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Patients are screened for coccidioidomycosis before kid- calcineurin inhibitor-induced thrombotic microangiopathy, ney transplant in endemic areas in the United States, namely BK nephropathy, ureteral stenosis, or any nontransplant- the Southwestern region. Prophylactic therapy with flucona- specific AKI cause. zole is initiated in patients with previous exposure. Disease Recurrence Glomerular diseases can recur in the transplant allograft. Cancer Focal segmental glomerulosclerosis is one of the most com- Because kidney transplant recipients are at higher risk for mon forms of glomerular disease to recur posttransplant developing cancer, it is important to follow age- and sex- and can occur within days to weeks after transplantation. appropriate cancer screening guidelines before transplant. Focal segmental glomerulosclerosis and thrombotic micro- In addition, ultrasonography should be used to screen angiopathy should be treated aggressively if disease recur- for renal cell carcinoma in patients on long-standing rence is seen in the transplanted kidney, because these hemodialysis. conditions are associated with high rates of graft failure. Immunosuppressive medications increase the risk for Patients with lupus or ANCA vasculitis should have quies- several forms of malignancy, with non-melanoma skin can- cent disease for several months preceding transplantation to cers being the most common. Therefore, transplant recipients reduce risk for disease recurrence. Diabetic kidney disease should be screened regularly for skin in addition to age- and and IgA nephropathy may also affect allograft function after sex-specific cancers. transplant. Posttransplant lymphoproliferative disorders can occur with long-term immunosuppression. These malignancies are Cardiovascular Disease caused by uncontrolled B-lymphocyte proliferation associated Cardiovascular disease is the leading cause of death in kid- with Epstein-Barr virus infection and impaired T-cell surveil- ney transplant recipients. Kidney transplantation, despite lance. Treatment involves reduction in immunosuppression, restoration of kidney function, should be treated as a cardio- administration of the anti-B-cell monoclonal antibody rituxi- vascular disease equivalent for purposes of risk factor mab, and chemotherapy. Additionally, calcineurin inhibitors modification. may be switched to sirolimus because of its antiproliferative Calcineurin inhibitors induce hypertension by activating effects. the sodium chloride cotransporter in the distal convoluted Kaposi sarcoma is common and is associated with human tubule of the kidney. Therefore, thiazide diuretics may be effi- herpesvirus-8 infection. Treatment involves reduction in cacious in these patients. Dyslipidemia is a common side effect immunosuppression dosing and switching to a sirolimus- of calcineurin inhibitors, sirolimus, and glucocorticoids. based regimen. Treatment with a statin improves cardiac outcomes; however, statins have drug-drug interactions with calcineurin inhibi- ¢ Within the first month following kidney transplanta- tors and can increase toxicity of both drugs.

Patients are screened for coccidioidomycosis before kid- calcineurin inhibitor-induced thrombotic microangiopathy, ney transplant in endemic areas in the United States, namely BK nephropathy, ureteral stenosis, or any nontransplant- the Southwestern region. Prophylactic therapy with flucona- specific AKI cause. zole is initiated in patients with previous exposure. Disease Recurrence Glomerular diseases can recur in the transplant allograft. Cancer Focal segmental glomerulosclerosis is one of the most com- Because kidney transplant recipients are at higher risk for mon forms of glomerular disease to recur posttransplant developing cancer, it is important to follow age- and sex- and can occur within days to weeks after transplantation. appropriate cancer screening guidelines before transplant. Focal segmental glomerulosclerosis and thrombotic micro- In addition, ultrasonography should be used to screen angiopathy should be treated aggressively if disease recur- for renal cell carcinoma in patients on long-standing rence is seen in the transplanted kidney, because these hemodialysis. conditions are associated with high rates of graft failure. Immunosuppressive medications increase the risk for Patients with lupus or ANCA vasculitis should have quies- several forms of malignancy, with non-melanoma skin can- cent disease for several months preceding transplantation to cers being the most common. Therefore, transplant recipients reduce risk for disease recurrence. Diabetic kidney disease should be screened regularly for skin in addition to age- and and IgA nephropathy may also affect allograft function after sex-specific cancers. transplant. Posttransplant lymphoproliferative disorders can occur with long-term immunosuppression. These malignancies are Cardiovascular Disease caused by uncontrolled B-lymphocyte proliferation associated Cardiovascular disease is the leading cause of death in kid- with Epstein-Barr virus infection and impaired T-cell surveil- ney transplant recipients. Kidney transplantation, despite lance. Treatment involves reduction in immunosuppression, restoration of kidney function, should be treated as a cardio- administration of the anti-B-cell monoclonal antibody rituxi- vascular disease equivalent for purposes of risk factor mab, and chemotherapy. Additionally, calcineurin inhibitors modification. may be switched to sirolimus because of its antiproliferative Calcineurin inhibitors induce hypertension by activating effects. the sodium chloride cotransporter in the distal convoluted Kaposi sarcoma is common and is associated with human tubule of the kidney. Therefore, thiazide diuretics may be effi- herpesvirus-8 infection. Treatment involves reduction in cacious in these patients. Dyslipidemia is a common side effect immunosuppression dosing and switching to a sirolimus- of calcineurin inhibitors, sirolimus, and glucocorticoids. based regimen. Treatment with a statin improves cardiac outcomes; however, statins have drug-drug interactions with calcineurin inhibi- ¢ Within the first month following kidney transplanta- tors and can increase toxicity of both drugs. tion, the most common infectious complications are similar to other surgeries and include urinary tract Bone Disease

Patients are screened for coccidioidomycosis before kid- calcineurin inhibitor-induced thrombotic microangiopathy, ney transplant in endemic areas in the United States, namely BK nephropathy, ureteral stenosis, or any nontransplant- the Southwestern region. Prophylactic therapy with flucona- specific AKI cause. zole is initiated in patients with previous exposure. Disease Recurrence Glomerular diseases can recur in the transplant allograft. Cancer Focal segmental glomerulosclerosis is one of the most com- Because kidney transplant recipients are at higher risk for mon forms of glomerular disease to recur posttransplant developing cancer, it is important to follow age- and sex- and can occur within days to weeks after transplantation. appropriate cancer screening guidelines before transplant. Focal segmental glomerulosclerosis and thrombotic micro- In addition, ultrasonography should be used to screen angiopathy should be treated aggressively if disease recur- for renal cell carcinoma in patients on long-standing rence is seen in the transplanted kidney, because these hemodialysis. conditions are associated with high rates of graft failure. Immunosuppressive medications increase the risk for Patients with lupus or ANCA vasculitis should have quies- several forms of malignancy, with non-melanoma skin can- cent disease for several months preceding transplantation to cers being the most common. Therefore, transplant recipients reduce risk for disease recurrence. Diabetic kidney disease should be screened regularly for skin in addition to age- and and IgA nephropathy may also affect allograft function after sex-specific cancers. transplant. Posttransplant lymphoproliferative disorders can occur with long-term immunosuppression. These malignancies are Cardiovascular Disease caused by uncontrolled B-lymphocyte proliferation associated Cardiovascular disease is the leading cause of death in kid- with Epstein-Barr virus infection and impaired T-cell surveil- ney transplant recipients. Kidney transplantation, despite lance. Treatment involves reduction in immunosuppression, restoration of kidney function, should be treated as a cardio- administration of the anti-B-cell monoclonal antibody rituxi- vascular disease equivalent for purposes of risk factor mab, and chemotherapy. Additionally, calcineurin inhibitors modification. may be switched to sirolimus because of its antiproliferative Calcineurin inhibitors induce hypertension by activating effects. the sodium chloride cotransporter in the distal convoluted Kaposi sarcoma is common and is associated with human tubule of the kidney. Therefore, thiazide diuretics may be effi- herpesvirus-8 infection. Treatment involves reduction in cacious in these patients. Dyslipidemia is a common side effect immunosuppression dosing and switching to a sirolimus- of calcineurin inhibitors, sirolimus, and glucocorticoids. based regimen. Treatment with a statin improves cardiac outcomes; however, statins have drug-drug interactions with calcineurin inhibi- ¢ Within the first month following kidney transplanta- tors and can increase toxicity of both drugs. tion, the most common infectious complications are similar to other surgeries and include urinary tract Bone Disease infections and wound infections; afterward, oppor- Secondary and tertiary hyperparathyroidism, common in

Patients are screened for coccidioidomycosis before kid- calcineurin inhibitor-induced thrombotic microangiopathy, ney transplant in endemic areas in the United States, namely BK nephropathy, ureteral stenosis, or any nontransplant- the Southwestern region. Prophylactic therapy with flucona- specific AKI cause. zole is initiated in patients with previous exposure. Disease Recurrence Glomerular diseases can recur in the transplant allograft. Cancer Focal segmental glomerulosclerosis is one of the most com- Because kidney transplant recipients are at higher risk for mon forms of glomerular disease to recur posttransplant developing cancer, it is important to follow age- and sex- and can occur within days to weeks after transplantation. appropriate cancer screening guidelines before transplant. Focal segmental glomerulosclerosis and thrombotic micro- In addition, ultrasonography should be used to screen angiopathy should be treated aggressively if disease recur- for renal cell carcinoma in patients on long-standing rence is seen in the transplanted kidney, because these hemodialysis. conditions are associated with high rates of graft failure. Immunosuppressive medications increase the risk for Patients with lupus or ANCA vasculitis should have quies- several forms of malignancy, with non-melanoma skin can- cent disease for several months preceding transplantation to cers being the most common. Therefore, transplant recipients reduce risk for disease recurrence. Diabetic kidney disease should be screened regularly for skin in addition to age- and and IgA nephropathy may also affect allograft function after sex-specific cancers. transplant. Posttransplant lymphoproliferative disorders can occur with long-term immunosuppression. These malignancies are Cardiovascular Disease caused by uncontrolled B-lymphocyte proliferation associated Cardiovascular disease is the leading cause of death in kid- with Epstein-Barr virus infection and impaired T-cell surveil- ney transplant recipients. Kidney transplantation, despite lance. Treatment involves reduction in immunosuppression, restoration of kidney function, should be treated as a cardio- administration of the anti-B-cell monoclonal antibody rituxi- vascular disease equivalent for purposes of risk factor mab, and chemotherapy. Additionally, calcineurin inhibitors modification. may be switched to sirolimus because of its antiproliferative Calcineurin inhibitors induce hypertension by activating effects. the sodium chloride cotransporter in the distal convoluted Kaposi sarcoma is common and is associated with human tubule of the kidney. Therefore, thiazide diuretics may be effi- herpesvirus-8 infection. Treatment involves reduction in cacious in these patients. Dyslipidemia is a common side effect immunosuppression dosing and switching to a sirolimus- of calcineurin inhibitors, sirolimus, and glucocorticoids. based regimen. Treatment with a statin improves cardiac outcomes; however, statins have drug-drug interactions with calcineurin inhibi- ¢ Within the first month following kidney transplanta- tors and can increase toxicity of both drugs. tion, the most common infectious complications are similar to other surgeries and include urinary tract Bone Disease infections and wound infections; afterward, oppor- Secondary and tertiary hyperparathyroidism, common in tunistic infections (such as cytomegalovirus, patients with ESKD, can persist for several months posttrans-