[Clinical surveillance after renal transplantation]. / Sorveglianza clinica dopo trapianto renale.

Renal transplantation restores quality of life and social activity, heavily compromised in dialysis patients. After receiving a renal transplantation, patients are looked after by different doctors, who are usually supervised by the team of nephrologists devoted to the Transplant Unit. Aims of the follow-up after renal transplantation are to prevent and cure all renal and systemic dysfunctions, in particular acute and chronic rejection, cardiovascular diseases, infections and malignancies, that a relevantly increased incidence because of immunosuppression. Transplanted patients with stable renal function and good general conditions need a medical care, which is not much different to that necessary for other categories of chronic outpatients. Consequently, participation in the post-transplant care by physicians not specifically involved in the transplant team and not particularly expert in renal transplantation, including GPs, is very welcome, at the condition that they receive adequate information about follow-up protocols and that they respect the indications of physicians responsible of the Transplant Unit.

Role of human leukocyte antigen-G 14-base pair polymorphism in kidney transplantation outcomes.

BACKGROUND: Both the membrane-bound and soluble forms of human leukocyte antigen-G (HLA-G) molecules exhibit a multitude of immunomodulatory properties that can potentially obviate or delay graft rejection. The 14-base pair (14-bp) polymorphism in the 3'-untranslated region of the HLA-G gene is thought to have a role in soluble HLA-G (sHLA-G) expression. METHODS: In this study, we retrospectively investigated a large cohort of 418 kidney transplant recipients with the aim of establishing whether the HLA-G 14-bp insertion/deletion polymorphism could serve as an effective genetic risk marker for acute and/or chronic deterioration of transplanted kidney function. RESULTS: A statistically significant higher incidence of chronic kidney dysfunction leading to allograft loss was observed in transplant recipients homozygous for the HLA-G 14-bp deletion polymorphism. This difference increased over time and was confirmed by progressive decline in the glomerular filtration rate. CONCLUSIONS: These results suggest that alongside other factors previously consolidated in clinical practice, recipient HLA-G 14-bp genotype may serve as an adjuvant independent predictor of long-term outcome of kidney transplantation.