Solid organ transplantation: has the promise been kept and the needs met? Solid Organ Transplantation in the Regenerative Medicine Era

Transplantation is a lifesaving treatment for many forms of solid organ failure. In the past half century, major improvements in surgical techniques, anesthesia, immunosuppression (IS), and perioperative care have led to a dramatic improvement in patient and graft survival, particularly following kidney and liver transplantation. Today the organ transplant community faces new challenges, which include not only improving the long-term survival of patients after transplantation, so that their survival expectancy is similar to that of nontransplanted patients but also expanding the pool of suitable donors and so allowing more people to receive a solid organ transplant. Currently, nearly all solid organ allografts require long-term IS to maintain good graft function. Current IS regimens are relatively nonspecific and so recipients are at greater risk of some infections and malignancies and are at increased risk of cardiovascular disease these contribute to reduced patient survival. With the success of general interventions to reduce premature death and changes in end of life care, not only is the potential donor pool shrinking but also getting older and heavier, so reducing both the number and the quality of organs suitable for transplantation. The advances in surgical, medical and anesthetic techniques have meant that more patients will be suitable candidates for transplantation. Thus, while solid organ transplantation remains the only effective treatment for many patients with end-stage disease, the availability of organs does not match the need and although the quality and length of life of those who do receive a graft is improved, both remain suboptimal