.…”

Soluble CD30 and Acute Renal Allograft Rejection

“…Novel immunosuppressive drugs and regimens have decreased the incidence of acute rejection occurrence, however, acute rejection (AR) is still a major risk of early graft dysfunction and late kidney graft loss (kamali et al, 2009). Despite the introduction of successful immunosuppressive drug therapies, acute renal allograft rejection still occurs in 10-20% of patients after cadaveric renal transplantation and causes graft loss in up to 6% in the first year after transplantation (Magee, Pascual., 2004). The early phase of diagnosis of acute allograft rejection might help clinicians to perform required procedures to prevent undesirable posttransplant complications (kamali et al, 2009).…”