Cause Of Return Research Articles

Return migration, self-selection and labour market outcomes

The extensive literature has determined that migration is often temporary rather than permanent. Nevertheless, the topic of return migration continues to be inadequately investigated. This paper offers a chronological review of the literature analysing the impact of labour market outcomes on the return decision. In this regard, the authors investigated the causes of return while presenting the main theoretical and empirical findings on self-selection. The empirical literature indi-cates that the selection in the return phase is negatively correlated to the one of the emigration phase. Furthermore, the authors assessed the influence of return migration on the labour market outcomes, thus finding that the most evident ef-fects occur in the short run, while the market structure determines their length and magnitude. In this context, Central-Eastern Europe represents a suitable case study for the impact of returnees' activities on the domestic labour market. Whereas the findings suggest a positive outcome, more adequate re-integration policies could further enhance both regional and national economic growth.

Rate and Causes of 30-day Unplanned Readmission/Return Following Head and Neck Surgery at a Tertiary Care Center in Saudi Arabia.

Identifying and targeting common preventable causes of 30-day hospital readmissions could help improve survival rates and reduce the healthcare burden. To determine the rate and causes of unplanned hospital return/readmission to the Outpatient Department (OPD) or Emergency Department (ED) within 30 days after discharge following head and neck surgery (HNS) at a tertiary hospital in Western Saudi Arabia. This retrospective study included all adult patients (aged ≥18 years) who had undergone HNS at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2015 and December 2022 and returned to the OPD or ED within 30 days of being discharged. Of 1041 patients who had undergone HNS, 84 (8.1%) returned to the hospital within 30 days after discharge: 63 (6.1%) to the OPD and 21 (2.0%) to the ED. A total of 9 (0.9%) patients were readmitted as inpatients, most commonly for infections (33.3%) and neurological symptoms, including weakness and seizures (22.2%). For OPD visits, common causes were wound swelling (25.4%) and neurological symptoms (17.5%). For ED returns, frequent causes were neurological symptoms (23.8%) and surgical site bleeding (19.1%). Readmission was associated with intensive care unit (ICU) admission during the primary hospital stay (P = 0.003) and higher preoperative baseline health burdens when examined using the American Society of Anesthesiology score (P = 0.022), the Cumulative Illness Rating Scale (P = 0.007), and the Charlson Comorbidity Index (CCI) (P = 0.006). The rate of 30-day unplanned hospital return following head and neck surgery was 6.1% and 2.0% through the OPD and the ED, respectively; 0.9% were readmitted as inpatients. Common causes of return included wound swelling, infections, bleeding, and neurological symptoms.

A Review of Researches on Return Migration

Driven by factors related to economic development, return migration has become a topic of increasing academic interest. There are several mainstream theoretical interpretations of the phenomenon of return migration, and the existing literature focuses on the causes of return, employment choice and return effects. Through literature review, it is found that both economic factors and non-economic factors will have an impact on the decision to return. Compared with non-migrant group, returned migrants are more likely to engage in self-employed. Returned migrants may bring back advanced ideas and technologies, which will have a positive impact on local economic and social development, but the driving effect on employment is limited. In developing countries, “entrepreneurship” means vulnerability. Entrepreneurship is a choice made when all other labor market opportunities are not satisfactory or individuals have no employment opportunities, which belongs to necessity-based entrepreneurship. This paper discusses the findings based on a summary of the review and provides the prospects for future research.

Characterization of the cervicovaginal microbiota of female beef cattle harboring Campylobacter fetus subsp. venerealis using 16S rDNA gene sequencing.

Bovine genital campylobacteriosis (BGC) is a leading cause of return to estrus in cows. The etiologic agent, Campylobacter fetus subsp. venerealis (Cfv) is transmitted by venereal route. Hence, the surrounding reproductive tract microenvironment could play a role in return to estrus in cows. The presence of Cfv in cervicovaginal mucus of Angus breed females provide three experimental groups, which were subject to bacteriome analyses: 10 Cfv-positive cows (CVP), 10 Cfv-negative cows (CVN), and 10 nonsexually active heifers (NSA). Cows with return to estrus showed higher bacterial richness than NSA. Beta diversity analysis showed a significant difference (P = 0.006) in bacterial composition among the three groups analyzed (CVP, CVN, and NSA). However, no significant difference was found when comparing the CVP versus CVN groups. Ureaplasma and Pseudomonas were the genera most frequently observed in NSA, being Ureaplasma the predictor genus to that group, whereas Alistipes, Bacteroides, Rikenellaceae_RC9_gut_group, UCG-005, and UCG-10 were both significantly more abundant and predictors genera in cows with return to estrus. Our results provide an overview of the cervicovaginal bacterial microbiota in cows harboring Cfv and improve the knowledge of the pathogenesis of BGC.

Outcomes and Cost Analysis of Virtual Fracture Clinic Management of 5th Metatarsal Base Fractures

Category:Midfoot/Forefoot; TraumaIntroduction/Purpose:Overwhelming demand for trauma services with increasing emergency department (ED) attendances, has increased pressure on fracture clinics in many units, with this demand exceeding capacity. Virtual fracture clinics (VFCs) have been shown to be safe and cost-effective in many specialties. Optimal treatment of 5th metatarsal base fractures remains controversial. Complications of base of 5th metatarsal fractures include delayed union and painful mal/non-union. Surgical fixation has been shown to enable faster return to sport, with lower faster union times and lower non-union rates than conservative management. The aims of this study were to assess whether the management of 5th metatarsal base fractures using a VFC model is safe, cost-effective and accceptable to the patients, whilst avoiding undesirable outcomes.Methods:All patients presenting to the VFC at our major trauma centre, with a 5th metatarsal base fracture between January 2019 and December 2019 were included in the study. One hundred and thirty six patients were identified. All patients had a standardised VFC treatment protocol including full weight bearing in a walker boot, rehabilitation planning to wean out of the boot and advice to contact the unit for follow-up if ongoing pain after 4 months. Minimum follow-up was one year. Patient records were retrospectively reviewed for baseline demographic data, including co-morbidities and smoking history. Overall complication rates, including mal and non-union as well as operative intervention rates were noted. Patients from the cohort who required face to face appointments were identified and the cause for return was identified. A cost analysis was also performed to evaluate the financial implications of the service.Results:Mean age was 41,6 years (18-92). Average time from ED attendance to VFC review was 2 days (1 - 5). Fractures were classified according to the Torg Classification with 106 (78%) Type 1 fractures, 15 (11%) Type 2 fractures and 15 (11%) Type 3 fractures. At VFC, 135/136 (99.2%) were discharged with the appropriate 5th metatarsal base fracture protocol. Twelve patients (8.8%) arranged further follow-up after initial discharge. The most common reason for return was ongoing pain (6/8 - 75.0%). This subgroup of the patients required an average of 3 (1-6) further appointments. There was 1 non-union during the study period. Based on 2 face to face visits on a traditional pathway, 248 clinic visits were saved with an approximate cost saving of nearly £40,000 ($55,500).Conclusion:Our study supports the management of 5th metatarsal base fractures in the VFC setting. We have shown that the VFC model, with well a defined protocol is both safe and cost effective. Fifth metatarsal base fractures have good outcomes with conservative management, removing the traditional need to have in-person clinic visits to confirm the diagnosis, management and prognosis.

Analysis of neurosurgical procedures with unplanned reoperation for quality improvement: A 5-year single hospital study.

The unplanned return to the operating room rate is a quality metric for assessing hospital performance. This study aimed to evaluate the cause, incidence, and time interval of unplanned returns in index neurosurgical procedures within 30 days of the initial surgery as an internal audit. We retrospectively analyzed neurosurgical procedures between January 2015, and December 2019, in a single regional hospital. The definition of an unplanned return to the operating room was a patient who underwent two operations within 30 days when the second procedure was not planned, staged, or related to the natural course of the disease.A total of 4365 patients were identified in our analysis, of which 93 (2%) had an unplanned return to the operating room within 30 days of their initial surgery during admission. The most common reason for an unplanned return to the operating room for a cranial procedure was hemorrhage, followed by hydrocephalus and subdural effusion, which accounted for 49.5%(46/93), 12%(11/93), and 5.4%(5/93) of cases, respectively. In spinal procedures, the most common cause of return was a residual disc, followed by surgical site infection, which accounted for 5.4%(5/93) and 4.3%(4/93) of cases, respectively. The overall median time interval for unplanned returns to the operating room was 3 days (interquartile range, 1–9).Lowering the rate of postoperative hemorrhage in cranial surgery and postoperative residual disc in spine surgery was crucial as an internal audit in a 5-year single institute follow-up. However, the unplanned reoperation rate is less helpful in benchmarking because of the heterogeneity of patients between hospitals.

A Case Study on the Detection and Prognosis of Internal Leakages in Electro-Hydraulic Flight Control Actuators

Electro-hydraulic servo-actuators (EHSAs) are currently considered the state-of-the art solution for the control of the primary flight control systems of civil and military aircraft. Combining the expected service life of a commercial aircraft with the fact that electro-hydraulic technology is employed in the vast majority of currently in-service aircraft and is planned to be used on future platforms as well, the development of an effective Prognostic and Health Management (PHM) system could provide significant advantages to fleet operators and aircraft maintenance, such as the reduction of unplanned flight disruptions and increased availability of the aircraft. The occurrence of excessive internal leakage within the EHSAs is one of the most common causes of return from the field of flight control actuators, making this failure mode a priority in the definition of any dedicated PHM routine. This paper presents a case study on the design of a prognostic system for this degradation mode, in the context of a wider effort toward the definition of a prognostic framework suitable to work on in-flight data. The study is performed by means of a high-fidelity simulation model supported by experimental activities. Results of both the simulation and the experimental work are used to select a suitable feature, then implemented within the prognostic framework based on particle filtering. The algorithm is at first theoretically discussed, and then tested against several degradation patterns. Performances are evaluated through state-of-the-art metrics, showing promising results and providing the basis towards future applications on real in-flight data.

Hybrid interventions for acute thrombosis after reconstructive operations on lower-limb arteries

A steadily growing number of primary lower extremity arterial reconstructions is inevitably followed by the need to perform repeat interventions. Shunt reocclusion may become a cause of return of ischaemia to the initial level, may significantly increase the degree of limb-threatening chronic ischaemia, as well as lead to the development of an acute condition requiring urgent corrective measures to be taken. A reoperation currently continues to remain the standard of treatment. Despite advances in modern resuscitation, the postoperative mortality rate in such patients reaches 20%. This study was aimed at assessing feasibility of hybrid technologies in acute thrombosis after reconstructive operations on lower-limb arteries. We retrospectively analysed the results of treatment of 66 consecutive patients urgently admitted to the City Clinical Hospital named after S.S. Yudin from 2015 to 2020 with acute lower limb ischaemia caused by acute occlusion of the zone of primary vascular reconstructions previously performed at other medical facilities. Depending on the method of surgical treatment, the patients were divided into two groups. The Study group included 20 patients subjected to open surgical interventions followed by angiographic control and using one or other type of X-ray-endovascular treatment. Endovascular interventions were performed for more than 70% stenoses in the major arteries and zone of the previously performed operation. The Comparison group comprised 46 patients treated without endovascular technologies. They were subjected to thrombectomy from the vascular construction with/without reconstructive-restorative operations. Seventeen (85%) of the 20 Study group patients were operated on in a stagewise manner, with the first stage consisting of an open intervention - thrombectomy and reconstruction followed by angiographic control and roentgenendovascular treatment. The remaining three (15%) patients underwent simultaneous interventions. In the postoperative period, limb amputations were performed in ten (22%) Comparison group patients and in one (5%) Study group patient (p=0.049). There were three (7%) lethal outcomes in the Comparison group, with none in the Study group. A combination of open and endovascular interventions in patients with shunt occlusion after vascular reconstructions makes it possible to reveal the cause of shunt occlusion, as well as to remove multilevel lesions, minimizing surgical wound and contributing to reducing the amputation rate.

Atuação da Nutrição Clínica na redução de custos por produção de resíduos: economicidade em saúde.

Objetivo: Descrever, a partir de um relato de caso, a atuação da nutrição clínica na redução da produção de resíduos por retorno de refeições (almoço) de pacientes hospitalizados não consumidas. Método: Após uma semana teste onde foi observado o quantitativo de refeições intactas que retornava do almoço diário dos pacientes, foram traçadas estimativas de desperdício diárias e mensais. Nesse momento foi realizado uma intervenção na atuação da nutrição clínica com objetivo de reduzir a compra de refeições evitáveis sendo esses dados coletados por três meses subsequente a intervenção. Resultados: Foi observado que o principal fator que influenciou no retorno da refeição foi o jejum seguido de alta hospitalar. Ao final do terceiro mês foi observado uma economia real de R$ 3.781,53 consequente do resultado da captação precoce das principais causas de retorno. No mês de fevereiro houve a maior redução na compra de refeições evitáveis e no mês de abril o menor retorno em número de refeições (28/mês totalizado 14 kg). Conclusão: Foi possível observar que a intervenção proposta apresentou resultado positivo na redução da produção de resíduos e custo.

Using website information to reduce postpurchase dissonance: A mediated moderating role of perceived risk

AbstractA significant body of research is dedicated to decreasing the product return rate by applying management measures that identify the factors and causes of returns. These studies examine how consumers' product return behavior can be explained by studying the information on retailers' websites. However, these studies have not shown how website information (WI) is linked to product returns. The study by Lee's work observed how product returns are motivated by consumers' need to mitigate postpurchase dissonance (PPD). However, a clear understanding of the relationship between WI and PPD is lacking. Therefore, our research examines the impact of WI on PPD in the product returns context. In our research, PPD serves as a key factor in understanding the linkage between WI and product returns. Our results showed that higher‐quality WI is associated with a lower level of PPD. In addition, a lower perceived risk (PR) or attractiveness of alternatives strengthens the association between WI and PPD. We also observed that PR partially mediated the moderation effect of the attractiveness of alternatives. These findings will help e‐retailers better understand customers' PPD, easing the process of reducing product returns.

Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19.

BackgroundData on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care.ObjectiveTo describe clinical characteristics of patients with COVID-19 who returned to the emergency department (ED) or required readmission within 14 days of discharge.DesignRetrospective cohort study of SARS-COV-2-positive patients with index hospitalization between February 27 and April 12, 2020, with ≥ 14-day follow-up. Significance was defined as P < 0.05 after multiplying P by 125 study-wide comparisons.ParticipantsHospitalized patients with confirmed SARS-CoV-2 discharged alive from five New York City hospitals.Main MeasuresReadmission or return to ED following discharge.ResultsOf 2864 discharged patients, 103 (3.6%) returned for emergency care after a median of 4.5 days, with 56 requiring inpatient readmission. The most common reason for return was respiratory distress (50%). Compared with patients who did not return, there were higher proportions of COPD (6.8% vs 2.9%) and hypertension (36% vs 22.1%) among those who returned. Patients who returned also had a shorter median length of stay (LOS) during index hospitalization (4.5 [2.9,9.1] vs 6.7 [3.5, 11.5] days; Padjusted = 0.006), and were less likely to have required intensive care on index hospitalization (5.8% vs 19%; Padjusted = 0.001). A trend towards association between absence of in-hospital treatment-dose anticoagulation on index admission and return to hospital was also observed (20.9% vs 30.9%, Padjusted = 0.06). On readmission, rates of intensive care and death were 5.8% and 3.6%, respectively.ConclusionsReturn to hospital after admission for COVID-19 was infrequent within 14 days of discharge. The most common cause for return was respiratory distress. Patients who returned more likely had COPD and hypertension, shorter LOS on index-hospitalization, and lower rates of in-hospital treatment-dose anticoagulation. Future studies should focus on whether these comorbid conditions, longer LOS, and anticoagulation are associated with reduced readmissions.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-06120-6) contains supplementary material, which is available to authorized users.

Use of a telehealth follow-up system to facilitate treatment and discharge of emergency department patients with severe cellulitis.

Novel long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with cellulitis who require intravenous antibiotics. Telehealth systems have shown success in remote management of dermatologic conditions; we implemented a telehealth follow-up program for patients diagnosed with cellulitis in the ED, treated with single-dose dalbavancin, and discharged. This was a prospective, multi-center observational study. Patients were included based on clinical criteria and ability to complete follow-up using a smartphone and enroll in an online care portal. We examined the rate of successful telehealth follow-up at 24- and 72-hour intervals from discharge. We also examined the ED return rate within 14days, reviewed any visits to determine cause of return, and for admission. 55 patients were enrolled. 54/55 patients completed at least one telehealth follow up encounter (98.2%). 13 patients (23.6%) had a return ED visit within 14days; no patients required admission for worsening cellulitis. Patient engagement in the telehealth program decreased over time; there was an approximately 11% decrease in engagement between the 24 and 72-hour follow-up call, and a 15% decrease in engagement between the 24 and 72-hour image upload. Patients over 65 had a lower rate of image upload (31%) than younger patients (80.6%). A telehealth follow-up system for discharged emergency department patients with cellulitis demonstrated high rates of engagement. In these patients who -may have otherwise required admission for intravenous antibiotics, telehealth-facilitated outpatient management resulted in a low ED return rate and no inpatient admissions for cellulitis.

Readmissions After Bariatric Surgery in France, 2013-2016: a Nationwide Study on Administrative Data.

Readmission rate is considered an indicator of quality of care, which is already used in some countries to impose financial penalties on hospital with readmissions in excess of the national average. Nevertheless, this indicator presents some controversial drawbacks. The objective of this study was the assessment of readmission rate after bariatric surgery. This is a retrospective observational study on a national administrative claims database, the Information Systems Medicalization Program, PMSI, which is a nationwide billing tool collecting information on all hospital discharges in France. All adult patients operated of bariatric surgery from January 1, 2013, through December 31, 2016, were included. The main outcome was unplanned 30-day readmission rate. Secondary outcome was the analysis of reasons for readmission. During the study period, out of 187,000 bariatric interventions, the unplanned readmission rate was 4.7%. A significant difference was found between bariatric procedures (gastric banding 3.1%, sleeve gastrectomy 4.5%, gastric bypass 5.7%, p < 0.001). The most important risk factors are the Charlson comorbidity index, the occurrence of a complication after the initial intervention, and the bariatric technique type itself. The main causes of return to the hospital are abdominal pain, peritonitis, nausea/vomiting, and bleeding. After adjustment for confounders, the rate of rehospitalization varies between 1.0% and 16.0% among all French hospitals. Approximately 5 % of patients undergoing bariatric surgery suffered a readmission within 30days. We identified common causes and identified patients at high risk for such an event. These information could be useful for developing strategies to improve in- and outpatient care in bariatric population.

Do product returns hurt relational outcomes? some evidence from online retailing

Customer product returns are a key challenge for online retailers. Previous research primarily focused on causes of returns and possible interventions to reduce customers’ product returns and concomitant costs for online retailers. However, little is known about the effect of product returns on key relational outcomes. Drawing on relationship marketing theory, we test a model that relates product returns to three relationship marketing outcomes—customer satisfaction, trust, and positive word-of-mouth. A field study based on online panel data from customers of eight large online retailers demonstrates that product returns negatively affect customer satisfaction with the retailer, customer trust, and word-of-mouth. The findings extend previous research by revealing that product returns can detrimentally affect relationships with customers. Implications for e-commerce research and management are discussed.

Characteristics of Patients with Hearing Aids according to the Degree and Pattern of Hearing Loss.

Background and ObjectivesThis study was designed to assess the characteristics of patients according to the degree and audiogram shape of hearing loss and the association of these characteristics with hearing aids (HA) choice, return rate, and cause of return.Subjects and MethodsThis study included 460 individuals who received HAs from 2011 to 2015. The relationships between type of HA and age, primary and accompanying symptoms, HA choice and return and cause of return were evaluated according to the degree and pattern of hearing loss.ResultsHA type did not differ significantly according to the degree and pattern of hearing loss. Intensity of hearing loss was greater in male than in female (p<0.05). Open and completely-in-canal types of HA decreased with age (p<0.05). As degree of hearing loss intensified, behind-the-ear and in-the-ear types increased and Open type decreased (p<0.05). The HA return rate was 9.7%, but was not associated with degree or pattern of hearing loss. The main causes of HA return were costs, psychological fears and adaptive failure.ConclusionsChoice of HA is affected by age, sex, and degree and pattern of hearing loss. HA for hearing rehabilitation in patients with hearing loss can be personalized according to each patient's characteristics and tendencies.

Diseases Led to Refer Iranian Pilgrims From Hajj in 2010

Background:Some Iranian pilgrims are referred to Iran because of catching a new disease or exacerbation of their disease during the Hajj ceremony. These diseases need prolonged and specialized treatments. Investigation of the reasons led to their return to Iran is useful and effective in policy-making and planning of preventive health services.Objectives:This study aimed to investigate the causes of referring Iranian patients to Iran during Hajj in 2010.Patients and Methods:In this cross-sectional study, all Iranian pilgrim cases in Hajj (2012) who referred to Iran were studied, and data analysis was performed. Demographic data and the causes of return to Iran during and after Hajj rituals were analyzed.Results:A total of 106 cases were referred Iran during Hajj 2012. Psychiatric problems, with 26.4% allocated the highest rate of return to Iran during Hajj days, and significant difference was observed in the reasons before and after performing Hajj rituals (P = 0.001).Conclusions:Psychiatric, neurological, gastrointestinal, and respiratory diseases are the most frequent reasons of referring patients to Iran. More accuracy in screening and care of patients are recommended before Hajj in order to prevent references to Iran and its complications.

322 – Study recurrence causes of mental diseases among hospitalized patients in ardabil

Most of the hospitalized mental patients have background of past medical history. Regarding the recurrence feature of the psychological diseases prevention and the causes of recurrence have gained a special importance. This prompted us to make a survey of the causes of the return of the psychological diseases. This retrospective study covered 200 cases that 100 of which gathered from men's ward and 100 of them from women. based on the cases the questionnaire including the demographic information nine main causes of return and 2 variables of the times of recurrent including up to 3 times recurrent and more than it were completed. The patients under study were 36.5 years old in average from among 100 female patients. 42 cases suffered from schizophrenia 42%, 23 cases (23%) BMD,28cases 28% major depression and 7 cases 7% OCD. From among 100 male patients 50 cases 50% suffered from schizophrenia 22 cases 22% BMD, 18 cases 18% major depression and 10 cases 10% OCD. This study shows that men suffered from schizophrenia more than women suffered major depression more than men. the cause of the recurrence of diseases include avoiding to use drugs,unknown,divorce,economic problems, family problems, immigration, the death of a beloved one, abandoning, child, pregnancy. The percent of each has been different in different kinds of diseases but in both sexes avoiding the use of drugs has been the major cause of recurrence in mental diseases.

Unplanned return visit to emergency department

The objective of this study was to determine the incidence, causes, and factors associated with unplanned return visits to emergency department of a tertiary care centre in a low-income country. We conducted a retrospective chart review of all patients who had unplanned returned visit to our emergency department within 48 h of their initial visit during a 1-year study period. The incidence of unplanned revisits is 2%. Two-thirds (69%) of these patients were adults. The most common presenting complaint was fever (29%). During return visits 55% of patients required admission. On multivariable logistic regression model; fever, triage categories 1 and 2, and patients leaving against medical advice were the independent risk factors for revisits requiring admission. Infectious diseases are the leading cause of return visits in our setting.

Food Craving as a Predictor of “Relapse” in the Bariatric Surgery Population: A Review with Suggestions

Obesity is reaching epidemic proportions in the United States and presents major threats to health and quality of life. Gastric bypass surgery is an effective treatment for obesity, and patients can expect to lose significant amounts of weight after surgery. However, there is a high rate of “relapse” in this population, where 20 to 50% of patients regain a significant portion of their weight after surgery. Predicting who is most likely to regain weight is critical for targeting more intensive interventions to those in need. In the addiction literature, craving of drugs/alcohol is one of the primary causes of return to substance use (relapse) following abstinence, and assessment of craving is a common element of assessment prior to and during treatment. This article presents the similarities between compulsive eating (binge eating, which is a common problem in patients presenting for bariatric surgery) and drug addiction. It reviews current instruments that assess food craving and suggests how the field may benefit by examining their utility in the bariatric surgery population.

Stratégies immunosuppressives et dysfonction chronique du greffon en transplantation rénale

Chronic graft dysfunction is a major cause of return to dialysis. In the majority of cases, it is correlated with histological signs of cellular and/or humoral rejection, the nephrotoxicity of anticalcineurins, or nonspecific lesions of interstitial fibrosis and tubular atrophy. Although the incidence of acute rejection has considerably decreased, renal toxicity of the calcineurin inhibitors remains problematic. In cases of established nephrotoxicity, the use of non-nephrotoxic immunosuppressors such as mycophenolic acid or the proliferation signal inhibitors makes it possible to reduce or even stop the anticalcineurins. In prevention of anticalcineurin nephrotoxicity, many attempts to minimize or wean patients from them have shown that improvement in renal function is only obtained at the cost of an increase in the incidence of acute rejection. This makes it necessary to select patients who may benefit from anticalcineurin-sparing treatment, based on clinical, histological, and biological markers. Finally, long-term follow-up is also fundamental in order to validate the positive impact on renal function of this strategy in terms of graft survival.