Long-Term Renal Allograft Survival in the United States: A Critical Reappraisal

Lamb, Kenneth; Lodhi, Sundus A.; Meier-Kriesche, Herwig Ulf

doi:10.1111/j.1600-6143.2010.03283.x

Cited by 816 publications

(633 citation statements)

References 11 publications

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“…In a large US transplant registry, the yearly attrition rate for allograft failure at 5-10 years after transplant changed between 1989 and 2008, respectively, from 4.7% to 4.3% for liver, from 10.9% to 10.1% for lung and from 6.4% to 5.1% for heart transplant recipients (5). Similar results have been observed in kidney transplant recipients (6).…”

Section: Introductionsupporting

confidence: 73%

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

Martín-Gandul

Mueller

Pascual

et al. 2015

American Journal of Transplantation

133

103

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Infectious diseases after solid organ transplantation (SOT) are a significant cause of morbidity and reduced allograft and patient survival; however, the influence of infection on the development of chronic allograft dysfunction has not been completely delineated. Some viral infections appear to affect allograft function by both inducing direct tissue damage and immunologically related injury, including acute rejection. In particular, this has been observed for cytomegalovirus (CMV) infection in all SOT recipients and for BK virus infection in kidney transplant recipients, for community-acquired respiratory viruses in lung transplant recipients, and for hepatitis C virus in liver transplant recipients. The impact of bacterial and fungal infections is less clear, but bacterial urinary tract infections and respiratory tract colonization by Pseudomonas aeruginosa and Aspergillus spp appear to be correlated with higher rates of chronic allograft dysfunction in kidney and lung transplant recipients, respectively. Evidence supports the beneficial effects of the use of antiviral prophylaxis for CMV in improving allograft function and survival in SOT recipients. Nevertheless, there is still a need for prospective interventional trials assessing the potential effects of preventive and therapeutic strategies against bacterial and fungal infection for reducing or delaying the development of chronic allograft dysfunction.

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Section: Introductionsupporting

confidence: 73%

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

Martín-Gandul

Mueller

Pascual

et al. 2015

American Journal of Transplantation

133

103

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“…Antibody-mediated rejection (ABMR), the leading cause of deterioration of kidney transplants, is a challenge for classification because of its diversity (1,2). ABMR has a broad dynamic range, from subclinical (3) to fulminant, and can present even 30 years posttransplantation, whereas T cell-mediated rejection (TCMR) is rare after 10 years (4).…”

Section: Introductionmentioning

confidence: 99%

Identifying Subphenotypes of Antibody-Mediated Rejection in Kidney Transplants

Halloran

Lopez

Pereira

2016

American Journal of Transplantation

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The key lesions in antibody-mediated kidney transplant rejection (ABMR) are microcirculation inflammation (peritubular capillaritis and/or glomerulitis lesions, abbreviated ''pg'') and glomerular double contours (cg lesions). We used these features to explore subphenotypes in 164 indication biopsies with ABMR-related diagnoses: 137 ABMR (109 pure and 28 mixed with T cellmediated rejection [TCMR]) and 27 transplant glomerulopathy (TG), identified from prospective multicenter studies. The lesions indicated three ABMR subphenotypes: pgABMR, cgABMR, and pgcgABMR. Principal component analysis confirmed these subphenotypes and showed that TG can be reclassified as pgcgABMR (n ¼ 17) or cgABMR (n ¼ 10). ABMR-related biopsies included 45 pgABMR, 90 pgcgABMR, and 25 cgABMR, with four unclassifiable. Dominating all time intervals was the subphenotype pgcgABMR. The pgABMR subphenotype presented earliest (median <2 years), frequently mixed with TCMR, and was most associated with nonadherence. The cgABMR subphenotype presented late (median 9 years). Subphenotypes differed in their molecular changes, with pgABMR having the most histologic-molecular discrepancies (i.e. potential errors). Donor-specific antibody (DSA) was not identified in 29% of pgcgABMR and 46% of cgABMR, but failure rates and molecular findings were similar to cases where DSA was known to be positive. Thus, ABMR presents distinct subphenotypes, early pg-dominant, late cg-dominant, and combined pgcg phenotype, differing in time, molecular features, accompanying TCMR, HLA antibody, and probability of nonadherence.

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“…3 Nonetheless, long-term survival has not improved to the same degree, and this has therefore become a great challenge for healthcare providers. 4 According to several studies, strict adherence to the drug regimen is one of the main goals of efficient treatment, and this reduces the frequency of complications, such as late acute rejection episodes and late graft loss. 5,6 Adherence is defined as "the degree to which a person's behavior corresponds to the recommendations from a healthcare provider".…”

Section: Introductionmentioning

confidence: 99%

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

et al. 2015

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CONTEXT AND OBJECTIVE: Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING:We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS: Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS: The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053). CONCLUSION: Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence. RESUMO

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Long-Term Renal Allograft Survival in the United States: A Critical Reappraisal

Cited by 816 publications

References 11 publications

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

Identifying Subphenotypes of Antibody-Mediated Rejection in Kidney Transplants

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

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