Renal transplantation strengths and shortcomings.

Although renal transplantation remains the treatment of choice for many uremic patients there are still problems not completely solved. The risk of acute rejection can be minimized by the modern immunosuppression but many grafts fail in the long-term because of the so-called chronic allograft nephropathy, which can be caused both by alloantigen dependent and independent mechanisms. Recurrent renal disease is another important cause of failure in the long-term. Death represents the second cause of failure. Cardiovascular complications, infections, and cancer are the most frequent causes of death. Careful selection of the candidate tailored immunosuppression, aggressive diagnostic and therapeutic approaches are needed to minimized mortality in transplant recipients. However, the main limit for the success of transplantation is the shortage of donors. Use of marginal donors, non-heart-beating donors, and living unrelated donors has been recommended by many authorities to overcome the shortage of organs.