Renal transplantation today.
BACKGROUND
The first successful renal transplant was carried out more than five decades ago between identical twins. At these early days, acute rejection was the limiting factor.


CONCLUSIONS
Due to tremendous progress in immunosuppressive therapy and surgical technique, today, renal transplantation is the gold standard therapy for patients with end-stage renal disease. In fact, in comparison with chronic hemodialysis, renal transplantation offers an increase in quality of life while reducing comorbidities associated with dialysis treatment.


RESULTS
Despite numerous beneficial achievements, no further improvement regarding patient outcome can be observed over the last two decades. Graft survival rates remain unchanged. The leading causes for graft loss are chronic allograft nephropathy and death with functioning graft. This might be related to a constant increase of the proportion of donors presenting extended donor criteria as well as a more liberal acceptance of candidates for a renal transplant.


CONCLUSIONS
In the near future, one has to focus more closely on the posttransplant patient care to minimize factors associated with chronic allograft damage. These include post-transplant diabetes, hyperlipidemia, high blood pressure, cytomegalovirus infection, etc.
Neipp
Michael
M
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Neipp.Michael@mh-hannover.de
Jackobs
Steffan
S
Klempnauer
Jürgen
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005544:Forecasting; D005858:Germany; D006084:Graft Rejection / Q000209:etiology / Q000628:therapy; D006085:Graft Survival / Q000276:immunology; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D007165:Immunosuppression Therapy / Q000639:trends; D007223:Infant; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data / Q000639:trends*; D019520:Living Donors / Q000600:supply & distribution; D008866:Microsurgery / Q000639:trends; D008875:Middle Aged; D011157:Population Dynamics; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011788:Quality of Life; D006435:Renal Dialysis / Q000706:statistics & numerical data / Q000639:trends; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000639:trends; D016896:Treatment Outcome; D014600:Utilization Review / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult