Kidney transplantation at the University of Pennsylvania: 1998-2008.
Kidney transplantation at the University of Pennsylvania has grown substantially over the past 11 years. Although our transplant volume has increased primarily as a consequence of multiorgan transplants as well as the utilization of historically "marginal" allografts, our post-transplantation outcomes remain excellent in both children and adults. We attribute these outcomes to technical improvements in tissue typing and donor-recipient crossmatching, modification of immunosuppression protocols, and rigorous donor and recipient selection. In the next decade, we hope to substantially expand our living donor program and refine our overall donor and recipient selection process such that we maintain excellent post-transplant outcomes in the face of aging and increasingly comorbid donors and recipients. We further predict significant changes in post-transplant management of kidney recipients with respect to immunosuppression regimens. In particular, we anticipate the modulation of immunosuppression regimens in recipients with high titers of donor-specific antibody and the integration of B-cell specific immunosuppression into post-transplant patient care. Only time will tell whether such therapies will 1) improve long-term outcomes, 2) allow us to diminish the degree of non-specific pharmacologic immunosuppression currently in use, 3) or even promote donor-specific tolerance in kidney transplant recipients.
Porrett
Paige M
PM
University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Kamoun
Malek
M
Parsons
Ron
R
Bloom
Roy
R
Goral
Simin
S
Reese
Peter
P
Grossman
Robert
R
Baluarte
Jorge
J
Bleicher
Melissa
M
Doyle
Alden
A
Markmann
James F
JF
Levine
Matt
M
Barker
Clyde
C
Olthoff
Kim
K
Naji
Ali
A
Shaked
Abraham
A
Abt
Peter
P
D000017:ABO Blood-Group System; D002102:Cadaver; D002648:Child; D005006:Ethnicity; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D019520:Living Donors; D018579:Patient Selection; D010414:Pennsylvania; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D014495:Universities; D014850:Waiting Lists
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents