Transplantation Overview
Indications for Transplantation
This section describes the indications for transplantation, including the most common conditions resulting in organ failure for each transplant group.
Also included is a discussion of alternatives to transplantation where appropriate.
Kidney
Kidney transplantation is the primary therapy for end-stage renal disease (ESRD; stage 5 chronic kidney disease).
Epidemiology
Here we discuss the epidemiology of transplantation, covering the scale of transplantation, the identification of suitable candidates for organ transplantation and the numbers of living and deceased donors in different regions. Also covered are the complication rates, burden of disease and difficulties of accessing transplant organs.
Also covered are the complication rates, burden of disease and difficulties of accessing transplant organs.
Surgical Procedures
Surgical procedures for transplantation are constantly evolving. This section aims to provide a focal point from which current guidelines and reviews can be accessed. Links to recent reviews on surgical technique can be found here, as well as guidance from sources providing comprehensive practical information on the complex issues surrounding kidney, liver, heart, lung, pancreas, SPK and intestine transplantation.
as well as guidance from sources providing comprehensive practical information on the complex issues surrounding kidney, liver, heart, lung, pancreas, SPK and intestine transplantation.
Immunosuppression
Modern medicine has revolutionised the field of transplantation. When the first human deceased kidney transplant took place in 1933, a mismatch in patient and donor blood groups resulted in patient mortality after just 2 days.
The first successful kidney transplant was achieved in monozygotic twins in 1954, when immunosuppression was not available, but fortunately not needed in this instance.
Long-term Outcomes
Transplantation is now recognised as the best therapy for patients with acute and chronic end-stage organ failure and its implementation has improved the lives of many patients worldwide, improving quality of life, and often life expectancy. However, overall life expectancy remains significantly reduced.
Despite marked improvements in surgical outcomes and the rate of rejection, cardiovascular disease cancer and infection remain significant morbidities and are the three main causes of death following transplantation (Chapman et al., 2013). In this section, we break down the reasons for these causes of mortality and discuss options for improving long-term outcomes.
Future Developments
Organ transplantation is still a relatively new field in medicine; although the first kidney transplant was performed in 1954, it was only with the development of immunosuppression in the 1980s that it became more widely utilised.
There remains a chronic mismatch between the number of patients on waiting lists and the availability of suitable organs for transplantation, which some consider to be the greatest challenge in modern transplant medicine.
References
Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 2008;3:471–80.
Abdelwahab Elhamahmi D, Heilman RL, Smith B, Huskey J, Khamash H, Kaplan B. Early conversion to belatacept in kidney transplant recipients with low glomerular filtration rate. Transplantation. 2018;102(3):478–83.
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Developed by EPG Health for Medthority in collaboration with Novartis Pharma AG, with content provided by Novartis Pharma AG. GLEM/RAD/0010008 (Jul 2018), 0012 (Sep 2018), 0017 (Jun 2019), 0033 (Nov 2019).