eMedicine Specialties > Transplantation > Surgery

Renal Transplantation (Medical): Follow-up

Author: Dixon B Kaufman, MD, PhD, Director of Pancreas Transplantation, Professor, Department of Surgery, Division of Transplantation, Feinberg School of Medicine, Northwestern University
Contributor Information and Disclosures

Updated: Jun 12, 2009

Follow-up

Further Outpatient Care

  • Improvements in surgical technique and the advent of more potent immunosuppressive agents have reduced early complications of renal transplantation. Greater emphasis is now placed on preventing late complications. This is accomplished in the outpatient setting by routine assessment of patients with transplants.
  • Possible complications include the following:
    • Hypertension
    • Hyperlipidemia
    • Metabolic bone disease
    • Chronic allograft nephropathy8

Complications

  • Chronic systemic immunosuppression is a double-edged sword. The same immunosuppressive effects that prevent rejection of the allograft pose a risk for development of malignancy and infectious diseases. Routine cancer surveillance is mandatory to assure rapid diagnosis and treatment of any malignancy.

Prognosis

  • Some of the most useful data on kidney transplantation has been collected by the Scientific Registry of Transplant Recipients (SRTR) of the United Network for Organ Sharing (UNOS). The outcome of kidney transplantation is superior in recipients receiving a kidney from a living donor.4 Within this category, recipients of sibling HLA-identical grafts do best.
  • UNOS percent graft survival data from 2005-2006 (1 y) and 2001-2006 (5 y)
    • Deceased donor kidneys (N = 8288)
      • Non-ECD (expanded criteria donors)
        • 1 year (92%)
        • 5 years (71%)
      • ECD
        • 1 year (85%)
        • 5 years (55%)
    • Living donor kidneys
      • 1 year (96%)
      • 5 years (81%)

Patient Education

Miscellaneous

Special Concerns

  • Pregnant women have special obstetric considerations.
  • Newborns also have special considerations because they are more often born premature and have lower birth weights for expected ages.
 


More on Renal Transplantation (Medical)

Overview: Renal Transplantation (Medical)
Differential Diagnoses & Workup: Renal Transplantation (Medical)
Treatment & Medication: Renal Transplantation (Medical)
Follow-up: Renal Transplantation (Medical)
References
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References

  1. Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. Aug 11 1994;331(6):365-76. [Medline].

  2. Nissenson AR, Rettig RA. Medicare's end-stage renal disease program: current status and future prospects. Health Aff (Millwood). Jan-Feb 1999;18(1):161-79. [Medline].

  3. Organ Procurement and Transplantation Network (OPTN). National Data, Kidney Graft/Patient Survival. OPTN Web site. Available at http://optn.transplant.hrsa.gov/latestData/viewDataReports.asp. Accessed June 12, 2009.

  4. McCullough KP, Keith DS, Meyer KH, Stock PG, Brayman KL, Leichtman AB. Kidney and pancreas transplantation in the United States, 1998-2007: access for patients with diabetes and end-stage renal disease. Am J Transplant. Apr 2009;9(4 Pt 2):894-906. [Medline].

  5. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. Dec 2 1999;341(23):1725-30. [Medline].

  6. Meyers CM, Kirk AD. Workshop on late renal allograft dysfunction. Am J Transplant. Jul 2005;5(7):1600-5. [Medline].

  7. Zarifian A, Meleg-Smith S, O'Donovan R, Tesi RJ, Batuman V. Cyclosporine-associated thrombotic microangiopathy in renal allografts. Kidney Int. Jun 1999;55(6):2457-66. [Medline].

  8. Cornell LD, Colvin RB. Chronic allograft nephropathy. Curr Opin Nephrol Hypertens. May 2005;14(3):229-34. [Medline].

  9. Wong W, Venetz JP, Tolkoff-Rubin N, Pascual M. 2005 immunosuppressive strategies in kidney transplantation: which role for the calcineurin inhibitors?. Transplantation. Aug 15 2005;80(3):289-96. [Medline].

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Further Reading

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Keywords

renal transplantation, allotransplantation, kidney transplantation, kidney transplant, renal transplant, end stage renal disease, end-stage renal disease, end stage kidney disease, end-stage kidney disease, ESRD, renal replacement, diabetic nephropathy, nephrectomy, organ transplant, organ transplantation, renal disease, kidney disease, diabetes, chronic glomerulonephritis, polycystic kidney disease, PKD, nephrosclerosis, hypertensive nephrosclerosis, systemic lupus erythematosus, SLE, interstitial nephritis, renal allograft, kidney allograft

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Contributor Information and Disclosures

Author

Dixon B Kaufman, MD, PhD, Director of Pancreas Transplantation, Professor, Department of Surgery, Division of Transplantation, Feinberg School of Medicine, Northwestern University
Dixon B Kaufman, MD, PhD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, American Surgical Association, Association for Academic Surgery, Central Surgical Association, National Kidney Foundation, Phi Beta Kappa, and Society of University Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Laura L Mulloy, DO, FACP, Professor of Medicine, Chief, Section of Nephrology, Hypertension and Transplantation Medicine, Glover/Mealing Eminent Scholar Chair in Immunology, Medical College of Georgia
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George R Aronoff, MD, Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine
George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

CME Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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