Kidney Transplantation

Abstract

Chronic kidney disease is estimated to afflict 200 million people worldwide, and since the first successful human kidney transplant was performed in 1954, the field of kidney transplantation has exploded, with approximately 85,000 kidney transplants occurring globally each year. Over time, we have learned that living donor grafts confer superior survival compared with organs from deceased donors, but despite using organs from both living and deceased donors, the demand for kidney transplantation continues to substantially outpace the supply.

The kidney transplant procedure involves the implantation of a donor kidney into a recipient artery, vein, and bladder. The iliac vessels are most commonly used for arterial inflow and venous outflow and the host bladder is used for urinary continence. Technical complications after transplantation include bleeding, thrombosis, or stenosis of the vascular anastomoses, lymphocele formation, and ureteral leaks, strictures, and reflux. Despite advances in induction and maintenance immunosuppression regimens, recipients also may experience cellular or antibody mediated rejection.

As we continue to experience a shortage of donor organs, issues of national self-sufficiency and organ trafficking have arisen. Self-sufficiency can be obtained through robust deceased donor programs or optimization of living donor transplants, and is critically important in allowing countries to meet the demand of their residents. Perhaps the most severe and unethical response to unmet demand is participation in organ trafficking, which the World Health Organization estimates to occur in approximately 10% of solid organ transplants. While we continue to pursue technical innovations, tinker with immunosuppression, and restructure allocation, we must keep these ethical issues at the core of our goals and behavior.