Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

Abstract

Kidney transplantation is the treatment of choice for patients with ESRD. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The use of kidney allografts from expandedcriteria donors, polyoma virus nephropathy, underimmunosuppression, and incomplete functional recovery after rejection episodes may play a role in the lack of improvement in long-term outcomes. Other factors, including cardiovascular disease, infections, and malignancies, also shorten patient survival and therefore reduce the functional life of an allograft. There is a need for interventions that improve long-term outcomes in kidney transplant recipients. These patients are a unique subset of patients with chronic kidney disease. Therefore, interventions need to address disease progression, comorbid conditions, and patient mortality through a multifaceted approach. The Kidney Disease Outcomes Quality Initiative from the National Kidney Foundation, the European Best Practice Guidelines, and the forthcoming Kidney Disease: Improving Global Outcomes clinical practice guidelines can serve as a cornerstone of this approach. The unique aspects of chronic kidney disease in the transplant recipient require the integration of specific transplant-oriented problems into this care schema and a concrete partnership among transplant centers, community nephrologists, and primary care physicians. This article reviews the contemporary aspects of care for these patients.

Urine Injury Biomarkers and Risk of Adverse Outcomes in Recipients of Prevalent Kidney Transplants: The Folic Acid for Vascular Outcome Reduction in Transplantation Trial

“…The mean age (6SD) of the random subcohort was 51 (69) years old, and eGFR was 46 (618) ml/min per 1.73 m 2 . Median (interquartile range) urine albumin-to-creatinine ratio (ACR) was 24.5 (9.5-104.7) mg/mg, urine NGAL was 20.2 (8.2-51.3) ng/ml, urine KIM-1 was 658 (319-1364) pg/ml, urine IL-18 was 29.1 (11.5-62.5) pg/ml, and urine L-FABP was 6.1 (3.0-17.6) ng/ml (Supplemental Table 1, column 1).…”

Recovery of Hyperphosphatoninism and Renal Phosphorus Wasting One Year after Successful Renal Transplantation

“…Renal transplant recipients (RTR) represent a unique subset of patients with CKD. Most of these patient have stage 2 or 3 CKD, based on the National Kidney Foundation CKD classification, even immediately posttransplantation (14).…”

Tolerance--Is It Worth It?

“…Opportunistic infections are even more prevalent in patients undergoing antilymphocyte induction therapy (Issa and Fishman 2009). Infection is second only to cardiovascular disease, which is one of the most common causes of death in kidney transplant recipients (Djamali et al 2006).…”