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Strategies for long-term preservation of kidney graft function

Research output: Contribution to journalArticle

Thomas Wekerle, Dorry Segev, Robert Lechler, Rainer Oberbauer

Original languageEnglish
Pages (from-to)2152-2162
Number of pages11
JournalLancet
Volume389
Issue number10084
DOIs
Publication statusE-pub ahead of print - 25 May 2017

King's Authors

Abstract

Kidney transplantation has become a routine procedure in the treatment of patients with kidney failure, and requires collaboration of experts from different disciplines, such as nephrology, surgery, immunology, pathology, infectious disease medicine, cardiology, and oncology. Grafts can be obtained from deceased or living donors, with different logistical requirements and implications for long-term graft patency. 1-year graft survival rates are greater than 95% in many centres but improvement of long-term function remains a challenge. New developments in molecular immunology and computational biology have increased precision of donor and recipient matching of HLA and non-HLA compatibility. Individual omics-wide molecular diagnostics, extracorporeal therapies, and drug developments allow for precise individual decision making and treatment. Tolerance induction by mixed chimerism without toxic conditioning and with a low risk of graft versus host disease is a visionary but realistic goal. Some of these innovations are already used in modern transplant centres and will allow advancement in long-term allograft preservation.

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