Transplantation Immunology.pdf - E-Lib FK UWKS

2 Callaghan and Bradley
Table 1
Underlying Renal Disease in UK Adult
Kidney-Only Transplants, 2003–2004
Not reported a 37.3%
Polycystic kidneys, adult type 10.4%
Pyelonephritis/interstitial nephritis 8.4%
Glomerulonephritis 7.7%
Diabetes mellitus (types 1 and 2) 6.7%
IgA nephropathy 6.6%
Renovascular disease 5.7%
Other diseases 17.2%
a A high proportion of this group is made up of patients
with end-stage renal disease of unknown cause.
Personal communication, UK Transplant, July 2004.
IgA, immunoglobulin A.
over dialysis (4). Transplantation is also the most cost-effective treatment for
ESRD (5,6).
This chapter aims to provide a brief overview of renal transplantation, with
emphasis on issues of current interest. For a more complete account of the field,
the reader is directed to one of the comprehensive textbooks available (7).
1.1. Current UK Activity and Results
The majority of patients with ESRD should be considered for renal transplantation.
The most common underlying diagnoses in adults undergoing renal
transplantation are glomerulonephritis, diabetes, pyelonephritis, renovascular
disease, and polycystic kidney disease (Table 1).* Contraindications to renal
transplantation are listed in Table 2. The success of renal transplantation is
reflected in the ever-growing numbers of patients waiting for a transplant. In
March 2003, 6447 people were on the active waiting list for a renal transplant
in the United Kingdom (Fig. 1), with a median waiting time for adults of approx
500 d. Although 1667 kidney transplants were performed in 2002, an increase
of 5% from the previous year, the disparity between demand and supply continues
to grow (Fig. 1).
The total number of renal transplants performed annually in the United Kingdom
has remained relatively static since the mid-1990s, despite recent improvements
in the number of living donor kidneys used. This is owing to reductions
* Statistics prepared by UK Transplant from the National Transplant Database maintained on
the behalf of transplant services in the United Kingdom and Republic of Ireland. UK Transplant
statistics can be found at http://www.uktransplant.org.uk/ukt/statistics/statistics.jsp.