Renal transplantation

Kidney transplantation is the optimal treatment for end stage renal disease. However, there are risks both from early complications directly related to the surgical procedure, and from longer-term complications resulting from the effects of immunosuppression. This chapter describes the transplant process from the evaluation of patients with renal failure for suitability for transplantation, through the surgical procedure itself, the early and late management of recipients, and the management of the complications that can arise, including acute and chronic graft dysfunction, infection, malignancy, and cardiovascular disease. It also covers the short- and long-term outcomes of kidney transplantation. Since live kidney donors have become an increasingly important source of kidneys for renal transplantation, it also describes the work-up process for potential live donors and the long-term outcomes following donation. Finally, combined kidney/pancreas transplantation is included separately and includes a discussion around the selection and evaluation recipients, the surgical procedure, short- and long-term complications, and the outcomes.

Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem

Glomerulonephritis (GN) continues to be one of the main causes of end-stage kidney disease (ESKD) with an incidence rating from 10.5% to 38.2%. Therefore, recurrent GN, previously considered to be a minor contributor to graft loss, is the third most common cause of graft failure 10 years after renal transplantation. However, the incidence, pathogenesis, and natural course of recurrences are still not completely understood. This review focuses on the most frequent diseases that recur after renal transplantation, analyzing rate of recurrence, epidemiology and risk factors, pathogenesis and bimolecular mechanisms, clinical presentation, diagnosis, and therapy, taking into consideration the limited data available in the literature. First of all, the risk for recurrence depends on the type of glomerulonephritis. For example, recipient patients with anti-glomerular basement membrane (GBM) disease present recurrence rarely, but often exhibit rapid graft loss. On the other hand, recipient patients with C3 glomerulonephritis present recurrence in more than 50% of cases, although the disease is generally slowly progressive. It should not be forgotten that every condition that can lead to chronic graft dysfunction should be considered in the differential diagnosis of recurrence. Therefore, a complete workup of renal biopsy, including light, immunofluorescence and electron microscopy study, is essential to provide the diagnosis, excluding alternative diagnosis that may require different treatment. We will examine in detail the biomolecular mechanisms of both native and transplanted kidney diseases, monitoring the risk of recurrence and optimizing the available treatment options.

Pancreatic Panniculitis: A Rare Presentation Case

A 46-year-old man with a personal history of kidney transplantation in 1994 for reflux nephropathy with chronic graft dysfunction.

Ischemia and Reperfusion Injury in Kidney Transplantation: Relevant Mechanisms in Injury and Repair

Ischemia and reperfusion injury (IRI) is a complex pathophysiological phenomenon, inevitable in kidney transplantation and one of the most important mechanisms for non- or delayed function immediately after transplantation. Long term, it is associated with acute rejection and chronic graft dysfunction due to interstitial fibrosis and tubular atrophy. Recently, more insight has been gained in the underlying molecular pathways and signalling cascades involved, which opens the door to new therapeutic opportunities aiming to reduce IRI and improve graft survival. This review systemically discusses the specific molecular pathways involved in the pathophysiology of IRI and highlights new therapeutic strategies targeting these pathways.