Diagnosis and prevention of chronic kidney allograft loss

  title={Diagnosis and prevention of chronic kidney allograft loss},
  author={Brian J Nankivell and Dirk R J Kuypers},
  journal={The Lancet},
Chronic renal allograft dysfunction: risk factors, immunology and prevention.
Evidence-based treatment strategies for chronic allograft dysfunction are lacking, but several prevention and management strategies are recommended in clinical practice.
Challenges and considerations in diagnosing the kidney disease in deteriorating graft function
  • H. Ekberg, M. Johansson
  • Medicine
    Transplant international : official journal of the European Society for Organ Transplantation
  • 2012
Despite significant reductions in acute‐rejection rates with the introduction of calcineurin inhibitor (CNI)‐based immunosuppressive therapy, improvements in long‐term graft survival in renal
Lifestyle, Inflammation, and Vascular Calcification in Kidney Transplant Recipients: Perspectives on Long-Term Outcomes
Modifiable dietary elements and toxic environmental contaminants that may explain increased risk of cardiovascular mortality and late graft failure in kidney transplant recipients (KTR) are discussed.
Prevention of cardiovascular disease after renal transplantation
To prevent CVD in renal transplant recipients, cardiovascular risk assessment should be performed regularly and prevention should include both lifestyle modifications, optimal treatment of cardiovascular risk factors and strategies to preserve graft function.
Has the survival of the graft improved after renal transplantation in the era of modern immunosuppression?
This review analyses some of the evidences conditioning graft failure as well as related therapeutic and prognostic aspects, and identifies the causes of graft failure and its risk factors, applying predictive models, and intervening in causal factors could constitute strategies for improving kidney transplantation results in terms of survival.
Eculizumab in renal transplantation.
Factors influencing long‐term outcome after kidney transplantation
Although current immunosuppression regimes are highly efficient in preventing acute rejection, the burden of specific (diabetes, nephrotoxicity) and nonspecific side effects has significant negative long‐term consequences that may well be worse in the future because of the increasing ages of both donors and recipients.


The natural history of chronic allograft nephropathy.
Chronic allograft nephropathy represents cumulative and incremental damage to nephrons from time-dependent immunologic and nonimmunologic causes, and was irreversible, resulting in declining renal function and graft failure.
Chronic Allograft Nephropathy: Current Concepts and Future Directions
The paradigm that chronic rejection causes all progressive late allograft failure has been replaced by a hypothesis of cumulative damage, where a series of time-dependent immune and nonimmune
Chronic renal failure after transplantation of a nonrenal organ.
The five-year risk of chronic renal failure after transplantation of a nonrenal organ ranges from 7 to 21 percent, depending on the type of organ transplanted, and is associated with an increase by a factor of more than four in the risk of death.
Achieving Chronic Kidney Disease Treatment Targets in Renal Transplant Recipients: Results From a Cross-Sectional Study in Spain
CKD and their complications were prevalent in renal transplant recipients and the control of some of these complications is far below targets established for nontransplant CKD patients despite a progressive intensification of therapy as graft function declines.
The kidney transplant: new horizons
  • M. Mengel
  • Medicine, Biology
    Current opinion in nephrology and hypertension
  • 2010
With new diagnostic tools available, a disease-specific approach in renal allograft damage becomes feasible, which will allow for designing entity-specific trials and establishment of specific treatments, eventually improving long-term allografted function.
Optimizing medication adherence: an ongoing opportunity to improve outcomes after kidney transplantation.
Identification of risk factors, coupled with measures that effectively address them, can have a positive effect at many levels--medically, socially, and economically.
Diagnosis of kidney transplant obstruction using Mag3 diuretic renography
Measurement of OE significantly improved the accuracy of diuretic MAG3 renography in the diagnosis of renal allograft KTO, especially when supplemented by the TTB, parenchymal transit time and shape of the renogram curve.
A primer on recurrent and de novo glomerulonephritis in renal allografts
  • B. Iványi
  • Medicine, Biology
    Nature Clinical Practice Nephrology
  • 2008
The prevalence, risk factors, pathogenesis, clinicopathological features, and effects on graft outcome of recurrent and de novo glomerulonephritis in renal allografts are discussed.
Comparison of the Predictive Performance of eGFR Formulae for Mortality and Graft Failure in Renal Transplant Recipients
Seven eGFR equations showed similar and limited utility in predicting mortality and graft failure after renal transplantation, which has important implications for the management of renal transplant recipients and the use of an eG FR as a surrogate endpoint in clinical trials.
A molecular classifier for predicting future graft loss in late kidney transplant biopsies.
The molecular risk score reflects active injury and is superior to either scarring or function in predicting graft failure and was the only predictor of graft loss in an independent validation set.