Immunosuppressive Drugs and Immune Regulation in Organ Transplantation

Solid organ transplantation is during the past two decades the fi nest and most suitable treatment with the best quality of life for patients with end stage organ failure. The fi rst documented ‘unrelated’ kidney transplantation was performed on June 17, 1950 in Chicago, United States on a 44-year-old woman with polycystic kidney disease2. Unfortunately, the donated kidney was rejected because no adequate immunosuppressive therapy was available at the time and the development of eff ective anti-rejection drugs was years away. The fi rst successful kidney transplantation was performed on December 23rd in 1954 from one healthy identical twin to his twin brother who was almost dying of renal disease3. The operation succeeded and renal function was restored in the recipient and resulted in enormous excitement in the media and among medical professionals. One decade further, the fi rst human liver transplantation was performed in 1963 by a surgical team led by dr. Thomas Starzl4. The discovery and availability of potent immunosuppressive drugs that were able to prevent rejection of the transplanted donor graft, was followed by an era of many successful solid organ transplantations. The use of these immunosuppressive drugs resulted in acceptable graftsurvival rates in the Netherlands. The graft survival rate over 2007 was 94% after clinical kidney transplantation with living donors, 85% after clinical kidney transplantation with deceased donors and 76% after clinical liver transplantation (Nederlandse Transplantatie Stichting). Nevertheless, acute rejection may occur in the fi rst 3 to 6 months after transplantation, but this can be well treated with (steroid) anti-rejection therapy.

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