Kidney transplantation: surgical aspects

The outcomes of kidney transplantation have improved dramatically over recent decades such that kidney transplantation is now the treatment of choice for end-stage renal failure. This success is attributable to improvements in histocompatibility testing, organ procurement and preservation, as well as more effective and safer immunosuppression. Kidneys are usually obtained from deceased donors, but the proportion of live donors has substantially increased. The increasing demand for organs has also necessitated the use of kidneys from less ideal deceased donors including older donors and donors with history of cardiovascular disease. Complications of kidney transplantation may be related to the surgery or sequelae of long-term immunosuppression such as malignancy and infections. Chronic graft dysfunction is multifactorial and continues to represent an important challenge for kidney transplantation.