Surgical aspects of renal transplantation: contributions to solutions for complex problems

The first successful human renal transplantation was done in 1954 at Boston and many viewed this as a technical success. Since the allograft was from an identical twin, the problem of immunosuppression was overcome and other lessons learnt from the procedure has come a long way to establish renal transplantation as the preferred treatment of choice for patients with end stage renal disease (ESRD). While the surgical technique has changed little, what has evolved over the last 50 years, has been the explosion in immunosuppression, the improvement in anesthetic techniques, imaging modalities and diagnostic techniques. This has made it possible for many patients to be accepted for transplantation who were earlier not considered fit for the procedure. Further understanding of bladder function and reconstructive surgical techniques of lower urinary abnormalities both congenital and acquired, which could lead to ESRD, has widened the patient base for renal transplantation. This article aims to discuss some of these issues.