The Most Commonly Transplanted Organ Is the Kidney

As mentioned above, the most commonly transplanted organ is the kidney; in 2000, there were 13,258 kidney transplants performed in the United States. Major factors contributing to this number are the numerous clinical indications for kidney transplantation. Many common diseases, such as diabetes and various types of nephritis, result in kidney failure that can be alleviated by transplantation. With respect to availability, kidneys can be obtained not only from cadavers but also from living relatives or volunteers, because it is possible to donate a kidney and live a normal life with the remaining kidney. In 1999,4457 of the 12,483 kidneys transplanted in the U.S. came from living donors. Surgical procedures for transplantation are straightforward; technically, the kidney is simpler to reimplant than the liver or heart. Because many kidney transplants have been done, patient-care procedures have been worked out in detail. Matching of blood and histocompatibility groups is advantageous in kidney transplantation because the organ is heavily vascularized, but the kidney presents no special problems that promote rejection or graft-versus-host disease (GVHD), as the bone marrow or liver do.

Two major problems are faced by patients waiting for a kidney. One is the short supply of available organs, and the second is the increasing number of sensitized recipients. The latter problem stems from rejection of a first transplant, which then sensitizes the individual and leads to the formation of antibodies and activation of cellular mechanisms directed against kidney antigens. Any subsequent graft containing antigens in common with the first would be quickly rejected. Therefore, detailed tissue typing procedures must be used to ascertain that the patient has no antibodies or active cellular mechanisms directed against the potential donor's kidney. In many cases, patients can never again find a match after one or two rejection episodes. It is almost always necessary to maintain kidney-transplant patients on some form of immunosuppression, usually for their entire lives. Unfortunately, this gives rise to complications, including risks of cancer and infection as well as other side effects such as hypertension and metabolic bone disease.

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