RENAL TRANSPLANTATION

Abstract

Renal transplantation is the treatment of choice for end stage renal disease, and every patient with chronic renal failure should be considered for a transplant. The type of organ allograft (living related, living unrelated, or cadaver) and the degree of HLA matching influence short-term and long-term graft survival. At the current time, recipients of kidney transplants need to be maintained on chronic maintenance immunosuppression with potentially toxic medications to prevent rejection. Therefore, adequate long-term medical follow-up of kidney transplant recipients is essential. Initial posttransplant complications include graft dysfunction and infections. Acute rejection remains to be the most common cause of early graft dysfunction, although ischemic acute tubular necrosis (in cadaver kidneys) and CsA nephrotoxicity are other potential etiologies. Chronic rejection, CsA nephrotoxicity, and rarely de novo or recurrent renal disease are the usual causes of chronic graft dysfunction. Infections with immunomodulating viruses, especially with cytomegalovirus, hepatitis C, and EBV are relatively common in the transplant recipient. EBV has been associated with development of posttransplant lymphoproliferative disorder, a potentially serious disease that sometimes responds to tapering of immunosuppressive drugs. Other long-term post-transplant complications include hypertension, glucose intolerance, dyslipidemia, atherosclerosis, and liver disease. Future development of less toxic, yet effective, immunosuppressive drugs should limit the development of these potentially serious medical complications without compromising, and perhaps improving, graft survival.