R. Y.Calne Surgeons are transplanting kidneys in ever increasing
numbers-more than 10000 renal allografts have now been reported to the
Transplant Registry. With related donors 75% of grafted kidneys
continued to function after 2 years, compared with 50% when the donors
were unrelated. The therapeutic value is obvious, but the management is
largely empirical and results have improved little in the past 5 years.
The basic sciences related to tissue transplantation have advanced
rapidly. New serological and tissue culture techniques and chemical
analysis of antigens and anti- bodies have produced complicated data
that is almost incomprehensible to the non- specialist. Mathematical
treatment of genetic probabilities and of immunological kinetics are
similarly difficult to follow for those not especially trained. There
has always been a gulf between the practical clinician whose patients do
not behave like inbred rodents and the biologist who likes carefully
controlled experiments with easily observed results. Both realize,
however, that predictable and safe control of rejection must involve
close collaboration and co-operation between the laboratory and the
clinic. Unfortwlately, the different nature of the work and the workers
has widened the gap between them. The clinicians tend to improve their
techniques and patient care, whilst the biologists seek clearer and more
precisely deflned experi- ments which lead them to use increasingly
artiflcial experimental models.
