What is the biggest challenge for the future of kidney transplantation?

First, finding donors is one of the biggest challenges for the future of kidney transplantation. The discrepancy between the number of patients on the waiting list and available donors is staggering. According to OPTN data from January 1, 2009, through September 30, 2009, there were 82,162 recipients waiting and only 7,923 deceased donors; live donation accounted for an additional 4,724 donors. Innovative ways to expand the live donor pool are being developed, such as paired and list exchanges and desensitization.

Second, most kidney transplant patients die of cardiovascular disease. We need to increase awareness about cardiovascular risk factors such as high cholesterol, diabetes mellitus, and hypertension and work harder to modify these risk factors.

The good news is that our understanding of the immune system has grown, and acute rejection has become a rare occurrence for our patients. More patients are being transplanted due to our ability to modify the immune response. Patients who would have been on the waiting list for years because of high antibody levels are being transplanted through processes such as desensitization.