Kidney Transplantation

In the last 35 years, few fields of medicine have undergone the rapid advances that have been seen with kidney transplantation. From the development of the surgical techniques necessary for transplantation at the beginning of the century, to the dawn of modern transplantation with the introduction of immunosuppressants in the late 1950s, and to its current status as the treatment of choice for end-stage renal disease (ESRD), renal transplantation has enjoyed remarkable progress. The surgical techniques for organ transplantation, including methods of vascular anastomosis, were developed in animal models by Carrel and Guthrie in the early 1900s. The first clinical deceased renal transplant was performed in 1933 by the Ukrainian surgeon Voronoy, with unsuccessful results secondary to the immunologic barrier. In the 1950s these obstacles were circumvented by performing the procedure between identical twins. The era of modern renal transplantation began with the introduction of the immunosuppressive agent azathioprine, and renal transplantation was established as a viable option for the treatment of ESRD.

For the majority of individuals with ESRD,transplantation results in superior survival, improved quality of life,and lower costs as compared with chronic dialysis.There are very few absolute contraindications and so most patients with ESRD should be considered as potential candidates. The surgery and general anesthesia, however, impose a significant cardiovascular stress.The subsequent lifelong chemical immunosuppression is also associated with considerable morbidity. Therefore, evaluation of a potential recipient must focus on identifying risk factors that could be minimized or may even contraindicate a transplant.