Management of Long-Term Complications

Death with a functioning graft is a major cause of late graft loss in kidney transplant recipients. The major causes of death include cardiovascular disease and malignancy. In addition to lifestyle modification, there are good data to support intensive reduction of LDL cholesterol to reduce cardiovascular risk with less robust data in support of blood pressure reduction. Malignancy is increased 2.7-fold post-transplantation, and there is a particular association with virally driven tumours, including lymphoproliferative disorders, cervical cancer and some forms of skin neoplasia. Surveillance for the more common forms of post-transplant neoplasia and modulation of immunosuppression should be considered. Although there is an increased risk of bone fracture, especially soon after transplantation, there are few data to guide the optimal choice of bone protection. Vitamin D supplementation appears safe and well tolerated, but bisphosphonates may have long-term negative consequences for bone, despite having positive effects on surrogate markers. © 2012 John Wiley & Sons, Ltd.