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Previous Volume 346:580-590 February 21, 2002 Number 8 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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After cyclosporine and muromonab-CD3 (OKT3 monoclonal antibody) were introduced into clinical practice in the early 1980s, one-year survival rates for renal allografts improved from approximately 60 percent to between 80 and 90 percent.^1,2,3 However, the incidence of acute rejection in the first six months after transplantation remained high; approximately half the recipients had at least one episode of acute rejection. In the 1990s, the introduction of new immunosuppressive agents led to a decrease in the incidence of acute rejection.⁴ Although long-term allograft survival has improved,¹ chronic rejection and death with a functioning graft remain leading causes of the late loss . . . [Full Text of this Article]

The Problem of Late Allograft Loss

Chronic Rejection in Renal Transplantation

Death with a Functioning Allograft

Current Strategies to Prevent Late Allograft Loss

Perioperative Management and HLA Matching

Pharmacologic Prevention of Acute Rejection

            Tacrolimus

            Mycophenolate Mofetil

            Sirolimus

            Monoclonal Antibodies against the Interleukin-2 Receptor

Treatment of Severe or Refractory Acute Rejection

Optimal Dose of Calcineurin Inhibitors beyond the First Year after Transplantation

Discontinuation of Corticosteroids

Treatment of Hypertension and Hyperlipidemia

Future Strategies to Minimize Late Allograft Loss

Avoidance of Calcineurin Inhibitors or Corticosteroids

Hyporesponsiveness, or the Induction of Tolerance

Conclusions

Source Information

From the Renal Unit (M.P., N.T.-R.) and the Transplantation Unit (M.P., T.T., T.K., N.T.-R., A.B.C.), Departments of Medicine and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston.

Address reprint requests to Dr. Pascual at the Renal Unit, Box MZ 70, Massachusetts General Hospital, Boston, MA 02114, or at mpascual@partners.org.

References

Related Letters:

Strategies to Improve Outcomes after Renal Transplantation
Rigatto C., Parfrey P., Montori V. M., Basu A., Kudva Y. C., Baum C. L., McGee A. P., Friedman A., Friedman A., Pascual M., Tolkoff-Rubin N., Cosimi A. B.
Extract | Full Text | PDF  
N Engl J Med 2002; 346:2089-2092, Jun 27, 2002. Correspondence

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