Medical care of kidney transplant recipients after the first posttransplant year.
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 expanded-criteria 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.
Djamali
Arjang
A
Department of Medicine, Nephrology Section, University of Wisconsin Madison, School of Medicine, 3034 Fish Hatchery Road, Suite B, Madison, WI 53713, USA. axd@medicine.wisc.edu
Samaniego
Millie
M
Muth
Brenda
B
Muehrer
Rebecca
R
Hofmann
R Michael
RM
Pirsch
John
J
Howard
Andrew
A
Mourad
Georges
G
Becker
Bryan N
BN
D000359:Aftercare; D002318:Cardiovascular Diseases / Q000628:therapy; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology; D011183:Postoperative Complications / Q000628:therapy; D013997:Time Factors