Aftercare of kidney transplant patients

An optimal care after kidney transplantation is crucial in order to maintain graft function as well as patient survival over the long term. Despite many improvements and a 1-year survival of nearly 100%, in the long term approximately one half of kidney grafts are lost due to death of patients with a functioning graft. This is mostly related to cardiovascular diseases, infections and malignant tumors. Thus, after transplantation it is important to control for cardiovascular risk factors, such as arterial hypertension, post-transplantation diabetes mellitus and disorders of lipid metabolism. As calcineurin inhibitors unfavorably influence the cardiovascular risks, alternative immunosuppressive substances such as co-stimulation blockers would be helpful. Furthermore, it is important to diagnose and treat infectious diseases particularly with opportunistic pathogens at an early time point (see article “infectious diseases after kidney transplantation” in this issue). An immunosuppressive therapy is also related to an increased incidence of malignancies. This is due to an increase of skin tumors as well as lymphoproliferative disorders. The mTOR inhibitors could be advantageous in comparison to other immunosuppressive substances. Altogether, the diagnosis and treatment of cardiovascular risk factors, infectious diseases and malignancies should be the focus of care of patients after kidney transplantation in order to achieve and maintain the graft function. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.