Update on the long-term complications of renal transplantation

Powerful immunosuppressive regimens have reduced rejection risk, leading to an expanding cohort of long-term kidney transplant recipients who are likely to encounter practitioners in other specialties.

Key review papers and primary literature identified through searches of PubMed, Google Scholar and Medline.

Death from cardiovascular disease and malignancy remain the chief causes of transplant loss. Risk factors and phenotypes for these differ from the general population.

Many guidelines for renal transplant recipients are based on extrapolation from studies on non-transplant cohorts and may not be appropriate. Emerging studies demonstrate that established interventions in the general population are less efficacious in transplant recipients.

The influence of immunosuppression on the development of complications.

Markers to guide individualized optimal immunosuppression and predict the development of complications would allow for targeted early intervention.