Brent W. Miller, M.D.

DEPARTMENT OF Internal Medicine
Keywords: chronic renal failure, renal transplantation, chronic allograft, rejection, immunology

Renal transplantation is now the treatment of choice for end-stage renal disease. With the introduction of potent new immunosuppressives, short-term survival of renal allografts has improved dramatically. Yet the most common cause of renal failure following transplantation is chronic allograft rejection, an ill-defined entity comprised of both immunologic and nonimmunologic damage to the transplanted kidney. The average half-life of a transplanted kidney in the United States remains less than a decade because of this problem.

Since Washington University performs more than 100 renal transplant procedures yearly, a significant number of patients develops chronic allograft rejection and renal failure each year. From the time of this diagnosis, a patient will return to renal replacement therapy, either dialysis or another kidney transplant, in an average of two years.

The goal of my research is to: 1) test new immunological therapies and protocols for chronic rejection; 2) test novel approaches to preventing nonimmunologic damage to renal allografts with chronic rejection; and 3) test protocols for facilitating a second kidney transplant including minimizing HLA sensitization and transplant nephrectomy.