The alloimmune response is a complex cascade like reaction of the host that eventually leads to the destruction of the allograft by cytotoxic T cells. This response needs antigen presentation and recognition, antigen response and T cell activation, proliferation and differentiation of cytotoxic T cells. An appropriate immunosuppression can interfere with the alloimmune response and this has allowed the clinical realisation of renal transplantation. The selection of the donor and recipient together with an impeccable surgical procedure represent the basis for the success of renal transplantation. Cyclosporine is the mainstay for immunosuppression, but other agents such as corticosteroids, azathioprine, and bioreagents have contributed to a significant improvement of the results in the last years. Acute rejection and a progressive loss of allografts over time continue to occur. Moreover, immunosuppressive agents may expose patients to complications which may impair the quality of life and interfere with survival, In spite of these problems, however, the cadaveric graft survival approaches 90% at 1 year and 50% at 10 years, at least in the best centres. While the availability of new immunosuppressive drugs may further improve the results in the near future, the shortage of kidneys for transplantation remains an unresolved problem. Renal transplantation represents the treatment: of choice for most patients with end stage renal failure. The progress of clinical medicine and the recent availability of more powerful and more selective immunosuppressive drugs have contributed in reducing morbidity and mortality and in improving the graft survival rate. However, the clinical problems related to renal transplantation are still numerous and difficult to cope with.
|Number of pages||13|
|Journal||FORUM - Trends in Experimental and Clinical Medicine|
|Publication status||Published - 1995|
- Renal transplantation
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