Non-immune interventions to protect kidney allografts in the long term

Research output: Contribution to journalArticle

Abstract

Chronic rejection, the primary cause of late renal allograft loss, results from a complex interplay between immunological and non-immunological factors. During the past few decades, transplant research has focused almost exclusively on identifying more powerful and minimally toxic immunosuppressive strategies to prevent acute rejection and alloimmune response toward the graft, whereas poor attention has been paid to non-immunological factors. However, the discrepancy between remarkable improvements in the prevention of acute rejection and failure to ameliorate long-term graft outcomes suggests that non-immunological injuries may have an important role in the progressive loss of graft function. As kidney graft resembles the remnant kidney, in which a low nephron mass initiates a self-perpetuating process of progressive renal function loss, the same therapeutic tools able to retard progression of chronic renal disease are expected to be effective in kidney transplant patients as well. Indeed, high blood pressure (BP) levels, along with increased urinary protein excretion and hyperlipidemia, have been associated with reduced graft survival. Hence, strict BP control, renin-angiotensin system blockade to reduce proteinuria, and statins for hyperlipidemia control should probably represent the standard of care for kidney transplant patients. Furthermore, a multimodal nephroprotective strategy that includes smoking cessation, and tight glucose control for diabetes, might eventually be crucial to improve long-term graft outcomes.

Original languageEnglish
JournalKidney International
Volume78
Issue numberSUPPL. 119
DOIs
Publication statusPublished - Dec 2010

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Allografts
Transplants
Kidney
Hyperlipidemias
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Poisons
Nephrons
Graft Survival
Smoking Cessation
Standard of Care
Immunosuppressive Agents
Renin-Angiotensin System
Chronic Renal Insufficiency
Proteinuria
Blood Pressure
Hypertension
Glucose
Wounds and Injuries
Research
Rejection (Psychology)

Keywords

  • chronic graft failure
  • hyperlipidemia
  • hypertension
  • kidney transplant
  • proteinuria

ASJC Scopus subject areas

  • Nephrology

Cite this

Non-immune interventions to protect kidney allografts in the long term. / Cravedi, Paolo; Perico, Norberto; Remuzzi, Giuseppe.

In: Kidney International, Vol. 78, No. SUPPL. 119, 12.2010.

Research output: Contribution to journalArticle

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