Full Name
Prof A. Vathsala
Designation
Co-Director National University Centre for Organ Transplantation

Senior Consultant, Division of Nephrology, Department of Medicine, National University Hospital

Head, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
Bio
Co-Director National University Centre for Organ Transplantation

Senior Consultant, Division of Nephrology, Department of Medicine, National University Hospital

Head, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
Topic
Advances in Kidney Transplantation
Abstract
The first successful kidney transplant was performed by Dr Joseph Murray between identical twins at the Peter Bent Brigham Hospital in 1954. Since then, advances in many fronts have made kidney transplantation one of the most significant success stories in modern medicine today. Advances in immunosuppression have led the way in reducing 1-year acute rejection rates from over 80% in the era of azathioprine and corticosteroids to less than 10% currently with induction with anti-lymphocyte preparations and maintenance therapy with calcineurin inhibitors and mycophenolate analogs. This reduced rejection incidence has allowed an expansion of the kidney donor pool, from beyond identical twins, to other biologically-related donors, to emotionally-related and unrelated donors and to deceased donors. Blood group incompatibility and HLA incompatibility, immunological barriers which had been deemed unsurmountable, have been overcome, and have allowed more patients with end stage kidney failure to undergo successful kidney transplantation. Surgical advances such as laparoscopic donor nephrectomy with attendant reduced morbidity has expanded the scope of living kidney donation, while machine perfusion and dual kidney implant of deceased donor kidneys into a single recipient from extended deceased donors have expanded the scope of deceased donation. Finally, advances in tissue typing, solid phase technologies to identify donor specific antibody, transcriptomics assessment of allograft biopsies and peripheral blood for donor derived cell free DNA offer prospects for better prediction and prevention of antibody mediated rejection of kidney allografts. These advances have transformed patient care for patients with kidney failure by increasing their access to transplantation, expanding opportunities for safe living donation and extending graft longevity.
A. Vathsala