CONTROVERSIES

13. Is HLA (human leukocyte) matching still important?

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It is somewhat important. Historically, HLA matching was an important consideration when matching cadaver kidneys to recipients. With today’s improved immunosuppressive agents, many transplant surgeons believe that HLA matching is no longer critical. Six antigen match kidneys are still shared nationally and do enjoy some improvement in long-term graft survival. Donor organ quality remains the primary determinant in how well the transplanted organ functions. For example, a poorly matched living-donor kidney will still usually outlast a well-matched cadaveric kidney.

14. Does pancreas transplantation halt the progression of diabetic disease?

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This is still unproven. Logically, we would expect it to. Regression of neuropathy and eye dysfunction has been reported. Recently, long-term recipients have exhibited some regression of microscopic nephropathy.

15. Are islet cell transplants the answer in the future?

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Probably, although this has been frustratingly slow to achieve. Recent protocols using new immunosuppressive regimens and new islet cell isolation techniques have shown promise, but long-term data are still not widely available. The process requires that isolated islet cells be extracted from a donor pancreas. These cells are then injected into the portal vein, lodge in the liver, and produce insulin. Theoretically, patients achieve the benefit of a pancreas transplant without the surgical risk.

References
WEB SITE
http://www.transplantation-soc.org
BIBLIOGRAPHY
1. Bartlett ST: Laparoscopic donor nephrectomy after seven years. Am J Transpl 2:896-897, 2002. Full article
2. Donovitch G: Handbook of Kidney Transplantation, 3rd ed. Philadelphia, Lippincott Williams & Wilkins, 2001.
3. Fioretto P, Steffes MW, Sutherland DER, et al: Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med 339:69-75, 1998. Medline Similar articles Full article
4. Morris JP: Kidney Transplantation: Principles and Practice, 5th ed. Philadelphia, W.B. Saunders, 2001.