Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 18, 2024; 14(1): 90149
Published online Mar 18, 2024. doi: 10.5500/wjt.v14.i1.90149
Predicting outcomes after kidney transplantation: Can Pareto’s rules help us to do so?
Fernando M Gonzalez, Francisca Gonzalez Cohens
Fernando M Gonzalez, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Santiago 7500922, Chile
Francisca Gonzalez Cohens, Web Intelligence Centre, Faculty of Physics and Mathematical Sciences, Santiago 7500922, Chile
Author contributions: Gonzalez FM is main author and mostly wrote the manuscript; Cohens FG contributed to bibliographic searches and core idea construction, and edited the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fernando M Gonzalez, MD, Full Professor, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Providencia, Santiago 7500922, Chile. fgonzalf@uc.cl
Received: November 24, 2023
Peer-review started: November 24, 2023
First decision: November 30, 2023
Revised: January 13, 2024
Accepted: February 5, 2024
Article in press: February 5, 2024
Published online: March 18, 2024

Kidney transplantation is the best option for kidney replacement therapy, even considering that most of the times the grafts do not survive as long as their recipients. In the Khalil et al's experience, published in this issue of the Journal, they analyze their second kidney graft survival and describe those significant predictors of early loss. This editorial comments on the results and put in perspective that most of the times, long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason, and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.

Keywords: Kidney transplantation, Graft survival, Acute rejection, Interstitial fibrosis and tubular atrophy, Immunosuppression

Core Tip: Most of the times, kidney graft and recipient survivals do not match because of earlier graft failure. Apart from surgical or urological complications, the reason frequently is the appearance of donor-specific antibodies that mediate acute and chronic allograft damage because treating physicians intend to construct a tailor-made immunosuppressive therapy to each of their patients.