Update on the long-term complications of renal transplantation

Abstract

Introduction: Powerful immunosuppressive regimens have reduced rejection risk, leading to an expanding cohort of long-term kidney transplant recipients who are likely to encounter practitioners in other specialties.

Sources of data: Key review papers and primary literature identified through searches of PubMed, Google Scholar and Medline.

Areas of agreement: Death from cardiovascular disease and malignancy remain the chief causes of transplant loss. Risk factors and phenotypes for these differ from the general population.

Areas of controversy: Many guidelines for renal transplant recipients are based on extrapolation from studies on non-transplant cohorts and may not be appropriate. Emerging studies demonstrate that established interventions in the general population are less efficacious in transplant recipients.

Growing points: The influence of immunosuppression on the development of complications.

Areas timely for developing research: Markers to guide individualized optimal immunosuppression and predict the development of complications would allow for targeted early intervention.

Keywords: cancer; cardiovascular; complications; kidney; long-term; malignancy; renal; transplant dysfunction; transplantation.