TRAMSPLATTTATION



In suitable individuals, renal transplantation is a valid option for treatment of patients with end-stage renal disease. Although patient survival is approximately equal in patients receiving a renal transplantation and those treated by dialysis, there are significant differences between these forms of replacement therapy. A successful trans­plant more closely approximates the function of the normal kidney than does dialysis. Dietary re­strictions are considerably less and the patient is no longer obligated to the time required to per­form dialysis. The advantages of transplantation are partially offset by the requirement for im­munosuppressive drugs, with the consequent re­sults of infections and neoplasms and the risks associated with immunological rejection of the transplanted kidney.

The success of a renal transplant is dependent upon a number of factors. Perhaps the most im­portant factor is the immune tolerance of the re­cipient. In general, the better the match of tissue antigens between donor and recipient, the better the outcome. Organ donation by a living relative therefore has a better renal outcome than does do­nation from a cadaveric source. The inherent im­mune responsivity of the recipient also deter­mines the tolerance to a transplanted organ. Finally, the ability of drugs to modify the immune response is a factor in the overall success rate of renal transplantation. Tissue typing and mea­surements of reactivity of the recipient to the donor are determined by clinical laboratory meth­ods. The use of these tests has improved the out­come from transplantation by providing a closer match between donor and recipient and avoiding transplantation in patients with unfavorable im­munological parameters. In addition, considera­ble progress has been made in modulating the im­mune response of the recipient by the use of immunosuppressive drugs, including corticoster­oids, azathioprine, cyclophosphamide, and cy-closporine, and by the use of other immuno-modulating agents, such as antilymphocyte globulins, monoclonal antibodies, and pretrans-plant blood transfusions. It is likely that contin­ued development of better matching techniques and the ability to modulate the immune response with drugs and agents with acceptable toxicities will improve the success rate of renal transplants.