Team-based kidney transplant care：A transplant nephrologist-led approach

Abstract

The role of transplant nephrologists has become increasingly important with the increase in the number of kidney transplantations. In Japan, glomerulonephritis treatment and dialysis therapy are excellent. Although appropriate treatment of glomerulonephritis is important to prevent long-term damage to native kidneys, most Japanese nephrologists cannot prepare for kidney transplantation in the early stages of chronic kidney disease (CKD). In the lifetime treatment of CKD patients, which includes kidney transplantation, nephrologists play important roles before and after kidney transplantation. Close relationship between transplant nephrologists at transplant facilities and regional nephrologists may lead to better long-term patient outcome. In addition, this cooperation before transplantation may increase the rate of preemptive kidney transplant (PEKT). PEKT could be beneficial for reducing DWFG (death with functioning graft), graft loss, and post-transplant cardiovascular disease (CVD) even in Japan, where the long-term outcomes of patients on hemodialysis are excellent. Strategies that can help CKD patients receive kidney transplantation sooner, especially as PEKT, are important for not only the improvement of long-term outcome but also for communication with members of the transplant team, which includes kidney transplant surgeons, transplant nephrologists, kidney transplant coordinators, nurses, clinical psychologists, social workers, and nutritionists. Cooperation with nephrologists after kidney transplantation promotes an increase in the number of kidney transplantations. Transplant nephrologists gather kidney transplant surgeons, local nephrologists, and other medical staff together to develop a long-term strategy for kidney transplant-requiring CKD.