Dr Chris Dudley
Consultant Nephrologist, Southmead Hospital, Bristol
With modern immunosuppression acute rejection rates are low and very few renal allografts are now
lost as a direct consequence. Furthermore, short-term patient and graft survival are good.
In the UK patient survival is 95% and 85% at one and five years respectively while the corresponding
graft survival is 88% and 72%. For most patients quality of life after transplantation
is much improved and in some to such a dramatic extent that patients think of themselves as cured.
In reality, substitution of one chronic disease by another has been made and the current challenges
are those of chronic disease management. Specifically this consists of managing suboptimal graft function and attendant chronic renal failure, issues associated with chronic drug use including side-effects and adherence, chronic immunosuppression, social and psychological rehabilitation particularly with respect to education and employment, and preventing premature death from infections, malignancies and most importantly, cardiovascular disease. Such a formidable list requires that those involved in the post-transplant care of patients are well organised and sufficiently trained to meet and manage these demands effectively.