The improving prognosis after kidney transplantation. New strategies to overcome immunologic rejection.

For the 70,000 patients with end-stage renal disease in the United States, renal transplantation offers the only hope of full recovery from chronic renal failure. However, transplantation has had only limited use, principally because of the risks of graft rejection and immunosuppression. The last ten years have witnessed striking improvements in the survival of patients and grafts resulting from advances in immunologic management, including restricted use of immunosuppression, better histocompatibility testing, HLA matching, blood transfusions, and new drugs for prevention and reversal of transplant rejection. Kidney transplantation now is safe and effective and should be considered for most young and middle-aged adults.