Improving Long‐Term Renal Allograft Survival via a Road Less Traveled By

• Published in: American journal of transplantation Vol. 11; no. 7; pp. 1382 - 1387
• Main Authors: Stegall, M. D., Park, W. D., Dean, P. G., Cosio, F. G.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-07-2011; Wiley
• Subjects: Allograft nephropathy; Biological and medical sciences; chronic rejection; Graft Rejection - mortality; Graft Survival; Humans; immunosuppressive therapy; kidney transplantation; Kidney Transplantation - mortality; long‐term graft survival; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Transplantation, Homologous - mortality; Kidney disease; long-term graft survival; Urinary system disease; Prognosis; Highway; Homograft; Homotransplantation; chronic rejection; Long term; Survival; Allograft nephropathy; Kidney; Rejection; immunosuppressive therapy; Travel; Improvement; Chronic; Nephropathy; Treatment; Urinary system; Surgery; Graft; Immunosuppressive agent; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2011.03557.x

It has become cliché to state that improvements in early renal allograft survival over the past two decades have not led to increased long‐term renal allograft survival. However, it is not clear how long‐term graft survival can be improved. Here, we present the viewpoint that the road forward does not involve searching for new and more ideal immunosuppressive regimens, but rather detailed patient follow‐up to identify specific causes of late renal allograft loss and the development of new therapy designed to address these problems before allograft damage becomes irreversible.
The authors opine that improvements in long‐term outcomes will not involve wholesale changes in current immunosuppression, but rather will entail in‐depth follow‐up aimed at the identification of the major causes of late graft loss and the development of therapy for each specific cause.