Renal transplantation: a quarter century of achievement.

Renal transplantation has become the treatment of choice for most types of end-stage renal failure. Immunosuppressive drug therapy has improved enormously over the past 25 years, and the advent of potent new drugs in addition to cyclosporine make multiple drug therapy for immunosuppression the direction of the immediate future. Monoclonal antibodies have so far had a limited role in immunosuppression, but are likely to prove of value in protocols aimed at inducing specific unresponsiveness to a renal allograft. This remains the goal of transplantation biology, because the long-term complications of all current nonspecific immunosuppressive protocols are formidable. In addition, the shortage of cadaver kidneys for transplantation has led to an increasing use of living related and unrelated donors, and stimulated a major research activity in xenotransplantation in an attempt to bring it to the clinic in the not too distant future.