Kidney transplantation--the long term view

Abstract

Kidney transplantation is a routine and highly successful treatment for end-stage renal disease and transforms the lives of most recipients.1 However, in contrast to the transplantation of other major organs, the availability of artificial kidney function in the form of dialysis means that patients without kidney function can live for many years without transplantation. For this reason, the risks and benefits of kidney transplantation must be carefully weighed up against those of dialysis for each patient. Since the first kidney transplants were performed in the 1950s,2 there have been major advances in both transplantation and dialysis and the risks and benefits for both options have changed. Kidney transplantation has lifestyle advantages and is cheaper than dialysis, but there is a shortage of organs. The UK kidney transplant waiting list grew by 8% last year3 and in 2006, 16% of patients on waiting lists in the US died while waiting for an organ transplant.4 Early kidney transplant regimens relied on steroids and azathioprine to prevent rejection with some success, but the introduction of cyclosporin over 30 years ago substantially reduced rejection.5 Further refinements came …