Renal transplantation

Renal transplantation is the preferred form of renal replacement therapy. It restores quality of life and increases longevity for individuals with end-stage renal failure (ESRF). Unfortunately, only 30% of patients who develop ESRF are fit enough to be listed for transplantation, because of excessive co-morbidities. The rejection process blighted initial attempts at human transplantation, but the advent of potent immunosuppression has markedly improved 1-year graft survival rates to over 90%. Nevertheless, the chronic deterioration of graft function after the first year remains a problem with only minor improvements in this respect over the last three decades. This is compounded by the deterioration in cadaveric donor organ quality, as donors have become progressively older, with increasing co-morbidity. Kidney transplant recipients (KTRs) swap one chronic illness for another, albeit one that is likely to be a change for the better. They must endure a lifetime with increased risks of vascular disease, neoplasia and infection.