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Medical care of kidney transplant recipients after the first posttransplant year Djamali A; Samaniego M; Muth B; Muehrer R; Hofmann RM; Pirsch J; Howard A; Mourad G; Becker BNClin J Am Soc Nephrol 2006[Jul]; 1 (4): 623-40Kidney 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.|*Aftercare[MESH]|*Kidney Transplantation/physiology[MESH]|Cardiovascular Diseases/therapy[MESH]|Humans[MESH]|Postoperative Complications/therapy[MESH]|Time Factors[MESH] |
