Mr Chris
Rudge
Medical Director, UK Transplant
Renal transplantation is now widely
held to be “successful”. For selected
patients, the likelihood of survival is greater following transplantation than
if the patient had continued on dialysis.
Short- term graft survival has been increasing steadily throughout the
last ten years, although chronic graft loss is still unacceptably high. Factors that influence patient and graft
survival are increasingly well documented and several - such as blood pressure, lipids and post-transplant
diabetes – can be controlled. The
influence of HLA matching is becoming less marked.
However there are other important ways of measuring whether
transplantation is successful. The shortage of cadaveric heartbeating donors
brings pressure to perform more transplants from living donors, both related
and unrelated, and from non-heartbeating donors. Currently it is reassuring that the increased numbers of such
transplants are being achieved with no reduction in transplant outcome. Appropriate allocation of donated organs is
another measure of success and at present there is clear inequality of access
to transplantation for patients across the country. Finally it is important to document success in different
transplant units and again it is reassuring that there are no significant
differences in outcomes between any renal transplant centres in the United
Kingdom.