Transplantation tolerance; myth or reality?

Implication for health policy/practice/research/medical education: Transplantation is now a well-accepted therapy for end organ failure. However the recipients are required to take life–long immunosuppression to prevent rejection. This leads to immunosuppression associated morbidity in the form of viral/ fungal/ bacterial infections in addition to causing financial burden on the system. Over a long run these patients are at high risk to develop malignancies. In spite of all these efforts, the graft is lost over 7-10 years to chronic graft attrition/ rejection. The only answer to this problem is “Transplant tolerance” which means stable allograft function while maintaining third party immune response intact in absence of rejections on no immunosuppression. Since last 60 years transplanters across the globe are in search of this “Mackenna’s gold”. The following editorial discusses how far have we progressed in our search for the promised land of “Transplant Tolerance.”