Chapman Jeremy R
Transplant Res. 2013 Nov 20;2(Suppl 1):S1. doi: 10.1186/2047-1440-2-S1-S1.
Transplantation is more predictable than it was 20 to 30 years ago and innovation over the last 20 years has been rapid, delivering substantial short-term and medium-term improvements. The challenges ahead are to deliver improved results globally in the context of also preventing chronic disease and reducing the costs of treatment. Countries achieving the best rates of transplantation combine deceased and living donors and can transplant more than 50 people per annum per million population, so why can this not be achieved everywhere? The mortality rates have dropped, but they are still up to 10-fold worse than age- and sex-matched controls, such that transplantation ages individuals by 30 years in terms of mortality risk. Cardiovascular disease, infection and malignancy remain the targets if mortality is to normalize. Graft survival rates will not change until the multiple injuries constituting chronic allograft dysfunction and the problems of recurrent disease can be brought to heel. Biomarkers may provide the next innovation to advance outcomes, but early experimental tolerance protocols implemented in clinical practice in at least three centers may deliver results more quickly.
移植手术如今比二三十年前更可预测，过去20年里创新迅速，带来了显著的短期和中期改善。未来的挑战是在预防慢性病和降低治疗成本的同时，在全球范围内取得更好的治疗效果。移植率最高的国家同时利用 deceased 和活体供体，每年每百万人口的移植人数超过50人，那么为什么不能在所有地方都实现这一点呢？死亡率有所下降，但仍比年龄和性别匹配的对照组高出10倍，以至于从死亡风险来看，移植手术使个体的年龄增加了30岁。如果要使死亡率正常化，心血管疾病、感染和恶性肿瘤仍是目标。在构成慢性移植物功能障碍的多种损伤以及复发性疾病问题得到解决之前，移植物存活率不会改变。生物标志物可能是推动治疗效果提升的下一项创新，但至少三个中心在临床实践中实施的早期实验性免疫耐受方案可能会更快取得成果。
