Multimorbidity after renal transplantation: incidence and implications for patients

Kidney transplant recipients are living longer with functioning grafts while remaining vulnerable to accumulating chronic conditions driven by preexisting CKD-related disease burden, ageing, and long-term immunosuppression. Multimorbidity is increasingly recognized as a determinant of survival, healthcare utilization, treatment burden, and quality of life, yet its trajectory after transplantation remains poorly characterized.

Recent literature shows that multimorbidity is common at transplantation and likely increases further afterwards, although posttransplant longitudinal data are scarce. Current themes include heterogeneity in how to define and measure multimorbidity, the contribution of immunosuppression and metabolic complications, associations with mortality and graft loss, and growing recognition of the importance of patient-reported outcomes and socioeconomic disadvantage.

Multimorbidity should be considered an impactful component of long-term transplant outcomes. Research priorities include standardized definitions and characterization of the burden and trajectory of multimorbidity after transplant from longitudinal cohort studies and routinely collected data, and interventions that reduce treatment burden while improving graft, patient, and quality-of-life outcomes. Clinical practice should emphasize integrated, patient-centred management and careful risk-factor modification.