Stratifying risk and targeting immunosuppressive strategies.
Despite short-term improvements, long-term outcomes in renal transplantation have not improved. Late graft loss arises as a result of immunologic and nonimmunologic insults that lead to chronic allograft nephropathy. One of the major nonimmunologic factors is the toxicity associated with current immunosuppressive regimens. In addition to these key factors, the current rate of death in renal transplant recipients with a functioning graft arises as a result of both cardiovascular risk and malignancy, as well as the growing challenge from infections. Renal transplant recipients are not a homogenous population, and donor factors add a further variable. Each individual recipient-donor combination will have its own unique set of risks of both graft loss and patient death. The choice of immunosuppressive regimens for an individual recipient needs to consider his or her risk profile, for early rejection and for late cardiovascular disease and malignancy. This meeting has considered all of these factors, together with strategies to reduce risk and offer potential for improved long-term outcomes. This situation requires change in current practice and flexibility in our approach to the wide range of patients we manage on a daily basis.
Russ
G
G
Queen Elizabeth Hospital, Adelaide, Australia. graeme.russ@health.sa.gov.au
D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D000076222:Mechanistic Target of Rapamycin Complex 1; D046912:Multiprotein Complexes; D011506:Proteins; D018570:Risk Assessment; D020123:Sirolimus / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases; D014157:Transcription Factors / Q000037:antagonists & inhibitors
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D046912:Multiprotein Complexes; D011506:Proteins; D014157:Transcription Factors; D016572:Cyclosporine; D000076222:Mechanistic Target of Rapamycin Complex 1; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus