Future Directions in Transplantation

Abstract

There have been extraordinary strides made in transplantation medicine as we near the 60th anniversary of the first human renal transplant procedure. Incremental improvements in graft and patient survival reflect refinements in patient and donor selection, better surgical techniques and immunosuppressive regimens, and the multidisciplinary approach to post-transplant management. The goal of establishing complete immunologic tolerance remains both elusive but at the same time inspiring. Barriers that have been overcome over the years include identification of donor specific antibodies pre- and post-transplant that can provoke immunologic responses, clinical and histopathologic criteria for the diagnosis of acute cellular rejection, recognition of antibody mediated rejection, development of potent anti-microbial drugs and identification of patients at risk for nosocomial infections such as mismatch donor-recipient patterns, development of an arsenal of immunosuppressive drugs that are more target-specific and less toxic, and increasingly sensitive and specific noninvasive techniques for the diagnosis of acute and chronic allograft rejection. Continuing impediments include the unremitting shortage of donor organs, the spiraling costs of pre-and post-transplant management and the limited number of new immunosuppressive drugs on the horizon.