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Editorial

      When I was in medical school and a resident in internal medicine, I considered transplant patients to be mysterious and magical. To be able to replace solid organs with those from a living donor or cadaver donor (deceased donor is the politically correct term today) seemed awesome. When I became a nephrologist and had the opportunity to work with the transplant team, I have to tell you that the magic did not dissipate. Transplantation is still awesome. We have come a long way since the first successful kidney transplant just over 50 years ago, but success creates its own problems, and many of those are addressed in this issue of Advances in Chronic Kidney Disease, which is devoted to chronic kidney disease in the transplant recipient. Dr Brent Miller has put together a stellar issue that addresses some of the issues that come with long-term kidney transplants. Although short-term outcomes have improved, acute rejection, infection, immunosupressent toxicity, and chronic allograft nephropathy continue to be problematic.
      Drs Joist, Brennan, and Coyne address the issue of anemia in the kidney transplant recipient, both as a cardiovascular risk factor and an undertreated comorbidity in this population. Dr Brennan describes and examines long-term trends in kidney allograft survival and recipient survival and the effects of newer immunosuppressive regimens. Dr Koch addresses the important issue of retransplantation—who should be considered? When should it be done? How should potential retransplant recipients be screened? Does it matter why the first allograft failed? What about expanded criteria for donors for retransplantation?
      Dr Miller considers the development of chronic kidney disease in the kidney allograft recipient. It has become apparent that even the most successful kidney allograft rarely has normal kidney function and that serum creatinine can be a misleading marker of kidney function in the transplant recipient. He also addresses the development of chronic kidney disease in the native kidneys of recipients of other organs such as the heart, liver, and lung. Treatment of chronic kidney disease in these patients can be very complex, particularly, for example, the heart transplant recipient who develops end-stage renal disease.
      Drs Zisman and Sprague discuss bone disease in the kidney transplant recipient. Most recipients have preexisting bone disease. Immunosuppressive medications and the level of kidney dysfunction that most kidney allograft recipients exhibit contribute to continuing impairments in mineral metabolism affecting bone health. They note that transplant recipients are at increased risk for bone fractures and generally exhibit low bone mineral density. Bone mineral density frequently continues to deteriorate posttransplantation, and treatment is difficult and complex.
      Drs Williams and Haragsim discuss calcineurin nephrotoxicity. Calcineurin inhibitors have clearly improved allograft survival but are associated with numerous side effects, one of the most serious of which is nephrotoxicity. A second article by Baluja, Haragsim, and Laszik looks at chronic allograft nepropathy, now the most common cause of kidney allograft loss after the first year.
      There are also 2 contributions from our section editors. Dr Neu describes pediatric kidney transplantation including the characteristics of the pediatric transplant population and graft and patient survival and addresses special issues such as the impact of chronic kidney disease and transplantation on neurocognitive development, linear growth, infection, and malignancy and special issues with adherence in this population. Dr Williams provides a thoughtful public policy article on the very controversial topic of internet organ solicitation.
      We also have 2 Wildcard articles in this issue: “Impact of Locus of Control on Clinical Outcomes in Renal Dialysis” by Elaine Dec and “Outcomes Study of a Customer Relations Educational Program in Dialysis Practice” by Jill Schmidt.
      Welcome to the third year of Advances in Chronic Kidney Disease!