Chronic Kidney Allograft Disease: New Concepts and Opportunities

Abstract

Chronic kidney disease (CKD) is increasing in most countries and kidney transplantation is the best option for those patients requiring renal replacement therapy. Therefore, there is a significant number of patients living with a functioning kidney allograft. However, progressive kidney allograft functional deterioration remains unchanged despite of major advances in the field. After the first post-transplant year, it has been estimated that this chronic allograft damage may cause a 5% graft loss per year. Most studies focused on mechanisms of kidney graft damage, especially on ischemia-reperfusion injury, alloimmunity, nephrotoxicity, infection and disease recurrence. Thus, therapeutic interventions focus on those modifiable factors associated with chronic kidney allograft disease (CKaD). There are strategies to reduce ischemia-reperfusion injury, to improve the immunologic risk stratification and monitoring, to reduce calcineurin-inhibitor exposure and to identify recurrence of primary renal disease early. On the other hand, control of risk factors for chronic disease progression are particularly relevant as kidney transplantation is inherently associated with renal mass reduction. However, despite progress in pathophysiology and interventions, clinical advances in terms of long-term kidney allograft survival have been subtle. New approaches are needed and probably a holistic view can help. Chronic kidney allograft deterioration is probably the consequence of damage from various etiologies but can be attenuated by kidney repair mechanisms. Thus, besides immunological and other mechanisms of damage, the intrinsic repair kidney graft capacity should be considered to generate new hypothesis and potential therapeutic targets. In this review, the critical risk factors that define CKaD will be discussed but also how the renal mechanisms of regeneration could contribute to a change chronic kidney allograft disease paradigm.

Long-term outcomes and prognostic factors in kidney transplant recipients in Jakarta, Indonesia: a cohort study

“…This finding was in accordance with a previous study in which post-transplant infection was listed as the second most common cause of death with functioning grafts in kidney recipients, owing to the prolonged use of immunosuppressive agents in this population. Although infection may cause graft failure through renal scarring and immunological imbalance, 12 we found no association between postoperative infection and death-censored graft failure in this study.…”

Langfristige körperliche und psychische Folgen chronischer Nierenerkrankungen

“…B. eine koronare Herzerkrankung) bleiben bestehen, auch wenn eine Verzögerung des Fortschreitens der Begleiterkrankungen nach Nierentransplantation eintritt. Außerdem können die Nebenwirkungen, die durch die erforderliche immunsuppressive Therapie auftreten, gravierend sein [ 59 – 61 ].…”

An enhanced level of VCAM in transplant preservation fluid is an independent predictor of early kidney allograft dysfunction

“…Kidney transplantation is the optimal treatment for most patients with end-stage kidney disease with benefits for both quality and quantity of life ( 1 , 2 ). In spite of considerable progress in improving graft survival after kidney transplantation, the issues that interfere with successful outcome remain unresolved.…”