Transplantation: focus on kidney, liver and islet cells.

Over the past decade, advances in immunosuppression, organ preservation, surgical techniques and perioperative management have resulted in improved survival rates for solid organ transplants. Even so, the field of transplantation still presents many challenges. A critical obstacle is the shortage of donor organs. The paucity of cadaveric organs has increased the demand for living donor transplantation. Although this option has expanded the organ pool, concerns over ethical issues and donor safety remain, and there is an ongoing effort to make living donation a safer and less invasive process. An alternative to solid organ transplantation involves the transplantation of cells, such as islet cells for type 1 diabetes mellitus. Whereas transplantation of solid organs has seen steady improvement over the past 2 decades, transplantation of islet cells has not. Recent advances in the field of islet cell transplantation, however, have made this procedure a clinical reality. Stem cell research has provided a glimpse into the possible future of transplantation for organ failure. Another major barrier to transplantation is the lifelong need for immunosuppression. Current immunosuppression protocols place transplant recipients at continuing risk for immunosuppression-associated complications such as infection and malignant disease. New agents continue to reduce the rates of acute graft rejection and to increase long-term survival; however, they have exposed metabolic and cardiovascular complications without affecting the incidence of chronic rejection. The ultimate goal of many investigators in this field is to achieve specific immunologic graft tolerance. In this article we summarize recent technical advances in the field of transplantation that address some of the challenges.