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Challenges and considerations in diagnosing the kidney disease in deteriorating graft function.

Ekberg, Henrik LU and Johansson, Martin E (2012) In Transplant international : official journal of the European Society for Organ Transplantation 25(11). p.1119-1128
Abstract
Despite significant reductions in acute-rejection rates with the introduction of calcineurin inhibitor (CNI)-based immunosuppressive therapy, improvements in long-term graft survival in renal transplantation have been mixed. Improving long-term graft survival continues to present a major challenge in the management of kidney-transplant patients. CNIs are a key component of immunosuppressive therapy, and chronic CNI toxicity has been widely thought to be a major factor in late graft failure. However, recent studies examining the causes of late graft failure in detail have challenged this view, highlighting the importance of antibody-mediated rejection and other factors. In addition, the diagnosis of CNI nephrotoxicity represents a challenge... (More)
Despite significant reductions in acute-rejection rates with the introduction of calcineurin inhibitor (CNI)-based immunosuppressive therapy, improvements in long-term graft survival in renal transplantation have been mixed. Improving long-term graft survival continues to present a major challenge in the management of kidney-transplant patients. CNIs are a key component of immunosuppressive therapy, and chronic CNI toxicity has been widely thought to be a major factor in late graft failure. However, recent studies examining the causes of late graft failure in detail have challenged this view, highlighting the importance of antibody-mediated rejection and other factors. In addition, the diagnosis of CNI nephrotoxicity represents a challenge to clinicians, with the potential for over-diagnosis and an inappropriate reduction in immunosuppressive therapy. When graft function is deteriorating, accurately determining the cause of the kidney disease is essential for effective long-term management of the patient. Diagnosis requires a thorough clinical investigation, and in the majority of cases a specific cause can be identified. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Transplant international : official journal of the European Society for Organ Transplantation
volume
25
issue
11
pages
1119 - 1128
publisher
Springer
external identifiers
  • WOS:000309748700004
  • PMID:22738034
  • Scopus:84867529594
ISSN
1432-2277
DOI
10.1111/j.1432-2277.2012.01516.x
language
English
LU publication?
yes
id
61aa7439-8dc3-4e4e-b10f-764116a7aa1e (old id 2858916)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22738034?dopt=Abstract
date added to LUP
2012-07-04 19:42:24
date last changed
2017-01-01 07:51:13
@article{61aa7439-8dc3-4e4e-b10f-764116a7aa1e,
  abstract     = {Despite significant reductions in acute-rejection rates with the introduction of calcineurin inhibitor (CNI)-based immunosuppressive therapy, improvements in long-term graft survival in renal transplantation have been mixed. Improving long-term graft survival continues to present a major challenge in the management of kidney-transplant patients. CNIs are a key component of immunosuppressive therapy, and chronic CNI toxicity has been widely thought to be a major factor in late graft failure. However, recent studies examining the causes of late graft failure in detail have challenged this view, highlighting the importance of antibody-mediated rejection and other factors. In addition, the diagnosis of CNI nephrotoxicity represents a challenge to clinicians, with the potential for over-diagnosis and an inappropriate reduction in immunosuppressive therapy. When graft function is deteriorating, accurately determining the cause of the kidney disease is essential for effective long-term management of the patient. Diagnosis requires a thorough clinical investigation, and in the majority of cases a specific cause can be identified.},
  author       = {Ekberg, Henrik and Johansson, Martin E},
  issn         = {1432-2277},
  language     = {eng},
  number       = {11},
  pages        = {1119--1128},
  publisher    = {Springer},
  series       = {Transplant international : official journal of the European Society for Organ Transplantation},
  title        = {Challenges and considerations in diagnosing the kidney disease in deteriorating graft function.},
  url          = {http://dx.doi.org/10.1111/j.1432-2277.2012.01516.x},
  volume       = {25},
  year         = {2012},
}