IN-DEPTH REVIEWS

Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

Arjang Djamali ^*1, 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

¹ To whom correspondence should be addressed. E-mail: axd{at}medicine.wisc.edu.

	Abstract

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.