PMID- 15726218
OWN - NLM
STAT- MEDLINE
DCOM- 20050609
LR  - 20200825
IS  - 0304-4602 (Print)
IS  - 0304-4602 (Linking)
VI  - 34
IP  - 1
DP  - 2005 Jan
TI  - Preventing renal transplant failure.
PG  - 36-43
AB  - INTRODUCTION: Allograft failure due to immunological or non-immunological causes 
      or a combination and patient death after transplantation are the 2 major causes 
      of renal transplant loss. This paper reviews the various causes of allograft 
      failure and explores strategies for its prevention. RESULTS: Immune mechanisms of 
      renal allograft failure are those mediated by acute and chronic rejection and are 
      initiated by human leukocyte antigen (HLA) disparity between donor and recipient 
      and increased recipient immune responsiveness that results in pre-sensitisation 
      against HLA antigens. Better HLA matching between donor and recipient in both 
      live-donor and cadaveric renal transplant recipients and the use of more potent 
      immunosuppressants has reduced the incidence of acute rejection and resulted in 
      improved overall graft survivals in recent years. However, as the use of more 
      potent immunosuppression increases the risk of infections and malignancy, 
      tailoring therapy by administering more potent immunosuppression to those at 
      higher immunological risk may result in a better balance between the risks and 
      benefits of immunosuppressive therapies. Ischaemia of the donor kidney, 
      calcineurin inhibitor (CNI), mediated nephrotoxicity, reduced renal mass, 
      hypertension, hyperlipidaemia and infections contribute to allograft failure 
      through non-immunological mechanisms. Indeed, any cause of renal injury that 
      results in nephron loss, either immunological or non-immunological, leads to 
      reduced renal mass and initiates further renal damage due to hyperfiltration. 
      Optimising these factors and minimising CNI nephrotoxicity are critical in 
      reducing chronic allograft failure. CONCLUSIONS: Optimising each of these 
      time-dependent and immunosuppressive drug-related factors would allow the 
      maximization of renal allograft function and survival.
FAU - Vathsala, A
AU  - Vathsala A
AD  - Department of Renal Medicine, Singapore General Hospital, Singapore.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Singapore
TA  - Ann Acad Med Singap
JT  - Annals of the Academy of Medicine, Singapore
JID - 7503289
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Animals
MH  - Calcineurin Inhibitors
MH  - Graft Rejection/etiology/pathology/*prevention & control
MH  - Graft Survival/drug effects/immunology
MH  - HLA Antigens/immunology
MH  - Humans
MH  - Hypertension/complications
MH  - Immunosuppressive Agents/adverse effects/*therapeutic use
MH  - Ischemia/complications/pathology
MH  - Kidney/blood supply/drug effects
MH  - *Kidney Transplantation
MH  - T-Lymphocytes/immunology
RF  - 45
EDAT- 2005/02/24 09:00
MHDA- 2005/06/10 09:00
CRDT- 2005/02/24 09:00
PHST- 2005/02/24 09:00 [pubmed]
PHST- 2005/06/10 09:00 [medline]
PHST- 2005/02/24 09:00 [entrez]
PST - ppublish
SO  - Ann Acad Med Singap. 2005 Jan;34(1):36-43.