Transplant update.

Solid organ transplantation has developed immeasurably over the last two decades. Even in relatively recent times such as the mid 1970's, transplantation was regarded as an experimental modality of treatment rather than an established clinical tool. Since then the speciality has risen from the roles of experiment so that transplantation of kidney, heart, liver, lung, pancreas and even small bowel has now become relatively commonplace. Ten to fifteen years ago, the one year graft survival for renal transplantation was not much greater than 50%. The single most common cause of early graft loss was acute rejection which was regarded as the "sword of Damocles" of transplantation. In the majority of cases acute rejection of transplants is no longer the scourge that it used to be. The purpose of this article is to briefly review current thoughts on the management of acute and chronic rejection and the role of new immunosuppressive agents in transplantation.