Factors influencing long-term allograft survival

Abstract

As the demand for solid organ transplants has continued to outgrow the available supply of cadaveric organs, increased attention has been focused upon the steady attrition of transplanted organs due to chronic rejection. The UNOS published half-life for cadaveric renal allografts is approximately 8.5 years, not significantly different from the 7.7 year half-life published for cadaveric renal allografts under azathioprine-prednisone immunosuppression. This steady loss of functioning cadaveric renal transplants has led some clinicians to state that this loss is inevitable, due to the inability of current immunosuppressive therapy to influence the immunobiologic processes leading to chronic rejection. These include low-level B-cell activation and expansion of TH₁ T-cell populations directed against donor antigens.