Immunologic tolerance in renal transplantation

The current excellent short-term results of renal transplantation are achieved at the expense of complications of chronic immunosuppression. These include increased risk for infection, malignancy, and long-term deterioration of function ("chronic allograft nephropathy"). The induction of transplantation tolerance, the long-term acceptance of an allograft without continuous immunosuppression, has been a goal of transplant immunologists for the last 40 years. Unfortunately, this has been easier to achieve in rodents than in humans. Nevertheless, this body of research has significantly increased our knowledge of the workings of the immune system and specifically, how the body differentiates between "self" and "nonself". Using these insights, several promising approaches to the clinical induction of transplant tolerance have emerged and are undergoing clinical evaluation.