Clinical results and outcome of kidney transplantation today

Kidney transplantation provides a successful clinical procedure in the repl acement of renal function. One year graft survival after primary cadaveric transplantation exceeds 90% today due to the introduction of new generation immunosuppressants. As organ shortages are the most important limitation i n clinical transplantation an increasing number of transplants from margina l donors are performed worldwide. Chronic rejection accounts for the most i mportant cause of graft failure and major improvements in the treatment of chronic allograft vasculopathy have not been achieved to date. Brain death can be considered as an independent risk factor for graft failure since reg istry data indicate that living-donor grafts from unrelated spouses result in superior survival rates as compared to well matched cadaveric transplant s. A striking difference exists between living and postmortal donor kidneys in that vascular adhesion molecules and MHC II are elevated after severe b rain injury. Employment of catecholamines to brain-dead donors has the pote ntial to reverse the expression of endothelial adhesion molecules thus redu cing acute rejection after transplantation. Kidney transplantation is assoc iated with superior health-related quality of life and results in a substan tial survival benefit in comparison with hemodialysis during long-term foll ow-up. In the absence of contraindications all patients with chronic renal failure should be forwarded to transplantation and the possibility of a liv ing transplant should be addressed.