Progress in Transplantation: Will It Be Achieved in Big Steps or by Marginal Gains?
A wish for progress in transplantation assumes that there are needs not met by the currently available therapy and that the barriers to resolving the problems can be surmounted. There are 5 major unmet needs: the potential to avoid transplantation either by prevention of disease or provision of an alternative to natural biological organ replacement; geographic heterogeneity of access to, and quality of, transplantation; availability of transplantation to those in need of it; survival of the patient and the transplant; and the avoidance of adverse effects of immunosuppression. During the past 50 years, there have been advances on at least 4 of these 5 fronts that illustrate the interplay of "big steps" and "marginal gains" in the following areas: surgical technique, testing the immunologic barriers, introduction of chemical and biological immunosuppression, and prophylaxis for microbial infections. The potential for further improvement comes in 5 major areas: blood biomarkers for monitoring of rejection, drug-free transplantation through the development of stable tolerance, eliminating the impact of ischemia-reperfusion injury, xenotransplantation of porcine kidneys, and finally, the possibility of autologous regeneration of functioning kidney tissue to treat advanced kidney disease.
Centre for Transplant and Renal Research, University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia. Electronic address: jeremy.chapman@sydney.edu.au.
Jeremy R
JR
Chapman
D000818:Animals; D035843:Biomedical Research; D006301:Health Services Needs and Demand; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007668:Kidney; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D011183:Postoperative Complications / Q000517:prevention & control; D058996:Quality Improvement; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D013997:Time Factors
Kidney transplantation; biomarkers; end-stage kidney disease; graft survival; health disparities; immunosuppression; ischemia-reperfusion injury; rejection; renal transplant; review; viral prophylaxis; xenotransplantation