Despite the substantial successes of kidney transplantation, this field continues to be hampered by the inability to monitor the intensity of the immunosuppressive regimens. As a result, chronic antibody-mediated rejection (under-immunosuppression), as well as drug-related toxicity, malignancies, and opportunistic infections (over-immunosuppression) continue to be the leading causes of allograft loss.
In addition, counter to all the predictions, the vast improvement in the early acute rejection rate has not resulted in similar improvement in long-term allograft survival. Serum creatinine, the traditional marker to monitor kidney function, is highly unreliable in predicting renal injury of any kind. Protocol kidney biopsies, in addition
Is it possible to turn unusable organs into transplantable organs? Ex vivo pulsatile machine perfusion of donor organs is a proven technique for superior organ preservation, reduced delayed graft function, and reduced ischemia-reperfusion injury. This has been the standard of care for over four decades in high-volume transplant centers.
The perfusate solutions used for kidneys are typically crystalloids with several additives, such as antioxidants, electrolytes, antibiotics, nutrients, vasodilators, and corticosteroids. The perfusion temperatures are typically kept at 4°C to 8°C to help minimize cell metabolism and hence, have a better preserved organ. However, the significant drawback of this hypothermic perfusion
The enduring success of solid organ transplantation over the past six decades is also accompanied by the need for immunosuppression regimens with their related systemic toxicity. Transplantation between immunologically diverse individuals led to shortened allograft survival for immunologic reasons (acute and chronic rejection) and nonimmunologic reasons (toxicity of the immunosuppressive medication regimens).
As a proof of concept, kidney transplantation between genetically identical twins without the requirement of immunosuppressive regimens was successful and ushered in a new era. However, for the larger majority of individuals undergoing allotransplantation, the concept that transplanting the donor’s immune system (bone marrow) along with the solid
In July 2019, President Trump signed an executive order to launch Advancing American Kidney Health. This event underscored the importance and the urgency of recognizing kidney disease as a national priority. One of the three goals of this order is to double the number of kidneys available for transplantation by 2030. Although this idea might appear to be impracticable at the outset, the data presented in this brief report suggest that the process is already well under way.
Since 2014, the majority of the kidney transplantation centers across the United States have reported record increases in the volume of kidney
In the March issue of Kidney News, a study by Axelrod et al. (1) was featured that analyzed the costs of kidney transplantation. The study found that costs are increasing substantially, mostly because of the increased complexity of transplant recipients and a lack of changes in the reimbursement model by payers.
This article will highlight several other points that contribute to the increasing costs and will focus on the unintended effects of the current regulatory environment, as well as review some of the historical aspects of kidney transplantation regulation. Specifically, the combination of increasing regulation by