http://onlinelibrary.wiley.com/doi/10.1111/ajt.12772/full

Editorial
One Kidney for Life
R. A. Montgomery*
DOI: 10.1111/ajt.12772
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)

Human clinical tolerance to renal allografts is now a reality. Protocols for achieving it vary but all involve withdrawing immunosuppression after transplanting a kidney along with donor bone marrow–derived cells. The benefits of eliminating immunosuppression are self-evident. Improvements in posttransplant quality of life without the need for constant compliance with a complex multi-drug regimen cannot be underestimated. Although unproven, the elimination of prophylactic immunosuppression may well be associated with a reduction in chronic diseases that continue to limit life expectancy after transplantation including hypertension, diabetes, ischemic heart disease, hyperlipidemia, metabolic bone disease, cancer and infectious diseases. The payoff of trading dialysis for a transplant will rise sharply for the segment of the transplant population that will be eligible for these protocols. For these patients, the cost to the health-care system will be limited to the transplant event and not continue on indefinitely.

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As in any new innovation in solid organ transplantation long-term follow-up will be required to prove efficacy and surrogates for long-term outcomes will need to be identified and verified to hasten progress. It will require a sea change to reverse the drift that has occurred away from the early, inspired observations of Medawar but imagine a future in which the gift of life will be for life [5].