Contemporary Kidney Transplantation

ISBN-13: 9783319196169 / Angielski / Twarda / 2018 / 437 str.

Carlo Gerardo B. Ramirez; Jerry McCauley

Opis

This book provides a comprehensive guide to successful kidney transplantation in the highly regulated environment of today. It covers the history of kidney transplant to highlight innovations that have made kidney transplantation so successful as well as the new deceased donor kidney allocation strategy and postulates what types of changes might occur with this new policy. The book highlights special areas of nephrology concern in kidney transplantation, especially diseases likely to recur following transplant. It deals with many of the medications used in kidney transplantation including different commonly used antirejection protocols. It also provides a complete reference on the various operations involved in kidney transplantation. The text includes detailed pictures and surgical technique sections on cadaveric kidney transplantation and living kidney transplantation. It includes information on living kidney donation surgery with a chapter dedicated to the minimally invasive techniques that have been popularized in the last fifteen years. Some coverage on open living kidney donation is presented. Included in this section is discussions of how to handle certain operative challenges like severe atherosclerosis, venous sclerosis and various urinary system aberrancies.Comprehensive coverage of common surgical complications is presented including management of urinary strictures, urinary leaks, lymphoceles, vascular problems following transplant, and what steps should be taken when an early kidney transplant biopsy is necessary. It also covers in detail what is required for maintenance of health after kidney transplantation including the major risks for graft loss as well as what disease processes kidney transplant patients are particularly vulnerable to.

Spis treści

Section 1.  History of kidney transplantation     

Section 2. Recipient Selection       

1. Indications and contraindications
2. Evaluation and selection
3. Special considerations in highly sensitized candidates
4. Waitlist maintenance

Section 3. Donor Selection

1. Living donor
a. Evaluation
b. Selection
2. Deceased donor
a. History of brain death and donation after cardiac death donors
b. Evaluation and management
c. Selection
i. Heart beating deceased donors
1. Standard criteria donors
2. Extended criteria donors
ii. Donation after cardiac death
iii. Specific donor issues and considerations
1. HBsAg, HBcAb+,  HCV donors
2. CDC high risk donors
3. Donors on ECMO

Section 4. Surgical Technique

1. Organ preservation and preparation Surgeon
a. History
b. Organ preservation solutions
c. Kidney graft biopsy findings
d. Static storage versus machine perfusion pump
i. Machine perfusion eq

uipment 
ii. Pump parameters
e. Kidney graft back table preparation
i. Short renal vein
ii. Multiple arteries or veins
iii. Other anatomic variants

2. Recipient kidney transplantation surgical technique   
a. The standard tec

hnique     
b. Technical considerations in recipients with extensive atherosclerosis 
i. Endarterectomy
ii. Renal artery onto vascular grafts
c. Venous sclerosis and alternate locations
d. Urinary tract anomalies (neurogenic bladder)
e. Special considerations: Robotic recipient kidney transplantation

3. Live donor nephrectomy
a. History and important trends.
b. Open donor nephrectomy.
i.  Operative Technique
ii. Common complications
c. Laparoscopic donor nephrectomy
i. Operative Techniques
ii. Common complications
d. Robotic laparoscopic donor nephrectomy, SILS, and alternate extractions site laparoscopic donor nephrectomy
4. Kidney Transplantation with other organs.
a. S

pecial technical concerns---Pancreas kidney transplantation
b. Others: liver, heart, small bowel

Section 4.  Anesthesia Management

Section 5.  Organ Procurement Organization and New Kidney Allocation

1. History and rationale for the change. 
2. Recent changes and what they will mean.
a. Reliance on the Kidney Donor Profile Index (KDPI) Score for allocation over the current definitions such as age<35(peds); ECD, DCD, SCD.
b. Consideration for top 20% adult post-transplant survival candidates   Estimated Post Transplant survival (EPTS≤20%) for 20% or bet

ter KDP

I kidneys.
c. Sensitization addressed in stratified fashion with special measures for the super sensitized—regional 99%, national 100%.
d. Simultaneous local and regional allocation of kidneys with KDPI >85%
e. Improved access for Blood type B candidates using A2 and A2B donors.
f. Elimination of Payback system.
g. Waiting time includes prior time on dialysis.
h. Elimination of other OPO specific variances.
i. Defining Living Donors by procurement not transplant.
3. Allocation policies in EU, UK, and other countries
Section 6.  Geographic Variations in Kidney Access- Final Rule Wida (UNOS)
 
Section 7. Vulnerable Populations

Section 8. Special Consideration in Living Donor Kidney Transplantation
1. Necessary components of a living donor team.
a. History
b. Team components- surgeons, social workers, independent donor advocate.
c. When living donors are taken advantage---stories from the US and elsewhere.
2. Living kidney donor paired exchanges
a. History
b. Exchange systems and algorithms behind their operation.
c. Benefits and potential pitfalls.
i. Loss of the medical out
ii. Legal implications

Section 9.  Early and Late Course after Kidney Transplantation

1. Early complications after kidney transplantation
d. Technical
i. Vascular
ii. Urinary

iii. W

ound problemsiv. Lymphocele formation
e. Medical
v. Rejection
vi. Infection
vii. Cardio-vascular events
viii. Disease recurrence
2. Late complications after kidney transplantation

Section 10.  Immunology of Kidney Transplantation

Section 11. Pathology of Kidney Transplantation

Section 12. Radiology of Kidney Transplantation
1. Radiology in kidney transplantation
2. The role of Interventional radiology

Section 13. Transplant Immunosuppression
1. History of immunosuppression: an overview
a. History of immunosuppression specific to drug development
b. Specific Drugs
i. Induction therapy---principals and various agents
ii. Maintenance therapy- principals and various agents
iii. Newer or more rarely used agents.
2. Special consideration
f. Hepatitis C
g. HIV

Section 14. Tolerance: The Holy grail of Transplantation

Section 15. Infection in Kidney Transplanation.

Section 16.  The Contemporary Successful Ki

dney Transplant Program
1. The Regulatory Environment
a. UNOS
b. CMS
c. JCHO
d. Insurance
2. Quality measure of a contemporary kidney transplant program
3. The role of transplant coordinators
4. The finance of kidney transplantation
5. Kidney transplantation in the third millennium in North Ame

rica: the strategy fo

r success
6. Legal issues of transplant programs in North America in the third millennium (HCV transmission at UPMC, HIV , live donor deaths, etc.)

Section 17. Epidemiology of Kidney Transplantation

Section 18. Ethics of Transplantation  
1. History- transplant as a driver of ethics
2. Principles3. Special cases 

Section 19. Psychosocial and financial Aspects of Transplantation   

Section 20. Pediatric Transplantation

Section 21, Special Topics
1. Pregnancy after Kidney Transplantation
2. Future Directions:
a. The artificial Kidney versus the xenograft that can avoid humoral rejection.

b. Prevention—Will the epidemiology of kidney failure change.

O autorze

Carlo Gerardo Ramirez, MD, FACS Jefferson University Physician Academic Title: Associate Professor Director, Lankenau Kidney Transplant Program Dr. Ramirez has vast experience in kidney and liver transplant surgery. He earned his medical degree at the University of Philippines and completed his internship and residency at Philippines General Hospital. Dr. Ramirez completed a fellowship at the University of Pittsburgh Medical Center, where he received extensive training in adult and pediatric abdominal transplant surgery at the Thomas Starzl Transplantation Institute. An associate professor at Jefferson Medical College, he has authored more than 90 articles and abstracts on transplantation and serves as Director of the Transplant Fellowship Program at Thomas Jefferson University. Dr. Ramirez is a Fellow of the American College of Surgeons and a member of the Association for Academic Surgery, the Philadelphia Academy of Surgery, the Society of University Surgeons, the American Society of Transplant Surgeons, the International Liver Transplant Society, the Transplantation Society and the American Society of Transplantation.