Modern renal transplantation: present challenges and future prospects.

Renal transplantation offers patients with end stage renal failure improved survival and quality of life compared with dialysis. Although more transplants are being performed in the UK and elsewhere, the size of the renal transplant waiting list is increasing at a faster rate. Live donor transplantation between antibody compatible and incompatible pairs is one of the short term solutions to this; it may also be a sensible long term strategy since it affords better outcomes. Following successful transplantation, balancing the chronic and often deleterious effects of immunosuppression with chronic immune damage poses the key clinical challenge for transplant physicians today. Research efforts worldwide are focused towards immunological tolerance of transplanted organs with two main questions: first, how can we induce tolerance; and second, how can we test that it is operational? Immunosuppressive protocols vary greatly between transplant units, which may be reflected in differing patient and allograft survival.