Factors influencing long-term outcomes following renal transplantation: a review

Despite continuing advances in immunosuppressive and supportive therapies, the success of renal transplantation is impacted by factors present in the donor and recipient pre- and post-transplantation. The pre-transplant factors influencing the long-term graft function in the donor include source, age, sex, and HLA mismatches; and in the recipient include age, duration of dialysis and sensitisation. After transplantation, a number of events may lead to progressive deterioration of renal function and graft loss, which include delayed graft function, acute rejection, viral infections, recurrent disease, drug nephrotoxicity, non-compliance and chronic allograft nephropathy. Modulation of individual factor is mandatory to preserve satisfactory renal function in long-term. In this review, each factor is discussed in the context of current transplant practice and an up to date review of literature is presented.