Transplantation

Abstract

The first successful human corneal transplant was around 1900 by Zirm, corneal xenografting having been tried as early as 1837 but without notable success. From the early 1950s, Calne envisaged kidney transplantation as a practicable therapy; and surgical, immunological, and immunosuppressive advances made it so by the mid‐1980s. By 1970, Barnard had pioneered heart transplantation; and liver transplantation was also under way. Xenografting from transgenic pigs was an unrealized challenge of the next decades, together with improvements in unrelated donor bone marrow transplantation and therapeutic exploitation of stem cell banking. Interventional ventilation has not been proceeded with, and there has been more emphasis on realizing national potentials for living related kidney transplantation together with ethical and matching safeguards for unrelated living renal transplantation. By 1990, transplantation had achieved 1‐year graft survival rates of 80% or more for most solid organs, and had done so through surgical innovation, advances in immunosuppression, beneficial and favorable matching of kidney donor to recipient, better preservation solutions, and by studying center variation in donor rates as well as in transplant outcome. In the 1990s, shortage of cadaveric donor organs was a limiting factor which the use of split livers or of domino heart transplants from cystic fibrosis heart‐lung block recipients mitigated only very partially. Epidemiological studies monitor malignancies secondary to immunosuppression. Quality of life as well as length of life ( see Life Expectancy ) is improved by transplantation. Statistical science has underpinned much of the above progress. The past decade has seen transplant organizations internationally seeking to increase the equity and transparency as well as efficiency (e.g., in terms of quality‐adjusted life‐years) of their policies for national (and local) allocation of cadaveric donor organs.