Are we making progress in kidney transplantation?

Purpose of review: Renal transplantation has become the preferred treatment modality for patients with end-stage renal disease. Renal transplantation confers both a quality of life and survival advantage over maintenance dialysis. Over the past 50 years tremendous strides have been made in our understanding of the immunobiology of transplantation, leading to the development of newer and more specific immunosuppressive agents. This, along with the advent of improved anti-infective strategies and diagnosis, has led to improvements in acute rejection and in short-term and intermediate-term graft survival. Recent findings: Although early projections appeared to indicate that short-term improvements in allograft survival were leading to improved long-term graft survival, more recent data indicate that long-term graft survival has not followed the salutary change in short-term outcomes. Furthermore, during the past 10 years we have witnessed a remarkable decrease in acute rejection, although clinical trials and registry analysis have failed to offer definite proof that this leads to improved long-term survival. Summary: In the future it will be vital to elucidate further the mechanisms of late allograft injury, and to develop reliable and validated surrogate markers to test new therapies that may improve graft survival.