[Kidney transplantation: more kidneys from living donors, individualised immunosuppression and better results].

In the period 1996-2001, the number of transplanted postmortal kidneys decreased from 425 to 380, while at the same time the number of kidneys transplanted from living donors increased from 81 in 1996 to 155 per year in 2001. There was a striking increase in the proportion of living non-related donors (59/155). Although the short-term results of kidney transplantation have improved, and kidneys are very rarely lost as a consequence of acute rejection, the average life of a transplanted kidney has scarcely improved. Chronic allograft dysfunction is now the major cause of transplant loss. This process is hardly influenced by the immunosuppressive drugs currently used. To improve the cardiovascular risk profile, several centres discontinue the use of cyclosporin, tacrolimus or prednisone at 6 or 12 months after transplantation or substitute these with other drugs. This is complicated by acute rejection episodes in 10-20% of patients. With the arrival of a number of new immunosuppressive drugs the risk of rejection might be reduced.