Advancing Transplantation: New Questions, New Possibilities in Kidney and Liver Transplantation
Solid organ transplantation has evolved into one of the great accomplishments in clinical medicine and remains the only lifesaving treatment for many types of end-stage organ failure. Breakthroughs in transplant procedures and the development of effective immunosuppressive therapies have helped health care professionals achieve significant improvements in graft and patient survival posttransplant. This is evident across all indications, including kidney and liver transplantation.1,2 Continuing the advances in improving long-term survival remains a key challenge for transplant medicine today.2,3
Maintaining a transplanted graft over time is complex. Multiple risk factors influence graft survival before, immediately after and late after transplantation. The use of marginal donors, to reduce the disparity between demand and availability of organs, has added to this complexity and brought new challenges to the field of transplantation. Recent research in the kidney and liver transplant arenas has identified a number of risk factors that contribute to poor graft survival (Figure 1). These risk factors can lead to irreversible pathological damage to the transplanted organ, with a negative impact on patient outcomes. By managing these risk factors, we aim to improve the long-term survival of transplanted grafts for our patients.
Health care professionals need to continually reassess how to improve care for their patients while managing limited resources and embracing the new age of digital technology and big data. Only by understanding the risk factors that are modifiable and translating this into changes in the clinic will the perspectives for patients be further improved. “Best practice” care for transplant patients needs to be constantly updated, taking new clinical developments into consideration. Here, we present our findings with regard to the ongoing risk factors for poor long-term outcomes in kidney and liver transplantation and our suggestions for best-practice management for each of these risk factors. We also include speculations as to future innovations that have the potential to change patient management for the transplantation and wider health care communities.