1. The field of transplantation has made tremendous advances
in the last 30 years, due mainly to refinements of surgical technique
and development of effective immunosuppression medications.
2. Although immunosuppression drugs are essential for transplant,
they are associated with significant short- and long-term morbidity.
3. Kidney transplantation now represents the treatment of choice
for almost all patients with end-stage renal disease.
4. Liver transplantation is the viable option at present for patients
with end-stage organ failure.
5. Pancreas transplantation and in the future islet cell transplantation
represent the most reliable way to achieve euglycemia in the poorly
controlled diabetic patient.
6. Opportunistic infections can be significantly lowered by the
use of appropriate prophylaxis agents.
Although references to transplantation have existed in the scientific literature
for centuries, the field of modern transplantation did not come
into being until the latter half of the twentieth century. Thus, given
its short history, it is truly remarkable how far this area of medicine
has advanced. From an experimental procedure just 50 years ago,
transplantation has evolved to become the treatment of choice for
end-stage organ failure resulting from almost any of a wide variety
of causes. Transplantation of the kidney, liver, pancreas, intestine,
heart, and lung has now become commonplace in all parts of the world.
In fact, transplantation is now so widely accepted and successful
that the main problem facing the field today is not surgical technique, rejection,
or management of complications, but rather supply of organs. An
increasing number of diseases and patients are now potentially treatable
with transplants; however, this increase, coupled with the decrease
in contraindications to transplants, has meant an increasing number
of patients are now awaiting organ replacement therapy. The number
of transplants performed yearly has increased over the last decade,
but has not kept pace with the steadily growing waiting list. As
a result, the gap is ever widening between the number of transplants
performed and the number of waiting patients (Fig.
Patients on waiting list and number of organ transplants for
2005. (U.S. data from Organ Procurement and Transplantation Network/Scientific
Registry of Transplant Recipients Annual Report, http://www.ustransplant.org).
KP = kidney and pancreas.
Transplantation statistics in the United States are tracked by
the United Network for Organ Sharing (UNOS). By the end of 2007, roughly
98,000 patients were awaiting a transplant, while the number of
transplants performed in that year was approximately 28,000.
Transplantation is the act of transferring an
organ, tissue, or cell from one place to another. Broadly speaking,
transplants are divided into three categories based on the similarity
between the donor and the recipient: autotransplants, allotransplants,
and xenotransplants. Autotransplants involve the
transfer of tissue or organs from one part of an individual ...