Abstract:

Inthe past 40 years, clinical renal transplantation has evolved from a risky, highly speculative endeavor to a fairly mature, well-established service. There are hundreds of programs around the world, transplanting thousands of patients annually, and reasonably good suecess rates have been achieved. Current expectations are of one year patient survival of 90 - 98%, and one year graft survival of 75 _90%. In addition, patients who have been successfully transplanted have a markedly improved quality oflife compared with patients on dialysis. However, in spite of these encouraging results, there remain significant problems. Among them are acute rejection, which still occurs in 40 - 75% of cases, and graft loss secondary to rejection, acute or chronic, which limits the half-life of cadaveric kidneys to 8 years. As part of an effort to address these issues, there have been a number of new immunosuppressive agents and therapeutic modalities that have been investigated over the past several years. This chapter will focus on 2 areas of ongoing research in our institution, the use of FK506 in renal transplant patients, and the program of combined kidney/bone marrow transplantation.

Authors:

Ron Shapiro, M.D., University of Pittsburgh School of Medicine, Pittsburgh PA

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