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KEY POINTS

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  1. The field of transplantation has made tremendous advances in the last 50 years, mainly due to refinements in surgical technique and development of effective immunosuppressive medications.

  2. Although immunosuppressive medications are essential for transplantation, they are associated with significant short- and long-term morbidity.

  3. Opportunistic infections can be significantly lowered by the use of appropriate antimicrobial agents.

  4. Kidney transplantation represents the treatment of choice for almost all patients with end-stage renal disease. The gap between demand (patients on the waiting list) and supply (available kidneys) continues to widen.

  5. Pancreas transplantation represents the most reliable way to achieve euglycemia in patients with poorly controlled diabetes.

  6. The results of islet transplantation continue to improve but still trail those of pancreas transplantation.

  7. Liver transplantation has become the standard of care for many patients with end-stage liver failure and/or liver cancer.

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BACKGROUND

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Organ transplantation is a relatively novel field of medicine that has made significant progress since the second half of the twentieth century. Advances in surgical technique and a better understanding of immunology are the two main reasons that transplants have evolved from experimental procedures, just several decades ago, to a widely accepted treatment today for patients with end-stage organ failure. Throughout the world, for a variety of indications, kidney, liver, pancreas, intestine, heart, and lung transplants are now the current standard of care.

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But the success of transplantation has created new challenges. A better understanding of the pathophysiology of end-stage organ failure as well as advances in critical care medicine and in the treatment of various diseases led to expanding the criteria for, and decreasing the contraindications to, transplants. As a result, the discrepancy between the ever-growing number of patients awaiting a transplant and the limited number of organs available is one of the biggest challenges (Fig. 11-1). In 2009 alone, according to the United Network for Organ Sharing (UNOS), about 105,000 patients in the United States were awaiting a transplant, yet the number of transplants performed was only about 28,000 (Fig. 11-2).

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Figure 11-1.

Patients on the waiting list and the number of organ transplants performed, 2000 to 2009. (U.S. data from the Scientific Registry of Transplant Recipients Annual Report, http://srtr.org)

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Figure 11-2.

Patients on the waiting list and the number of organ transplants performed, 2009. KP = kidney and pancreas. (U.S. data from the Scientific Registry of Transplant Recipients Annual Report, http://srtr.org)

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DEFINITIONS

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In addition to being the overall name of this relatively new field of medicine, transplantation is the process of transferring an organ, tissue, or cell from one place to another. An organ transplant is a surgical procedure in which a failing organ is replaced by a functioning ...

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