Transplantation for identical twins took place in the 1950s. The technical challenges were largely solved, and the operation done at that time (iliac fossa placement, ureter dropped into recipient bladder) has not changed much. This story is summarised at …
From the early 1960s transplantation from deceased donors or relatives were undertaken, but the results in the early years were very poor because of inability to control rejection. However dialysis was not a proven long-term technique either at this time. The only part-proven method of immunosuppression at this time was whole body irradiation. It proved ineffective at controlling rejection without rendering patients very susceptible to overwhelming infection, and was quickly abandoned when early recipients of Azathioprine showed some success.
During the 1970s, understanding of transplant rejection was maturing, and techniques of immunosuppression becoming refined to the point where transplantation began to be seen as a viable alternative to long term haemodialysis. Probably helped by the possibility of returning to haemodialysis if unsuccessful.
The outcomes of transplantation have shown a remarkable steady improvement across the decades, so that this treatment is now more common than long-term dialysis in the UK. People with kidney transplants may be encountered in just about every profession and setting. However this is achieved by continuing exposure to immunosuppressive drugs. In the 2020s we still have not achieved the holy grail of reliably being able to induce immune tolerance to an allograft, except by prior bone marrow transplantation from the same donor.
Last Updated on February 7, 2023 by neilturn