During the first 20 years of kidney transplantation, survival rates of transplanted organs increased steadily. Since 1970, however, one-year survival of cadaver grafts at even the best centers has plateaued at about 55%, a fact mentioned with frustration whenever transplant surgeons convene.
The major approach to changing this has been to develop new methods of immunosuppression, both more effective and less toxic than the currently used steroids and cytotoxic drugs. At a meeting held last summer in San Francisco under the sponsorship of Pacific Medical Center, researchers discussed new and varied work in immunosuppression.
The tactical approaches to outwitting the enemy— the normally vigilant host lymphocytes—include such maneuvers as encouraging fifth columnists among them (inducing tolerance), sending most of the troops away before the battle (thoracic duct drainage), frontally attacking them (total lymphoid irradiation and cyclosporin A), and but weakly provoking them (donor[ill]pretreatment and HLA-DR matching). Some of these approaches