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Since the first successful transplantations were performed around 50 years ago, the lack of improvement in long-term graft survival and the risks associated with immunosuppressive therapy have made the ability to induce tolerance a burning desire among transplantation immunobiologists. These authors outline the considerable challenges that stand in the way of this goal, and proffer their opinion on which strategies are most likely to succeed.
Bomback and Klemmer have systematically reviewed the literature on aldosterone breakthrough in people treated with angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers. Although the data are not yet supportive of widespread screening of asymptomatic patients, the authors contend that physicians should test for this phenomenon in selected patients and consider initiating treatment with aldosterone antagonists or renin inhibitors.
Although cardiovascular disease is the most common cause of death among people with chronic renal dysfunction, conventional cardiovascular risk factors are paradoxically associated with improved survival in hemodialysis populations. Here, the authors analyze emerging data that support this 'reverse epidemiology'. Confirmation of this phenomenon might lead to the formulation of more effective management strategies, tailored to patient characteristics and disease stage.
Studies of kidney function after orthotopic liver transplantation have yielded conflicting results, and there is a paucity of data on renal outcomes after combined liver–kidney transplantation. In this Review, authors from the University of California, Los Angeles attempt to synthesize the available findings into a cohesive update. Focus is given to the effect of the introduction of the MELD scoring system.