m o d THE FOURTH DECADE of publication of Transplantation Proceedings illustrated the worldwide implementation of kidney, liver, pancreas, heart, lung and progressively small bowel transplantation. Documenting this therapeutic expansion, the Proceedings markedly extended its vistas to describe the activities of numerous regional, national and international societies (Table 1). The series of 50-year retrospective reviews of the field after the first successful renal transplantation between identical twins included contributions related to the kidney by Murray and by Calne; the liver by Starzl; the lung by Hardy; kidney plus pancreas by Najarian; immunobiology y Rapaport, Bach, and Brent; immunosuppression y Schwartz; human leukocyte locus A by Dausset and by Terasaki; cyclosporine (CsA) by its developer, Jean Borel, s well as Stiller, Starzl, and Kahan. Cutting edge updates in transplantation were subsequently provided by Shapiro et al who described the dmonton Protocol for islet; Barr, lung; Starling’s team, heart; Harmon, pediatric renal; Kelly, pediatric liver; Sutherland and Gruessner, pancreas; Stock et al, HIVositive patients; Ponticelli, steroid-free immunosuppresion; Grinyo’s team, gene therapy; and Moreno-Casado, combined lung plus liver procedures. The tremendous expansion of the enterprise demands implementation of strategies to maintain physician contact with patients by telematic networks, as described by Arias’ team, as well as computer-based physician training, for example, in aspects of liver transplantation as reported by Kallinowski’s group. Intestinal transplantation emerged at the horizon of routine clinical practice, as described by Tzakis’ team and by Langnas. Thiede’s group confirmed amelioration f small bowel alloimmunity by simultaneous orthotopic iver transplantation (OLT) as noted previously by Grant. lthough Tzakis et al obtained prolonged bowel survival by induction of mixed allogeneic chimerism using nonlethal irradiation and antilymphocyte serum, they later proselytized a more flexible immunosuppressive trategy employing the anti-CD52 monoclonal antibody