Bruce Kaplan and Herwig-Ulf Meier-Kriesche
With improvements in surgical technique and the advent of more potent and selective immunosuppressive agents, early complications of whole organ transplantation have been reduced. This improvement in early outcome has led to a greater emphasis on the management of late complications of the transplant patient. The fact that improvements in long-term graft (and patient) survival have not kept pace with the improvement in short-term survival points out the necessity of concentrating on these late problems. Broadly, late complications can be classified into several areas: Those affecting the kidney, e.g., chronic rejection and recurrent renal disease, cardiovascular diseases, metabolic disease, bone disease, and infectious complications. Further, these complications can either be secondary to the medications used to control the acute rejection process, comorbid disease states, the aging process, or some combination of the three. This chapter will attempt to cover these late complications with concentration on pathophysiology as well as theoretical and practical treatment options.
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When over eighty years of age, the poet Bryant said that he had added more than ten years to his life by taking a simple exercise while dressing in the morning. Those who knew Bryant and the facts of his life never doubted the truth of this statement.