Abstract
The global prevalence of renal transplants is increasing with time, and renal transplantation is the only definite treatment for end-stage renal disease. We have limited the acute and late acute rejection of kidney allografts, but the long-term survival of renal tissues still remains a difficult and unanswered question as most of the renal transplants undergo failure within a decade of their transplantation.Among various histopathological changes that signify chronic allograft nephropathy (CAN), tubular atrophy, fibrous thickening of the arteries, fibrosis of the kidney interstitium, and glomerulosclerosis are the most important. Moreover, these structural changes are followed by a decline in the kidney function as well. The underlying mechanism that triggers the long-term rejection of renal transplants involves both humoral and cell-mediated immunity. T cells, with their related cytokines, cause tissue damage. In addition, CD 20+ B cells and their antibodies play an important role in the long-term graft rejection. Other risk factors that predispose a recipient to long-term graft rejection include HLA-mismatching, acute episodes of graft rejection, mismatch in donor-recipient age, and smoking.The purpose of this review article is the analyze current literature and find different anti-proliferative agents that can suppress the immune system and can thus contribute to the long-term survival of renal transplants. The findings of this review paper can be helpful in understanding the long-term survival of renal transplants and various ways to improve it.
Highlights
BackgroundKidney transplantation is the only effective treatment option for managing end-stage renal disease
Multiple studies have shown that the use of mycophenolate mofetil over an extended period can significantly reduce the chance of long-term graft rejection and can increase the mean survival of the transplant [64,65]
Several studies have shown that use of rapamycin in the maintenance regime after transplants can lead to immune suppression, decrease in smooth muscle proliferation, a decrease in the chances of acute and sub-acute transplant rejection, and improve the long-term survival and function of renal allografts [68,69,70]
Summary
Kidney transplantation is the only effective treatment option for managing end-stage renal disease. Time is of the utmost importance in understanding the underlying mechanism of long-term renal transplant rejection and explore different drug targets that can improve survival of both the graft and the patient. Multiple studies have shown that the use of mycophenolate mofetil over an extended period can significantly reduce the chance of long-term graft rejection and can increase the mean survival of the transplant [64,65]. Several studies have shown that use of rapamycin in the maintenance regime after transplants can lead to immune suppression, decrease in smooth muscle proliferation, a decrease in the chances of acute and sub-acute transplant rejection, and improve the long-term survival and function of renal allografts [68,69,70]. Antibody-dependent cellular cytotoxicity, direct signaling, and antibody-mediated cytotoxicity are all the important pieces in its mechanism of action [97,98,99].There is some evidence that support the use of rituximab for improving the long-term survival of the kidneys [100,101]
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