RT Book, Section A1 Nemr, Saed A1 Asch, William S. A2 Lerma, Edgar V. A2 Rosner, Mitchell H. A2 Perazella, Mark A. SR Print(0) ID 1149116755 T1 Kidney Transplantation T2 CURRENT Diagnosis & Treatment: Nephrology & Hypertension, 2e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9781259861055 LK accessmedicine.mhmedical.com/content.aspx?aid=1149116755 RD 2024/11/06 AB Essentials of DiagnosisThe demographic of kidney transplant candidates and recipients has increasingly shifted toward older patients with the greatest growth among recipients between 45 and 65 years of age, and especially those with a history of diabetes or hypertension. Many of these recipient candidates are frail and require a more comprehensive pretransplant evaluation to determine the appropriateness of proceeding with transplantation.Tacrolimus remains the backbone of the most commonly used immunosuppressive regimen in the United States, however, the novel intravenous costimulation blocking drug belatacept is associated with higher GFRs compared with cyclosporine. It is anticipated that allograft survival will be prolonged by belatacept as this drug is not associated with development of interstitial fibrosis and tubular atrophy in kidney transplants.The incidence and burden of malignancy development in immunosuppressed kidney transplants in increasingly a concern. It is imperative that healthcare professions caring for transplant recipients not overlook the need to continue age appropriate cancer screening.Recurrent disease remains a cause of premature allograft failure following kidney transplantation. Efforts to further characterize the putative soluble “circulating permeability factor” of FSGS have thus far been unsuccessful while C3 glomerulonephritis is associated with a high rate of recurrence and allograft loss following kidney transplantation.The decision to discontinue immunosuppression following kidney transplant failure when subsequent retransplantation is expected remains controversial. While the data indicate that survival on dialysis off immunosuppression is increased, patients who have had their immunosuppression withdrawn may be at increased risk of becoming sensitized, making identification of a subsequent compatible donor more challenging.