Organ Transplantation

Abstract

The ancient dream of successful organ transplantation was finally realized 50 yr ago, on December 23, 1954, at the Peter Bent Brigham Hospital in Boston. Over the subsequent half century, the separate disciplines of clinical transplantation and transplant immunology have made remarkable progress. The story of the convergent evolution of these two fields represents one of modern medicine's most important advances. This path of discovery has uncovered both the practical and the fantastic, and along the way, it has been marked by the awarding of more Nobel Prizes than any other field of medicine. The movement of functional organs from one individual to another and the clinical manipulation of the immune system necessary to make this movement successful have gone from being a tour de force to part of everyday clinical practice in just 50 yr. Perhaps most striking, however, is the enduring effect of these advances on the way we think and dream about medicine itself.The purpose of this review is to enable the reader to share the hope and excitement present in the disciplines of immunology and transplantation, which together stand on the brink of what we believe will be a revolutionary second half century. We will focus in equal measure on the historical context in which the first successful kidney transplant operation occurred and the current milieu of transplantation, which itself is characterized by both rapid discovery and continued controversy. Finally, predictions about both the probable and the possible landmarks for the next 50 yr of transplantation will be proposed.

Randomized Trial of Immunosuppressive Regimens in Renal Transplantation

“…Although randomization of 50 patients per treatment arm only allowed reasonable statis- 1 Number of patients with the event (actuarial estimate of failure at 96 mo post-transplant Ϯ SE). 2 The P-values listed in this column represent the results of the logrank test (with 2 degrees of freedom) for any differences among the 3 treatment groups' hazard rates failure. The logrank test comparing the hazard rate of developing a protocol violation between Groups TAC/SRL and CSA/SRL combined vs. Group TAC/MMF yielded P Ͻ 0.0001, and the logrank test comparing this hazard rate between Groups TAC/SRL and CSA/SRL yielded P ϭ 0.12.…”

Thickening of the Peritubular Capillary Basement Membrane Is a Useful Diagnostic Marker of Chronic Rejection in Renal Allografts

“…Since the introduction of calcineurin inhibitors in the 1980s, the short-term survival of kidney transplants has improved significantly thanks to the reduced incidence of acute rejection (1,2). Improving the long-term survival of kidney allografts to more than 10 or 15 years is the major concern today (1,3), as increasing numbers of patients are on transplantation waiting lists.…”

Long-Term Graft Function in a Randomized Clinical Trial Comparing Laparoscopic Versus Open Donor Nephrectomy

“…1,2 The gap between supply and demand is increasing. Therefore, there is global trend toward living-donor kidney transplant.…”