Long-term outcomes of renal transplantation: a result of the original endowment of the donor kidney and the inflammatory response to both alloantigens and injury

Recent data suggest that long-term allograft survival might be affected by two factors. The first is the endowment of the allograft, which consists of two elements: the nephron mass and the ability of these nephrons to repair injuries sustained during the transplant process. The second factor is ren al inflammation. Although inflammation is traditionally ascribed to allorea ctivity, recent data have shown that there is also a renal inflammatory res ponse to early injury after transplantation, to brain death in the donor, a nd as part of the maladaptive response to nephron loss. These two factors c ontribute to the detrimental effects of delayed graft function or acute rej ection on the long-term survival seen in most studies, and the beneficial e ffects of anti-inflammatory agents on the maladaptive response to nephron l oss. Curr Opin Nephrol Hypertens 9:643-648. (C) 2000 Lippincott Williams & Wilkins.