New concepts in organ transplantation

Over the past several decades, many factors have led to higher rates of patient and graft survival in organ transplantation. These factors include enhanced immunosuppressants available in recent years such as Neoral, Prograf, sirolimus, mycophenolate mofetil and anti-interleukin-2 receptor monoclonal antibodies. In addition, other new drugs, such as FTY 720, FK 778, anti-CD20, anti-CD40, and anti-CH52 monoclonal antibodies, are now being tested in clinical studies. Furthermore, there have been advances in surgical techniques, such as the piggyback method without venovenous bypass, side-to-side anastomosis of the hepatic veins, use of vascular staplers, biliary duct-to-duct anastomosis with or without tube drainage, microsurgical hepatic artery anastomosis and laparoscopic donor nephrectomy. Finally, better patient and donor selection criteria with regard to HBV- and HCV-seropositive donors, diabetic donors, donors with malignancies, older donors, ABO-incompatible donors, and non-heart-beating donors have been combined with optimal timing of transplantation, better options for treating early surgical and late medical complications, and improved management in intensive-care units. Other noteworthy scientific and social development are on the horizon namely genetic advances in xenografting and cell transplantation, and induction of immunologic tolerance. This article reviews the current developments that have significantly improved graft and patient survival among solid-organ transplants.