[Renal transplantation in 2046: Future and perspectives].
OBJECTIVE
To report major findings that may build the future of kidney transplantation.


METHODS
Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) database from 1960 to 2016 using the following keywords, in association, "bio-engineering; heterotransplantation; immunomodulation; kidney; regenerative medicine; xenotransplantation". Articles were selected according to methods, language of publication and relevance. A total of 5621 articles were identified including 2264 for xenotransplantation, 1058 for regenerative medicine and 2299 for immunomodulation; after careful selection, 86 publications were eligible for our review.


RESULTS
Despite genetic constructs, xenotransplantation faces the inevitable obstacle of species barrier. Uncertainty regarding xenograft acceptance by recipients as well as ethical considerations due to the debatable utilization of animal lives, are major limits for its future. Regenerative medicine and tridimensional bioprinting allow successful implantation of organs. Bioengineering, using decellularized tissue matrices or synthetic scaffold, seeded with pluripotent cells and assembled using bioreactors, provide exciting results but remain far for reconstituting renal complexity and vascular patency. Immune tolerance may be achieved through a tough initial T-cell depletion or a combined haplo-identical bone marrow transplant leading to lymphohematopoietic chimerism.


CONCLUSIONS
Current researches aim to increase the pool of organs available for transplantation (xenotransplants and bio-artificial kidneys) and to increase allograft survival through the induction of immune tolerance. Reported results suggest the onset of a thrilling new era for renal transplantation providing end-stage renal disease-patients with an improved survival and quality of life.
Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France. Electronic address: marc-olivier.timsit@aphp.fr.
M-O
MO
Timsit
Service d'urologie et transplantation, CHU de Nantes, 44000 Nantes, France.
J
J
Branchereau
Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France.
R
R
Thuret
Service d'urologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
F
F
Kleinclauss
D005544:Forecasting; D006801:Humans; D056747:Immunomodulation; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000639:trends*; D023822:Tissue Engineering; D014183:Transplantation, Heterologous
Bio-ingénierie; Bioengineering; Immunomodulation; Kidney; Médecine régénérative; Regenerative medicine; Rein; Tolerance; Tolérance immunitaire; Xenotransplantation; Xénotransplantation