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Workshop Sponsored by the Division of Kidney, Urologic
and Hematologic Diseases of the National Institute of Diabetes and
Digestive and Kidney Diseases, and the Division of Allergy, Immunology,
and Transplantation of the National Institute of Allergy and Infectious
Diseases, National Institutes of Health, Bethesda, Maryland
Over the last decade, the incidence of ESRD has increased at a faster
rate than the availability of kidney donors (USRDS 2003 Annual Data
Report). As a result, the rate of kidney transplants per 100 patient
years on dialysis has declined steadily. Although renal allograft and
recipient survivals have also increased during the last decade, over
the last several years one-year graft survival and allograft half-life
are largely unchanged.
Despite effective immunosuppressive strategies that have markedly reduced
rates of early allograft failure over time, occurrence of late renal
allograft loss remains a significant problem in the transplant patient
population. The number of patients returning to dialysis therapy each
year has nearly doubled in the last decade, as approximately 4,500
patients with failed transplants restarted dialysis in 2001 (USRDS).
Such patients represented approximately 4.7% of the total number of
patients starting or restarting dialysis in 2001.
Observations from clinical studies suggest that in addition to cellular
and humorally-mediated allograft rejection, other non-immunologically-mediated
factors likely contribute to progressive loss of kidney function in
transplant recipients. Donor factors such as age and cadaveric status,
as well as transplant characteristics such as form of preservation
and vascular anatomy also contribute to progressive renal dysfunction.
In addition, recipient factors such as hypertension, vascular disease,
proteinuria, drug exposure, and post-transplant infections likely play
a role in late allograft failure.
In view of the apparent trends for late renal allograft loss, and the
increasing incidence of chronic kidney disease and ESRD in this patient
population, NIDDK and NIAID are sponsoring a workshop to discuss immunologic
and non-immunologic factors that influence late allograft outcome.
Clinical investigators interested in late renal allograft dysfunction
will discuss the current understanding of the problem, outline important
questions that should be studied, and recommend strategies for future
investigations.
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Organizing Committee
Chair:
Phillip F. Halloran, MD
University of Alberta
William E. Harmon, MD
Children's Hospital Boston
Lawrence G. Hunsicker, MD
University of Iowa
Arthur J. Matas, MD
University of Minnesota
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NIH Committee Members
Josephine P. Briggs, MD
National Institute of Diabetes and
Digestive and Kidney Diseases
Allan D. Kirk, MD, PhD
National Institute of Diabetes and Digestive
and Kidney Diseases
Roslyn B. Mannon, MD
National Institute of Diabetes and Digestive
and Kidney Diseases
Catherine M. Meyers, MD
National Institute of Diabetes and Digestive and Kidney
Diseases
Shiv A. Prasad, PhD
National Institute of Allergy and Infectious Diseases |
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