title: Why hasn't eliminating acute rejection improved graft survival?
abstract: Although patients with end-stage renal disease can be maintained with dialysis therapy, the superiority of patient survival with renal transplantation makes transplantation the preferred method of renal replacement. Potent immunosuppressive therapies, particularly calcineurin inhibitors, have greatly reduced the incidence of acute rejection. However, long-term allograft survival remains limited. We discuss the impact of acute rejection on long-term allograft survival and discuss other factors leading to late allograft loss, including calcineurin inhibitor toxicity, chronic allograft nephropathy, and BK virus nephropathy, as well as donor and recipient factors associated with long-term allograft loss.
authors.affiliation: Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida College of Medicine, Gainesville, Florida 32601-0224, USA.
authors.forename: JogiRaju
authors.initials: J
authors.lastname: Tantravahi
authors.forename: Karl L
authors.initials: KL
authors.lastname: Womer
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
mesh_terms: D051799:Delayed Graft Function / Q000209:etiology; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000276:immunology*