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.
University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Paige M
PM
Porrett
Malek
M
Kamoun
Ron
R
Parsons
Roy
R
Bloom
Simin
S
Goral
Peter
P
Reese
Robert
R
Grossman
Jorge
J
Baluarte
Melissa
M
Bleicher
Alden
A
Doyle
James F
JF
Markmann
Matt
M
Levine
Clyde
C
Barker
Kim
K
Olthoff
Ali
A
Naji
Abraham
A
Shaked
Peter
P
Abt
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