ABSTRACT
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Organ transplantation offers the possibility to replace defective organs with new ones. For thousands of patients, transplantation represents the difference between life and death or significant improvement in quality of life. One of the most concerning challenges facing transplantation today is the rapidly increasing demand for organ replacement in the face of limited organ supply. More than 55,000 patients were on a wait list to receive deceased donor kidney transplantation in the United States in 2003. Only 8,500 organs were available for transplantation.1 Only a minority of potential recipients will thus have the chance to receive a new organ. The early success rates after transplantation have improved dramatically. Potential recipients can expect graft and patient survival rates above 90% for most organs. However, the long-term results are associated with chronic dysfunction of the graft and toxicity related to the immunosuppressive agents used. A better understanding of the rejection process as well as the mechanism involved in tolerance or acceptance of the graft by the recipient could help improve the longevity of the grafts and minimize medication-related toxicity. Recent technical advances have allowed researchers to inves-
tigate the rejection and tolerance processes at the nanoscale of biology: genes and proteins. Microarrays technology is shedding a new light on our comprehension of the interaction between the graft and the host. The first section of this chapter will review the actual state of genomic evaluation in transplantation and envision the potential applications in the future. Organ shortage will likely continue to increase unless an unlimited source of organs is found, such as xenotransplantation. Meanwhile, the development of artificial organs may become an interesting alternative to organ transplantation. Nanotechnology would certainly be the cornerstone of such development. The second section of this chapter will describe the current progress in the development of artificial organs. The possibility of working at a nanoscale appears to be crucial to any progress in this field.
