[Renal transplantation in adult]

Renal transplantation is now considered the best treatment to be offered to patients with a stage 5 chronic kidney disease. It produces an improvement in the patients quality of life and more importantly a prolongation of their survival. These good results have created an organ shortage due to the discrepancy between the ever growing demand of patients and the lesser increase in the number of available kidneys to be transplanted. The success of kidney transplantation relies on both the quality of the graft itself and also on the immunosuppressive therapy aiming at the prevention of allograft ejection, be it acute or chonic. Currently available treatments are very efficient on a short term basis but stable long term results over time suggest a lesser efficacy on the long term probably and partly due to the observance difficulties. One year after kidney transplantation, patients may lose their kidney either as a consequence of chronic allograft dysfunction (of immunologic or non immunologic origin) or die with a functionning kidney secondary to cardiovascular disease, cancer or infection. Current research is aiming at a better utilization of available ressources (living donors, marginal kidneys, patients at high immunological risk), individualization of immunosuppression, new immunosuppressive agents with a better efficacy and less side effects with the hope that it will be possible in the near future to either reveal or induce a state of tolerance towards the transplanted kidney.