A Report of the Lisbon Conference on the Care of the Kidney Transplant Recipient

Abstract

An International Conference on the Care of the Kidney Transplant Recipient was convened in Lisbon, Portugal from February 2–4, 2006 under the auspices of the National Kidney Foundation and Kidney Disease: Improving Global Outcomes (KDIGO), and in cooperation with The Transplantation Society. Conference participants included over 100 experts and leaders in kidney transplantation, representing more than 40 countries from around the world, including participants from Africa, Asia, Australia, Europe, North American, and South America (Appendix). The goal of the conference was to develop recommendations to improve the outcomes of kidney transplant recipients worldwide with regard to the following basic medical issues: cardiovascular disease (Work Group I), cancer and infection (Work Group II), and anemia, bone disease, reproductive issues, growth and development (Work Group III). Work Groups I, II, and III addressed the preand posttransplant care of kidney transplant recipients by the following components: timelines of pre- and posttransplantation, immunosuppression, level of kidney allograft function, and burden of disease (prior history of dialysis or preemptive transplant and how that history affects outcome). A graft maintenance section (Work Group IV) addressed: 1) recipient (and donor) selection; 2) surgical aspects and immediate posttransplant care of recipients including consideration of minimal surgical infrastructure; 3) immunosuppression including an assessment of the incremental expected value of more complex and expensive regimens in comparison to simpler and less expensive regimens, generics, mid- and long-term immunosuppression; 4) living donor versus deceased donor transplantation; and 5) mid- and long-term posttransplant care and monitoring of allograft function. In addition, conference participants were asked to examine the issue of applicability of the recently published Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines for chronic kidney disease (CKD) in kidney allograft recipients (1). Specifically, Work Group V addressed the role of estimated glomerular filtration rate (eGFR) in monitoring kidney function after transplantation, as well as the stratification for intervention according to eGFR values. Work Group I: Cardiovascular Disease Bertram Kasiske, Gabriel Danovitch, and Fernando Cosio: Co-Chairs Chronic kidney disease, before and after transplantation, is an independent risk factor for cardiovascular disease (CVD). Risk for CVD should be managed from the earliest stages of CKD. Although the absolute risk increases with age (2–5), the highest relative risk of CVD is in young adults with CKD. Prevention of CVD includes risk factor management and education (professionals and patients). Kidney transplantation provides a better outcome than dialysis, including less occurrence of CVD and a lower cost (6–8). Preemptive transplantation may also help to prevent CVD, and is now best accomplished with a living donor. Rationale for Assessing CVD Risk in Transplant Candidates The risk of CVD should be assessed for all potential transplant recipients to maximize safety and informed consent in transplantation and to prevent CVD events. Optimizing graft function may reduce CVD risk. This risk assessment will also optimize the utilization of scarce and the level of for the CVD should a history and to disease, and an of for CVD may as a on and that of in CVD with the following CVD CVD risk as more than on dialysis age and may from kidney is an of over for transplantation, assessment of CVD should be in risk The is a for CVD for is for transplant to prevent CVD and should be to on a before should be assessed for in the is a to transplantation CVD is a of and after with a graft in the immediate posttransplant is by care should CVD risk factor management with a on and should be managed according to guidelines for should be (and lower in with of be in transplant recipients and to be to after kidney should be of potential in kidney transplant and with the of in kidney transplant is after transplantation, a the an in that and in kidney transplant may to may of and a of A may be by the cost of and also in kidney transplant may to anemia, and an in that to kidney allograft in transplant and may be in with and also in transplant a of is to be with consideration should be to graft or of the the In addition, the may to is to consideration should be to kidney should be managed according to guidelines for to prevent the occurrence of that is should be with a is and is should also be transplant with is to for to before a the in that be with and is in be expected reduce to by a should be with is of the of in the of should be of potential in kidney transplant The of should be in with increases the of The of that and as and should a or of the and a to a a be should be in with a to the risk of the best of a is the should be managed according to guidelines may be to after of after kidney transplantation is to of in the The be after transplantation, may be with and is an for in the and in clinical to reduce the of from in with kidney function. kidney transplant recipients to develop kidney to be in kidney transplant In the and with with of and A risk of after transplantation and is with risk for CVD all should be before transplantation on the risk for and following and of and of may reduce the risk for in should be managed according to guidelines for should be before and after kidney transplantation that and should be should be for the risk transplant should be and to and in of of graft function, is on may prevent CVD events. a of is the may be to and CVD risk of the is that CVD events. 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