immunology allergic disorders
Kidney Transplantation
Prognosis for Kidney Transplantation
Most rejection episodes and other complications occur within 3 to 4 months after transplantation; most patients then return to more normal health and activity but must take maintenance doses of immunosuppressants indefinitely. At 1 year after kidney transplantation, survival rates are Living-donor grafts: 98% (patients) and 94% (grafts) Deceased-donor grafts: 95% (patients) and 88% (grafts) Subsequent annual graft loss rates are 3 to 5% with a living-donor graft and 5 to 8% with a deceased-donor graft. Among patients whose graft survives the first year, half die of other causes (eg, cardiovascular disease, infection) with the graft functioning normally; half develop chronic allograft nephropathy with the graft malfunctioning in 1 to 5 years. Rates of late failure are higher for patients with African ancestry. Doppler ultrasonographic measurement of peak systolic and minimal end-diastolic flow in renal segmental arteries≥3 months after transplantation may help assess prognosis. Thebest clinical predictorremains Serial determination of serum creatinine In a specific patient, the most recently obtained creatinine levels should be compared with previous levels; a sudden increase in creatinine indicates the need to look for rejection or another problem (eg, vascular compromise, obstruction of the ureter). Ideally, serum creatinine should be normal in all posttransplant patients 4 to 6 weeks after kidney transplantation. 