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Transplantation

  • Hao DingEmail author
  • Junwei YangEmail author
Chapter

Abstract

Renal transplantation is the best modality of renal replacement therapy available for most patients with end-stage renal disease and is one of the breakthroughs in medical science in recent decades. Our knowledge of HLA typing, cross-match testing, recipient preparation, donor management, and postoperative care have advanced and brought widespread benefits, and these are crucial for clinicians to formulate an appropriate treatment regimen. Great effects should be paid to selection and preparation of kidney transplant recipients because of the risks from immunosuppressive therapy. Reducing acute rejection episodes and minimizing ischemic damage is the main goal of immunosuppressive therapy. The general concepts that most clinicians agree useful include induction therapy and maintenance treatment. Delayed graft function after kidney transplantation is usually defined as the need for dialysis during the first postoperative week, anuria, or failure of prompt azotemia resolution, and most studies suggest that patients with DGF have worse long-term outcomes than patients with immediate function. Although the outcomes of renal transplant patients have improved over the years, this population continues to show significant morbidity and mortality due to infection. Transplantation team should attempt to achieve a balance between preventing allograft rejection and maintaining immune system integrity.

References

  1. 1.
    Hart A, et al. OPTN/SRTR 2015 annual data report: kidney. Am J Transplant. 2017;17(Suppl 1):21–116.CrossRefGoogle Scholar
  2. 2.
    Lo P, et al. Preconditioning therapy in ABO-incompatible living kidney transplantation: a systematic review and meta-analysis. Transplantation. 2016;100(4):933–42.CrossRefGoogle Scholar
  3. 3.
    Tinckam KJ. Basic histocompatibility testing methods. In: Core concepts in renal transplantation; 2012.Google Scholar
  4. 4.
    Anjum S, et al. Patterns of end-stage renal disease caused by diabetes, hypertension, and glomerulonephritis in live kidney donors. Am J Transplant. 2016;16(12):3540–7.CrossRefGoogle Scholar
  5. 5.
    Lin J. Medical evaluation of the living kidney donor. In: Core concepts in renal transplantation; 2012.Google Scholar
  6. 6.
    Hart A, et al. Kidney. Am J Transplant. 2016;16(Suppl 2):11–46.CrossRefGoogle Scholar
  7. 7.
    Kennedy CM, Magee CC. Immunosuppression in the renal transplant recipient. In: Lerma EV, Rosner M, editors. Clinical decisions in nephrology, hypertension and kidney transplantation. New York: Springer; 2013. p. 395–409.CrossRefGoogle Scholar
  8. 8.
    Massie AB, et al. Early changes in kidney distribution under the new allocation system. J Am Soc Nephrol. 2016;27(8):2495–501.CrossRefGoogle Scholar
  9. 9.
    Wu WK, et al. Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int. 2015;88(4):851–8.CrossRefGoogle Scholar
  10. 10.
    Magee CC. Allograft dysfunction: diagnosis and management. In: Core concepts in renal transplantation; 2012.Google Scholar
  11. 11.
    Loupy A, et al. The Banff 2015 kidney meeting report: current challenges in rejection classification and prospects for adopting molecular pathology. Am J Transplant. 2017;17(1):28–41.CrossRefGoogle Scholar
  12. 12.
    Martin-Gandul C, et al. The impact of infection on chronic allograft dysfunction and allograft survival after solid organ transplantation. Am J Transplant. 2015;15(12):3024–40.CrossRefGoogle Scholar
  13. 13.
    Santos RD, Brennan DC. Prevention and management of infectious complications in kidney transplant recipients. In: Weir MR, Lerma EV, editors. Kidney transplantation: practical guide to management. New York: Springer; 2014. p. 301–18.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Centre for Kidney DiseaseSecond Affiliated Hospital, Nanjing Medical UniversityNanjingChina

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