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Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

Arjang Djamali^*, Millie Samaniego^*, Brenda Muth^*, Rebecca Muehrer^*, R. Michael Hofmann^*, John Pirsch^*, Andrew Howard, Georges Mourad, and Bryan N. Becker^*

^* Department of Medicine, Nephrology Section, University of Wisconsin, Madison, Madison, Wisconsin; Metropolitan Nephrology Associates, Alexandria, Virginia; and Montpellier Medical School, Montpellier, France

Address correspondence to: Dr. Arjang Djamali, University of Wisconsin Madison, School of Medicine, 3034 Fish Hatchery Road, Suite B, Madison, WI 53713. Phone: 608-270-5681; Fax: 608-270-5677; E-mail: axd{at}medicine.wisc.edu

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.

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				A. Kukla, M. Adulla, J. Pascual, M. Samaniego, L. Nanovic, B. N. Becker, and A. Djamali CKD stage-to-stage progression in native and transplant kidney disease Nephrol. Dial. Transplant., February 1, 2008; 23(2): 693 - 700. [Abstract] [Full Text] [PDF]