Transplantation
Organ transplantation is now a well-established therapy for patients with end-stage organ failure. Over the last 20 years, the results of transplantation have improved incrementally for many reasons, including better recipient selection, improved anaesthetic and surgical techniques, the introduction of more effective antiviral agents, and better post-transplant immunosuppressive management. The problem of early graft loss from acute rejection is now uncommon, and the main challenges today are chronic allograft rejection and the side effects of non-specific suppression of the immune response. Randomized clinical trials continue to inform and further improve clinical practice. Because transplantation today is largely successful, the traditional endpoints of 1-year patient and graft survival are no longer sufficient, and more sophisticated endpoints are needed that reflect graft function and quality of life after transplantation. This chapter brings together studies which recognize this need for clinical trials which improve practice and focus on more broadly defined endpoints.