Transplantation: current developments and future directions.

An historical overview of transplantation is presented in which the medical, legal, ethical, physiological and immunological issues are reviewed in the context of the definition of death. A discussion of the benefits of minimal immunosuppression is presented as an attractive proposal compared with conventional immunosuppression. Prope tolerance was first used with the powerful lympholytic monoclonal antibody Campath 1H. The five-year follow-up of the first renal transplant patients treated with Campath induction and maintenance low-dose cyclosporine has been satisfactory, thus indicating considerable experience of the use of induction followed by steroid-free minimal maintenance immunosuppression. It appears likely that this will become a favoured method of recipient management.