My name is Steven Sacks,
and I'm a clinical nephrologist with a particular interest in transplantation.
My interest in complement stems from local complement synthesis,
and I want to try and develop some of the ideas
that have sprung up around that particular aspect of cell biology.
Transplantation has been a highly successful procedure but it's not totally successful.
There are two particular barriers which still hold up
the procedure in terms of long-term outcome.
The first of these is what I've called metabolic and physical injury which
sums up a lot of different stimuli that occurred during the transfer of the organ,
and in particular the kidney,
from the donor to the recipient.
That results in a number of different forms of stress
which are just conveniently labelled as metabolic and physical injury.
The second aspect is a recognition of a donor organ as non-self.
That triggers a series of events which can be summarized into two things,
one is the cell-mediated rejection and the other is antibody-mediated rejection.
Each produces its own form of injury,
that when these are together they
can shorten the half-life of kidney by up to eight years.
In other words, about 50 percent of the grafts are lost by
67 years if both are present together and if neither of those insults are present,
then the kidney last for many years longer,
perhaps about eight or nine years longer than that on average.
A number of observations have shaped my thoughts about complement.