Human Tubular Epithelial Cells and T-cell Alloreactivity

Abstract

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. The first successful transplantation was performed in 1954 and acceptable renal allograft survival was achieved after introduction of azathioporine in combination with high dose of corticosteroids in the mid sixties of the 20th century. Introduction of the immunosuppressant calcineurin inhibitor (CNI) cyclosporin A and later on tacrolimus significantly improved the outcome of kidney graft survival. Tacrolimus compared to cyclosporin diminished the acute rejection rate by 31% during the first year after transplantation, and this percentage was even more reduced using anti-CD25 mAb as induction treatment [5]. This success have shifted the problem of transplantation from short term graft survival to how to improve the long term graft survival. The 5-year allograft survival rate in the Netherlands is 83% for deceased donor kidneys and 92% for living donor kidney transplants (Nederlandse Transplantatie Stichting, 12th August 2013). In contrast, the overall European 5-year graft survival is 77% and the USA 5-year graft survival is even worse, representing only 71% graft survival.