New developments in kidney transplantation are making the procedure available to more patients and improving the rejection rates and donor recovery. A clinical trial that is still underway could improve rejection rates while sparing the long-term use of steroids. "One of the drugs with the most long-term negative effects in patients is prednisone," explains Dr. Mark Deierhoi, professor of surgery and director of renal transplantation at UAB. "That has been a problem for patients for a long time in transplantation. Most protocols include prednisone as a part of the regimen. Patients have problems with bone disease and cataracts and post-transplant diabetes, wound healing problems and things like that. If we can avoid the use of steroids, then some of these chronic long-term complications will be lessened significantly." Under this trial, the patient gets steroids for four days following surgery. "It's a somewhat different combination of some drugs that we already use, and we're a little more aggressive with some of the dosing of those drugs. We are using somewhat different drugs right at the beginning at the time of transplantation," says Deierhoi. "The results so far are very encouraging. I think within six months we will be offering it to patients, not as part of a trial, but as part of a standard protocol." In another improvement in transplantations, laparoscopic surgery is now being used routinely with donors, allowing for a less painful operation with a quicker recovery. "A kidney is about the size of your fist, and we actually have to make a big enough incision that it will come out, but it is a quarter of the size of incisions that we've used in the past to do this, and we don't have to go through a rib. The recovery because of the pain issues and the size of incision is different," says Deierhoi. UAB is also exploring new approaches to living donor transplantation, including the use of altruistic donors, or donors who are willing to donate a kidney even though they don't know someone needing a transplant. "Believe it or not, there are actually a fair number of people who are interested in doing that," Deierhoi says. The donor must be healthy and able to donate safely, but there are other issues, he points out. "How do you allocate those kidneys? How do you decide who gets a kidney from a donor like that? That's the part that we're working with right now. Our goal is to make it as equitable as we can for the patients on the list so that we don't exclude patients from the opportunity to have a transplant."