Nephrol Dial Transplant Vol. 19 No. 12 © ERA-EDTA 2004; all rights reserved
Fernando Valderrabano Memorial Lecture
Special Feature
Renal transplantation 2004: where do we stand today?
Ospedale San Luca, Istituto Scientific Auxologica
Correspondence and offprint requests to: C. Ponticelli, Ospedale San Luca, vie spagnotetto 13, 1-20149, Italy. Email: claudio.ponticelli{at}fastwebnet.it
In spite of considerable progress in immunosuppressive and supportive treatment, numerous problems persist which interfere with the success of renal transplantation. Before transplantation has been performed, factors impacting on outcome include the donor (living vs cadaver, age and HLA system) as well as the recipient (age, immunological reactivity, potential sensitization and duration of dialysis). These are the main factors that affect the outcome of the transplant, particularly in the long-term. After transplantation a number of events may put graft function at risk: potential recurrence of the primary renal disease in the allograft; ‘de novo’ renal disease triggered by infections, drugs or autoimmunity; and non-specific progression promoters, such as diabetes, hypertension, proteinuria, nephrotoxic agents and/or viral infections. The two most frequent causes of chronic allograft dysfunction are (i) chronic rejection (often triggered by preceding acute rejection, delayed graft function or poor compliance) and (ii) calcineurin-inhibitor nephrotoxicity (more likely to develop in kidneys of older donors or in marginal kidneys). The differential diagnosis between these two entities is generally difficult, but some histological clues (reduplication of glomerular basement membrane, obliterating vasculopathy and C4d deposits) as well as the demonstration of humoral antibodies are pointers suggesting rejection. Treatment of chronic graft dysfunction is difficult, whatever the cause, particularly in cases with advanced renal lesions. Therefore, early diagnosis is of paramount importance. In this regard, graft biopsy can be of great help. In spite of many problems and complications, not only short-term but also long-term results of renal transplantation are improving progressively, as documented by CTS data showing that in Europe for transplants performed between 1982 and 1984 the mean graft half-life was 7 years, while for transplants performed between 1997 and 1999 it was 20 years.
Keywords: calcineurin inhibitors; chronic allograft nephropathy; chronic rejection; recurrent disease; renal transplantation
On September 6, 2001, Professor Fernando Valderrabano (Hospital Gregorio Marañon, Madrid) died at the age of 59 years. He was a leading figure in Spanish nephrology, a full professor of Medicine/Nephrology at the University Complutense of Madrid, and an outstanding scientist who published more than 300 articles in medical journals. He was a very intelligent and cultured person, and a man of great style who enjoyed a wide range of hobbies and interests in addition to his medical work. All his colleagues and friends mourn his passing.
|
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. S. Dugan, M. L. Gasparovic, and W. J. Atwood Direct Correlation between Sialic Acid Binding and Infection of Cells by Two Human Polyomaviruses (JC Virus and BK Virus) J. Virol., March 1, 2008; 82(5): 2560 - 2564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A J Cronin Allowing autonomous agents freedom J. Med. Ethics, March 1, 2008; 34(3): 129 - 132. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Dugan, S. Eash, and W. J. Atwood An N-Linked Glycoprotein with {alpha}(2,3)-Linked Sialic Acid Is a Receptor for BK Virus J. Virol., November 15, 2005; 79(22): 14442 - 14445. [Abstract] [Full Text] [PDF]
|
|