Strategies for improving long-term renal transplant outcome

This dissertation examines strategies for improving the long-term outcomes of kidney transplantation. It was shown that after changing the immunosuppressant (a drug that reduces or inhibits the rejection of transplanted material) from cyclosporine to tacrolimus, long after a kidney transplant, cholesterol levels, kidney function and blood pressure improved, without an increased risk of diabetes mellitus. Ten years’ exposure to tacrolimus did not result in impaired kidney function following kidney transplantation. It was also shown that administering tacrolimus in combination with the drug sirolimus has a favourable effect in patients with a normal kidney at the time of transplantation, resulting in less progression of interstitial fibrosis and tubular atrophy (markers of damage in the transplanted kidney) after one year, and better kidney function. Finally, it was shown that the loss of small vessels around the kidney tubules is potentially an early marker of interstitial fibrosis and tubular atrophy.