Kidney transplantation: future challenges.

Kidney transplantation is the best replacement therapy for the patients with end-stage renal disease, by offering an increased longevity and quality of life. However, the demand for kidney exceeds the available supply, so that the number of people on waiting list is steadily increasing. Many transplant centers have tried to supply to this chronic shortage of organs, by utilizing kidney from older donors or from donors with a previous hepatitis, and this strategy resulted in a safe way to increase the donor pool. Living transplantation has progressively increased in last years so that the number of living donors exceeds in the USA the deceased donors. Although one-year graft survival is excellent, long-term outcomes has not improved in last years. Death from cardiovascular disease, infection and malignancy are common complications of immunosuppression and are the leading causes of mortality in kidney transplant recipients. Viral infections and donor-transmitted infections will be probably the emerging challenge in the next years. Physicians must be aware in developing newer immunosuppressive regimens, with lower side effects, which may improve the long-term outcome of kidney transplantation. Reduction of death with functioning graft and chronic allograft nephropathy will be the greatest challenge of all physicians who care for kidney transplant recipients.