[Renal transplantation in 2046: Future and perspectives]

Area of Science:

• Nephrology and Transplant Surgery
• Bioengineering and Regenerative Medicine
• Immunology

Background:

• Kidney transplantation faces organ shortages, necessitating alternative strategies.
• Xenotransplantation and regenerative medicine offer potential solutions but face significant hurdles.
• Inducing immune tolerance is crucial for transplant success.

Purpose of the Study:

• To review major findings shaping the future of kidney transplantation.
• To explore advancements in xenotransplantation, regenerative medicine, and immunomodulation.
• To identify key challenges and potential solutions for increasing organ availability and graft survival.

Main Methods:

• A comprehensive literature search was conducted using Medline and Embase databases (1960-2016).
• Keywords included bio-engineering, heterotransplantation, immunomodulation, kidney, regenerative medicine, and xenotransplantation.
• 86 relevant publications were selected from over 5600 identified articles.

Main Results:

• Xenotransplantation is limited by species barriers, recipient acceptance uncertainty, and ethical concerns.
• Regenerative medicine and bioengineering show promise but struggle with replicating renal complexity and vascularization.
• Immune tolerance can be achieved through T-cell depletion or bone marrow transplantation for lymphohematopoietic chimerism.

Conclusions:

• Research focuses on expanding the organ pool via xenotransplants and bio-artificial kidneys.
• Inducing immune tolerance is a primary goal to enhance allograft survival.
• These advancements herald a new era for renal transplantation, improving patient outcomes.