Exasperated by the frequency and multiplicity of postgastroenterostomy complications, a noted surgeon once remarked that the operation was not a cure but a disease. Renal transplantation may well deserve similar comment. The operation is bedeviled by complications.
The most formidable complication by far is immunogenic rejection. The recipient, whose body cells recognize the implant as a "non-self" is hardly a gracious host. Unless the donor and the patient are monovular twins, the transplanted kidney is not apt to enjoy a prolonged stay without aid of drugs which suppress immune processes. Nor, once rejected, has the transplant much chance of paving a way for a more fortunate successor. Gifford et al (this issue p 799) report little success in their series of second transplantations after the first attempt has been foiled by the immune reaction.
Antimetabolites, such as azathioprine (Imuran), particularly when bolstered by corticosteroids and by the cytostatic antibiotic cactinomycin,