Kidney transplantation

Renal transplantation is the optimal form of renal replacement therapy, and should be considered in all patients with end stage renal failure. It is effective and cost-effective. Kidneys can be obtained from living donation or deceased donation (either after brain death or after circulatory death). Immunosuppression is required for the life of the allograft to prevent rejection. A typical regimen comprises an induction agent (either an IL-2 or CD52 receptor antagonist) and maintenance triple therapy (calcineurin inhibitor, anti-proliferative agent and steroids). Retrieval of the kidneys from a deceased donor is performed as part of the multi-organ retrieval process. Living donor nephrectomy can be performed laparoscopically or open. A number of risks are attached to the transplant operation, but generally outcomes are good. New approaches to shorten waiting lists for renal transplantation include paired-exchange programmes, domino transplants and transplantation across ABO or HLA boundaries.