BOOK
Kidney Transplantation - Principles and Practice E-Book
Stuart J. Knechtle | Peter J Morris
(2013)
Additional Information
Book Details
Abstract
With meticulous updates throughout, Kidney Transplantation remains your definitive medical resource for state-of-the-art answers on every aspect of renal transplantation. A multidisciplinary approach from internationally renowned nephrologists from around the world offers practice-applicable guidance for all members of the transplant team. With coverage encompassing applied science, surgical techniques, immunosuppressive methods, outcomes, risks, and medical considerations related to kidney transplantation, both in adults and children, you’ll have the balanced information you need to achieve the best possible outcomes.
Visualize key concepts and discern nuances of renal transplantation techniques through more than 335 superb illustrations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| KIDNEY TRANSPLANTATION: PRINCIPLES AND PRACTICE | iii | ||
| COPYRIGHT | iv | ||
| CONTENTS | v | ||
| VIDEO TABLE OF CONTENTS | vii | ||
| PREFACE TO THE FIRST EDITION | ix | ||
| PREFACE TO THE SEVENTH EDITION | xi | ||
| LIST OF CONTRIBUTORS | xiii | ||
| CHAPTER 1: KIDNEY TRANSPLANTATION: A HISTORY | 1 | ||
| EARLY EXPERIMENTS | 1 | ||
| HUMAN KIDNEY TRANSPLANTS | 1 | ||
| THE MIDDLE YEARS | 3 | ||
| POST WORLD WAR II | 4 | ||
| IMMUNOSUPPRESSION AND THE MODERN ERA | 5 | ||
| CHEMICAL IMMUNOSUPPRESSION | 5 | ||
| A TIME OF OPTIMISM | 6 | ||
| TISSUE TYPING | 6 | ||
| THE 1970s PLATEAU | 7 | ||
| WAITING FOR XENOGRAFTS | 7 | ||
| CONCLUSION | 7 | ||
| REFERENCES | 8 | ||
| CHAPTER 2: IMMUNOLOGY OF GRAFT REJECTION | 10 | ||
| INITIATION OF ALLOIMMUNITY BY THE INNATE IMMUNE SYSTEM | 11 | ||
| The Trauma of Transplantation | 11 | ||
| Innate Immunity | 11 | ||
| Receptors of the Innate Immune System | 11 | ||
| Cells at the Intersection of Innate and Adaptive Immunity | 13 | ||
| Complement | 14 | ||
| STIMULATION OF ADAPTIVE ALLOIMMUNITY | 14 | ||
| Antigens That Stimulate Graft Rejection | 14 | ||
| Major Histocompatibility Antigens | 14 | ||
| MHC Antigens in Experimental Models of Transplantation | 17 | ||
| Non-Classical MHC Antigens | 17 | ||
| Minor Histocompatibility Antigens | 17 | ||
| Donor Dendritic Cells and Direct Antigen Presentation | 18 | ||
| Direct Antigen Presentation ( Figure 2-5 A) | 18 | ||
| Indirect Antigen Presentation ( Figure 2-5 B) | 19 | ||
| Semidirect Antigen Presentation ( Figure 2-5 C) | 19 | ||
| Activation and Types of Dendritic Cell | 19 | ||
| ACTIVATION OF CELLULAR IMMUNITY | 20 | ||
| Location of T-Cell Activation | 20 | ||
| Immune Synapse | 21 | ||
| T-Cell Receptor Signals | 21 | ||
| Second or Costimulatory Signals | 21 | ||
| CD28–B7 Interaction | 21 | ||
| Other Costimulatory Molecules | 22 | ||
| The Generation of Effector Immunity and Cytokine Production | 22 | ||
| T-Regulatory Cells | 24 | ||
| MECHANISMS OF GRAFT INJURY | 24 | ||
| Migration of Activated Cells into the Graft | 24 | ||
| Cell–Cell Interactions | 24 | ||
| Chemokines | 25 | ||
| Mechanisms of Cytotoxicity | 25 | ||
| Specificity of Cellular Immune Responses in Rejection | 25 | ||
| Cytotoxic T-Cell Responses | 26 | ||
| Alloantibody and Alloantigen-Specific B cells | 26 | ||
| Natural Killer Cells | 27 | ||
| Macrophages and Delayed-Type Hypersensitivity Reactions | 28 | ||
| Cytokines | 28 | ||
| Eosinophils | 28 | ||
| Target Cells of Destructive Immunity | 28 | ||
| Chronic Rejection | 29 | ||
| SUMMARY | 29 | ||
| REFERENCES | 30 | ||
| CHAPTER 3: CHRONIC KIDNEY FAILURE: RENAL REPLACEMENT THERAPY | 39 | ||
| INTRODUCTION | 39 | ||
| DEFINITION AND TIMING REFERRAL | 40 | ||
| PREVALENCE AND INCIDENCE | 40 | ||
| ETIOLOGY | 41 | ||
| TREATMENT OF CKD5 | 42 | ||
| Dialysis | 42 | ||
| General Aspects | 42 | ||
| Hypertension and Fluid and Electrolyte Balance | 43 | ||
| Hematopoiesis and Immunity | 43 | ||
| Calcium, Phosphate, and the Skeleton | 43 | ||
| Nutrition and Metabolism | 44 | ||
| Hemostasis | 44 | ||
| Skin | 44 | ||
| Neurological and Musculoskeletal Manifestations | 44 | ||
| Endocrine Abnormalities | 44 | ||
| Psychological Problems | 44 | ||
| Initiation of Dialysis | 44 | ||
| Hemodialysis | 45 | ||
| Complications | 45 | ||
| Peritoneal Dialysis | 46 | ||
| Dialysis Adequacy | 46 | ||
| Dialysis Transport | 46 | ||
| Automated Peritoneal Dialysis | 46 | ||
| Continuous Ambulatory Peritoneal Dialysis | 47 | ||
| Practical Considerations | 47 | ||
| Indications for and Advantages of Peritoneal Dialysis | 47 | ||
| Posttransplantation | 47 | ||
| Complications | 47 | ||
| Loss of Ultrafiltration | 47 | ||
| Peritonitis | 48 | ||
| Exit Site and Tunnel Infection | 48 | ||
| Anatomical Complications | 49 | ||
| Encapsulating Peritoneal Sclerosis | 49 | ||
| Metabolic Complications | 49 | ||
| CHOICE AND PLANNING FOR THE INDIVIDUAL PATIENT | 49 | ||
| DIALYSIS POSTTRANSPLANT | 50 | ||
| Hemodialysis | 50 | ||
| Continuous Ambulatory Peritoneal Dialysis | 51 | ||
| RETURN TO DIALYSIS AFTER TRANSPLANT FAILURE | 51 | ||
| RRT MODALITY AND SURVIVAL | 51 | ||
| QUALITY OF LIFE | 52 | ||
| REFERENCES | 52 | ||
| CHAPTER 4: THE RECIPIENT OF A KIDNEY TRANSPLANT | 54 | ||
| THE PATIENT WITH CHRONIC KIDNEY DISEASE | 54 | ||
| GENERAL CONCEPTS | 55 | ||
| Fitness to Transplant | 55 | ||
| Appropriateness to Transplant | 56 | ||
| Waitlisting and Allocation of Deceased Donor Organs | 56 | ||
| COUNSELING | 57 | ||
| What the Patient Needs to Know | 57 | ||
| Consent | 57 | ||
| What the Potential Living Donor Needs to Know | 58 | ||
| What the Family Needs to Know | 58 | ||
| SPECIFIC MEDICAL CONSIDERATIONS | 58 | ||
| Cardiac (see Chapter 30) | 58 | ||
| Vascular (see Chapter 28) | 59 | ||
| Respiratory | 59 | ||
| Hepatic Disease (see Chapter 32) | 60 | ||
| Hepatitis B | 60 | ||
| Hepatitis C | 60 | ||
| Other Liver Disease | 60 | ||
| Infectious Disease (see Chapter 31) | 61 | ||
| Vaccination Strategies | 61 | ||
| Human Immunodeficiency Virus | 61 | ||
| Other Viral Infections – CMV, EBV, HHV6/7, HHV8 | 61 | ||
| Dental | 61 | ||
| Miscellaneous Infections – Syphilis, Strongyloides, Toxoplasmosis, Trypanosoma | 61 | ||
| Malignancy (see Chapter 35) | 61 | ||
| Psychiatric Disease and Drug Dependency | 62 | ||
| Bone | 63 | ||
| Gastrointestinal Tract | 63 | ||
| Diabetes | 63 | ||
| Type 1 Diabetes Mellitus | 63 | ||
| Type 2 Diabetes Mellitus | 64 | ||
| Renal Disease | 64 | ||
| Recurrent Renal Disease (see Chapter 26) | 64 | ||
| Glomerulonephritis | 64 | ||
| Focal Segmental Glomerulosclerosis (FSGS) | 64 | ||
| IgA Nephropathy | 64 | ||
| Henoch-Schönlein Purpura | 65 | ||
| Membranous Nephropathy | 65 | ||
| Mesangiocapillary Glomerulonephritis | 65 | ||
| Antiglomerular Basement Membrane Disease | 65 | ||
| Recurrent Vasculitis | 65 | ||
| Hereditary Disease | 65 | ||
| Urogenital Tract Abnormalities (see Chapter 12) | 66 | ||
| Bladder | 66 | ||
| Reflux Nephropathy | 66 | ||
| Polycystic Kidney Disease | 66 | ||
| Coagulation Disorders | 66 | ||
| Obesity | 66 | ||
| Psychosocial Factors | 67 | ||
| Sensitization and Transfusion Status (see Chapters 10 and 24) | 67 | ||
| Previous Transplantation | 67 | ||
| PREPARATION FOR TRANSPLANTATION | 67 | ||
| To Join and Remain on the Deceased Donor Waiting List | 67 | ||
| To Undergo Elective Living Donor Transplantation | 68 | ||
| To Undergo Deceased Donor Transplantation | 68 | ||
| REFERENCES | 68 | ||
| CHAPTER 5: ACCESS FOR RENAL REPLACEMENT THERAPY | 72 | ||
| INTRODUCTION | 72 | ||
| VASCULAR ACCESS CATHETERS | 72 | ||
| Temporary Vascular Access | 72 | ||
| Catheter Insertion Techniques | 73 | ||
| Complications of Hemodialysis Catheters | 74 | ||
| Catheter Dysfunction | 74 | ||
| Central Vein Occlusion | 74 | ||
| Infection | 74 | ||
| FISTULAS AND SYNTHETIC GRAFTS | 75 | ||
| Historical Development of Vascular Access Surgery | 75 | ||
| Planning Vascular Access | 75 | ||
| Requirements of Arteriovenous Fistulas for Hemodialysis | 76 | ||
| Preoperative Assessment | 76 | ||
| Anesthesia | 76 | ||
| Surgical Technique | 77 | ||
| Autogenous Arteriovenous Fistulas | 77 | ||
| Wrist Fistula | 77 | ||
| Elbow Fistulas | 77 | ||
| Brachiocephalic Arteriovenous Fistulas. | 77 | ||
| Brachiobasilic Arteriovenous Fistula. | 78 | ||
| Graft Arteriovenous Fistulas | 78 | ||
| Fistula Maturation and Venepuncture | 79 | ||
| Complications of Arteriovenous Fistulas | 80 | ||
| Hemorrhage | 80 | ||
| Thrombosis | 80 | ||
| Infection | 80 | ||
| Aneurysm Formation | 81 | ||
| Steal Syndrome | 81 | ||
| Arteriovenous Fistula Surveillance | 81 | ||
| PERITONEAL DIALYSIS | 82 | ||
| Peritoneal Dialysis Delivery Systems and Catheters | 82 | ||
| Catheter Selection | 83 | ||
| Catheter Insertion | 83 | ||
| Complications Associated with Peritoneal Dialysis Catheters | 84 | ||
| Bleeding | 84 | ||
| Pain | 84 | ||
| Cuff Extrusion | 84 | ||
| Catheter Obstruction | 84 | ||
| Pericatheter Leak | 85 | ||
| Hernias | 85 | ||
| Exit Site and Tunnel Infections | 85 | ||
| Peritoneal Dialysis Peritonitis | 85 | ||
| Encapsulating Peritoneal Sclerosis | 86 | ||
| RENAL TRANSPLANT ISSUES WITH PERITONEAL DIALYSIS | 87 | ||
| CONCLUSION | 87 | ||
| REFERENCES | 87 | ||
| CHAPTER 6: BRAIN DEATH AND CARDIAC DEATH: DONOR CRITERIA AND CARE OF DECEASED DONOR | 91 | ||
| INTRODUCTION | 91 | ||
| BRAIN DEATH | 91 | ||
| Incidence and Causes | 91 | ||
| Physiologic Response | 91 | ||
| Cardiac | 92 | ||
| Pulmonary | 92 | ||
| Renal | 92 | ||
| Hepatic | 92 | ||
| Endocrine | 92 | ||
| Inflammatory | 93 | ||
| Diagnosis | 93 | ||
| CARDIAC DEATH | 96 | ||
| Diagnosis | 96 | ||
| DONOR MANAGEMENT | 98 | ||
| Cardiac | 98 | ||
| Respiratory | 99 | ||
| Renal | 100 | ||
| Endocrine | 100 | ||
| Infectious Disease | 101 | ||
| Hematology | 102 | ||
| OTHER TOPICS IN DONOR MANAGEMENT | 102 | ||
| Ethics | 102 | ||
| Future Technologies | 102 | ||
| CONCLUSION | 102 | ||
| REFERENCES | 102 | ||
| CHAPTER 7: MEDICAL EVALUATION OF THE LIVING DONOR | 105 | ||
| INTRODUCTION | 105 | ||
| HISTORICAL PERSPECTIVE AND CURRENT STATUS | 105 | ||
| RATIONALE FOR LIVE KIDNEY DONATION | 106 | ||
| RISKS OF LIVE KIDNEY DONATION | 107 | ||
| THE EVALUATION PROCESS | 107 | ||
| Education, Counseling, and Consent of the Potential Donor | 107 | ||
| Psychosocial Evaluation | 108 | ||
| Medical Screening Process | 108 | ||
| Review of All Results at a Multidisciplinary Meeting | 110 | ||
| Special Considerations in the Evaluation and Selection of Living Kidney Donors | 110 | ||
| Donor Age | 112 | ||
| Hypertension | 112 | ||
| Obesity | 113 | ||
| Diabetes and Impaired Glucose Tolerance | 113 | ||
| Reduced Renal Function | 113 | ||
| Heritable Diseases Associated with Renal Pathology | 114 | ||
| Special Considerations Pertaining to Non-directed Living Kidney Donors and Donors Participating in Paired Donor Exchange P ... | 115 | ||
| Long-term Follow-up of Living Kidney Donors | 115 | ||
| SUMMARY | 116 | ||
| REFERENCES | 116 | ||
| CHAPTER 8: DONOR NEPHRECTOMY | 118 | ||
| DECEASED DONOR NEPHRECTOMY | 118 | ||
| DONATION AFTER BRAIN DEATH | 118 | ||
| DONATION AFTER CARDIAC DEATH | 119 | ||
| LIVING DONOR NEPHRECTOMY | 121 | ||
| ANESTHETIC MANAGEMENT | 121 | ||
| OPEN DONOR NEPHRECTOMY | 122 | ||
| LAPAROSCOPIC DONOR NEPHRECTOMY | 122 | ||
| Hand-Assisted Technique | 122 | ||
| Total Laparoscopic Approach | 123 | ||
| RIGHT DONOR NEPHRECTOMY | 126 | ||
| SINGLE-PORT DONOR NEPHRECTOMY | 126 | ||
| ROBOTIC DONOR NEPHRECTOMY | 128 | ||
| COMPLICATIONS | 128 | ||
| SUMMARY | 128 | ||
| REFERENCES | 129 | ||
| CHAPTER 9: KIDNEY PRESERVATION | 130 | ||
| TOWARDS “TAILORED” PRESERVATION STRATEGIES | 130 | ||
| PRINCIPLES OF COLD STORAGE PRESERVATION | 131 | ||
| Energy and Acidosis | 131 | ||
| Cell Swelling | 132 | ||
| Reactive Oxygen Species | 132 | ||
| Calcium | 132 | ||
| Enzymes | 132 | ||
| COMPOSITION OF CLINICALLY USED SOLUTIONS | 133 | ||
| Eurocollins Solution | 133 | ||
| University of Wisconsin Solution | 133 | ||
| Histidine-Tryptophan-Ketoglutarate Solution | 134 | ||
| Hyperosmolar Citrate Solution | 134 | ||
| Celsior Solution | 134 | ||
| Institut Georges Lopez-1 Solution | 134 | ||
| HYPOTHERMIC MACHINE PERFUSION REVISITED | 134 | ||
| NORMOTHERMIC PERFUSION | 136 | ||
| Normothermic Regional Perfusion | 136 | ||
| Normothermic Machine Perfusion | 137 | ||
| Normothermic Reconditioning | 137 | ||
| Mechanism of Action | 137 | ||
| Perfusion Fluid and Oxygen Carrier | 138 | ||
| Viability Assessment | 138 | ||
| FUTURE OUTLOOK | 138 | ||
| REFERENCES | 138 | ||
| CHAPTER 10: HISTOCOMPATIBILITY IN KIDNEY TRANSPLANTATION | 142 | ||
| HISTORICAL BACKGROUND | 142 | ||
| THE HLA SYSTEM | 142 | ||
| HLA Genes and their Products | 143 | ||
| HLA Class I | 143 | ||
| HLA Class II | 145 | ||
| HLA Polymorphism and Nomenclature | 145 | ||
| Resolution of HLA-Typing Methods | 145 | ||
| WHO Nomenclature for HLA | 145 | ||
| Extended HLA Haplotypes | 146 | ||
| HLA on the Web | 146 | ||
| HLA MATCHING | 146 | ||
| HLA-SPECIFIC ALLOSENSITIZATION | 148 | ||
| Routes of Sensitization | 148 | ||
| Antibody Detection and Specificity Definition | 148 | ||
| Complement-Dependent Cytotoxicity | 148 | ||
| Solid-Phase Assays for HLA-Specific Antibody Detection and Specification | 148 | ||
| Enzyme-Linked Immunosorbent Assays (ELISA) | 148 | ||
| Flow Cytometry | 148 | ||
| Antibody-Screening Strategies | 151 | ||
| Patient Sensitization Profile and Definition of Unacceptable Specificities | 151 | ||
| DONOR CROSSMATCH | 151 | ||
| Crossmatch Techniques and their Clinical Relevance | 151 | ||
| Complement-Dependent Lymphocytotoxic Crossmatch | 151 | ||
| B-Cell Crossmatch | 152 | ||
| Crossmatch Serum Sample Selection (Timing) | 152 | ||
| Immunoglobulin Class and Specificity | 152 | ||
| Flow Cytometric Crossmatch Test | 153 | ||
| Crossmatch Policies and Clinical Interpretation | 153 | ||
| The Crossmatch Veto: Which Antibodies are Harmful? | 154 | ||
| Organ Allocation and Pretransplant Donor Crossmatch Testing | 154 | ||
| The Virtual Crossmatch | 155 | ||
| Immunological Risk Stratification | 155 | ||
| STRATEGIES FOR TRANSPLANTING SENSITIZED AND HIGHLY SENSITIZED PATIENTS | 155 | ||
| Antibody Removal (see Chapter 24) | 156 | ||
| Paired Exchange | 156 | ||
| POSTTRANSPLANT MONITORING | 157 | ||
| CONCLUDING REMARKS | 157 | ||
| Acknowledgment | 157 | ||
| REFERENCES | 157 | ||
| CHAPTER 11: SURGICAL TECHNIQUES OF KIDNEY TRANSPLANTATION | 161 | ||
| PREPARATION OF RECIPIENT | 161 | ||
| SITE | 162 | ||
| INCISION | 162 | ||
| PREPARATION OF OPERATIVE BED | 163 | ||
| PREPARATION OF KIDNEY | 164 | ||
| REVASCULARIZATION | 165 | ||
| Arterial Anastomosis | 165 | ||
| Venous Anastomosis | 166 | ||
| Reperfusion of the Kidney | 166 | ||
| RECONSTRUCTION OF THE URINARY TRACT | 167 | ||
| Ureteroneocystostomy (Anastomosis of the Transplant Ureter Directly to the Bladder) | 167 | ||
| Transvesical Ureteroneocystostomy | 167 | ||
| Extravesical Ureteroneocystostomy | 168 | ||
| Double Ureters | 169 | ||
| Augmented Bladder | 170 | ||
| Pyelopyelostomy | 170 | ||
| Pyeloureterostomy and Ureteroureterostomy | 170 | ||
| Pyelovesicostomy | 171 | ||
| Ureteroenterostomy | 171 | ||
| Ureteric Stents | 171 | ||
| Management of Catheter and Stent | 172 | ||
| CLOSURE | 172 | ||
| PEDIATRIC RECIPIENT | 172 | ||
| PEDIATRIC DONOR | 172 | ||
| DOUBLE KIDNEY TRANSPLANT | 173 | ||
| TRANSPLANT NEPHRECTOMY | 173 | ||
| REFERENCES | 173 | ||
| CHAPTER 12: TRANSPLANTATION AND THE ABNORMAL BLADDER | 176 | ||
| ASSESSMENT OF BLADDER FUNCTION | 176 | ||
| GENERAL CONCEPTS OF MANAGEMENT OF BLADDER DYSFUNCTION | 177 | ||
| Methods to Enhance Bladder Emptying | 177 | ||
| Methods to Improve Capacity and Compliance | 178 | ||
| Alternatives to the Use of Ileum or Left Colon 24 | 180 | ||
| Methods to Achieve Continence | 182 | ||
| Urinary Diversion (Continent and Incontinent) | 184 | ||
| Other Considerations in Patients with Abnormal Bladder | 184 | ||
| Reflux | 184 | ||
| Timing of Bladder Reconstruction | 184 | ||
| Results of Renal Transplantation into Reconstructed Abnormal Bladders | 184 | ||
| Posterior Urethral Valves | 186 | ||
| Prune-Belly Syndrome | 186 | ||
| Neurogenic Bladder Dysfunction | 188 | ||
| CONCLUSION | 188 | ||
| REFERENCES | 188 | ||
| CHAPTER 13: PERIOPERATIVE CARE OF PATIENTS UNDERGOING KIDNEY TRANSPLANTATION | 191 | ||
| COMORBIDITIES IN END-STAGE RENAL DISEASE | 191 | ||
| Cardiovascular Complications | 191 | ||
| Hematologic Abnormalities | 193 | ||
| Uremia | 193 | ||
| PREOPERATIVE CONSIDERATIONS | 193 | ||
| INTRAOPERATIVE CONSIDERATIONS | 195 | ||
| POSTOPERATIVE CARE | 199 | ||
| ANESTHESIA FOR PATIENTS AFTER KIDNEY TRANSPLANTATION | 199 | ||
| KIDNEY–PANCREAS TRANSPLANTATION | 199 | ||
| Preoperative Considerations | 200 | ||
| Intraoperative Considerations | 200 | ||
| Postoperative Care | 201 | ||
| REFERENCES | 201 | ||
| CHAPTER 14: EARLY COURSE OF THE PATIENT WITH A KIDNEY TRANSPLANT | 204 | ||
| OVERVIEW | 204 | ||
| Perioperative Management | 204 | ||
| Graft Dysfunction | 205 | ||
| SURGICAL COMPLICATIONS | 205 | ||
| Urinary Problems | 205 | ||
| Urinary Obstruction | 205 | ||
| Bleeding into the Urinary System | 206 | ||
| Urine Leak | 207 | ||
| Vascular Problems | 207 | ||
| Arterial Stenosis | 207 | ||
| Arterial Thrombosis | 207 | ||
| Renal Vein Thrombosis | 208 | ||
| Postoperative Bleeding | 208 | ||
| Graft Loss and Transplant Nephrectomy | 209 | ||
| REJECTION DURING THE EARLY POSTOPERATIVE PERIOD | 209 | ||
| Hyperacute Rejection | 209 | ||
| Antibody-Mediated Rejection | 209 | ||
| Acute Rejection | 209 | ||
| Borderline Rejection | 210 | ||
| MEDICAL COMPLICATIONS | 210 | ||
| Delayed Graft Function | 210 | ||
| Nephrotoxicity from Calcineurin Inhibitors | 210 | ||
| Prerenal Azotemia and Volume Depletion | 211 | ||
| Other Drug Toxicity | 211 | ||
| Recurrent Disease | 211 | ||
| Infection | 212 | ||
| Hypertension | 212 | ||
| Management of Graft Dysfunction | 213 | ||
| SUMMARY | 213 | ||
| REFERENCES | 213 | ||
| CHAPTER 15: AZATHIOPRINE | 216 | ||
| INTRODUCTION | 216 | ||
| MECHANISM OF ACTION | 217 | ||
| DOSAGE | 217 | ||
| SIDE EFFECTS | 217 | ||
| MONITORING OF AZATHIOPRINE THERAPY | 217 | ||
| AZATHIOPRINE AND MYCOPHENOLATE MOFETIL | 218 | ||
| CYCLOSPORINE CONVERSION TO AZATHIOPRINE | 219 | ||
| AZATHIOPRINE CONVERSION TO MYCOPHENOLATE MOFETIL | 219 | ||
| TACROLIMUS AND AZATHIOPRINE | 219 | ||
| CONCLUSION | 219 | ||
| REFERENCES | 219 | ||
| CHAPTER 16: STEROIDS | 221 | ||
| INTRODUCTION | 221 | ||
| MECHANISM OF ACTION | 221 | ||
| STEROID RESISTANCE | 222 | ||
| DOSAGE | 222 | ||
| TREATMENT OF ACUTE REJECTION | 223 | ||
| SIDE EFFECTS | 223 | ||
| Cushingoid Facies | 223 | ||
| Wound Healing | 223 | ||
| Growth Retardation | 224 | ||
| Diabetes | 224 | ||
| Hyperlipidemia | 224 | ||
| Bone Disease | 224 | ||
| Obesity | 224 | ||
| Hypertension | 224 | ||
| Psychiatric Disturbance | 224 | ||
| Cataracts | 224 | ||
| Pancreatitis | 224 | ||
| Skin Changes | 224 | ||
| Peptic Ulceration | 225 | ||
| Acute Abdomen | 225 | ||
| STEROID WITHDRAWAL AND AVOIDANCE | 225 | ||
| Steroid Withdrawal in Children | 228 | ||
| CONCLUSIONS | 228 | ||
| REFERENCES | 228 | ||
| CHAPTER 17: CALCINEURIN INHIBITORS | 231 | ||
| MECHANISM OF ACTION | 232 | ||
| PHARMACOKINETIC PROPERTIES | 232 | ||
| PHARMACOGENETICS | 232 | ||
| ABSORPTION AND DISTRIBUTION | 233 | ||
| METABOLISM AND ELIMINATION | 233 | ||
| SPECIAL PATIENT POPULATIONS | 233 | ||
| CLINICAL STUDIES IN KIDNEY TRANSPLANTATION | 234 | ||
| Rescue Therapy in Adults | 234 | ||
| Antibody-Mediated Rejection | 234 | ||
| Maintenance Immunosuppression | 234 | ||
| Comparison of Tacrolimus-Based and Cyclosporine-Based Regimens | 234 | ||
| Comparison of Calcineurin Inhibitor/Azathioprine and Tacrolimus/Mycophenolate Mofetil Regimens | 236 | ||
| Comparison of Tacrolimus/Mycophenolate Mofetil and Calcineurin Inhibitor/Sirolimus Regimens | 236 | ||
| Comparison of Tacrolimus-Based Dual versus Triple Immunosuppression Therapy | 237 | ||
| Induction Therapies with Calcineurin Inhibitor Regimens | 237 | ||
| Role of Calcineurin Inhibitors and Corticosteroids in the Development of Hypertension and Hyperglycemia | 238 | ||
| Early Corticosteroid Withdrawal Regimens | 238 | ||
| Corticosteroid-Free Immunosuppression Regimens | 238 | ||
| Comparison of Corticosteroid-Sparing Regimens Using Tacrolimus-Based and Cyclosporine-Based Immunosuppression | 239 | ||
| Calcineurin Inhibitor Avoidance and Low-Dose Tacrolimus Regimens | 239 | ||
| Other Calcineurin Inhibitors and Formulations | 240 | ||
| Pediatric Renal Transplantation (see Chapter 37) | 240 | ||
| CLINICAL STUDIES IN KIDNEY–PANCREAS TRANSPLANTATION (SEE CHAPTER 36) | 241 | ||
| Simultaneous Pancreas–Kidney Transplantation | 241 | ||
| Steroid Withdrawal and Steroid-Free Protocols | 242 | ||
| Pancreas after Kidney Transplantation | 243 | ||
| SIDE EFFECTS AND TOLERABILITY OF CALCINEURIN INHIBITORS | 243 | ||
| Cardiovascular Adverse Effects | 244 | ||
| Posttransplant Diabetes Mellitus | 244 | ||
| Malignancies (see Chapters 34 and 35) | 245 | ||
| Other Side Effects | 245 | ||
| Special Patient Populations | 245 | ||
| CONCLUSION | 245 | ||
| REFERENCES | 246 | ||
| CHAPTER 18: MYCOPHENOLATES | 250 | ||
| INTRODUCTION | 250 | ||
| HISTORY OF MYCOPHENOLATES | 250 | ||
| MECHANISM OF ACTION | 251 | ||
| CLINICAL PHARMACOLOGY AND BLOOD MONITORING | 253 | ||
| Dosing | 253 | ||
| Absorption | 253 | ||
| Metabolism and Clearance | 254 | ||
| Assays and Blood Monitoring | 254 | ||
| Drug–Drug Interactions | 255 | ||
| CLINICAL TOXICITIES | 256 | ||
| Gastrointestinal Adverse Reactions | 256 | ||
| Myelosuppression | 256 | ||
| Infections | 257 | ||
| Neoplastic Diseases | 257 | ||
| Pregnancy and Reproduction | 257 | ||
| EARLY CLINICAL TRIALS OF MYCOPHENOLATES IN KIDNEY TRANSPLANTATION | 257 | ||
| COMBINATION THERAPY UTILIZING MMF IN KIDNEY TRANSPLANTATION | 258 | ||
| Cyclosporines (see Chapter 16) | 258 | ||
| Tacrolimus (see Chapter 17) | 259 | ||
| mTOR Inhibitors | 259 | ||
| Belatacept | 260 | ||
| USE OF MYCOPHENOLATES TO MINIMIZE OR AVOID OTHER IMMUNOSUPPRESSANTS | 260 | ||
| Minimization of Calcineurin Inhibitors | 260 | ||
| Withdrawal of Calcineurin Inhibitors | 260 | ||
| Avoidance of Calcineurin Inhibitors | 260 | ||
| Steroid Avoidance or Withdrawal | 261 | ||
| THERAPEUTIC DRUG MONITORING | 261 | ||
| REFERENCES | 262 | ||
| CHAPTER 19: MTOR INHIBITORS: SIROLIMUS AND EVEROLIMUS | 267 | ||
| DISCOVERY | 267 | ||
| MECHANISM OF ACTION | 268 | ||
| PHARMACOKINETICS | 269 | ||
| THERAPEUTIC BLOOD MONITORING | 270 | ||
| PHARMACOGENETICS | 270 | ||
| DRUG INTERACTIONS | 270 | ||
| USE OF mTOR INHIBITORS | 270 | ||
| De Novo Therapy with mTOR Inhibitors in the Absence of Calcineurin Inhibitors | 270 | ||
| De Novo Combination Therapy with mTOR Inhibitors and Calcineurin Inhibitors | 272 | ||
| Maintenance Therapy with mTOR Inhibitors | 274 | ||
| mTOR INHIBITORS AND MALIGNANCY | 275 | ||
| mTOR Inhibitors as Antitumor Agents | 275 | ||
| mTOR Inhibitors and Posttransplant Malignancy | 275 | ||
| mTOR Inhibitors and Non-Melanoma Skin Cancer | 275 | ||
| mTOR Inhibitors and Posttransplant Lymphoproliferative Disorder | 276 | ||
| mTOR Inhibitors and Kaposi's Sarcoma | 276 | ||
| mTOR Inhibitors and BK Virus | 276 | ||
| SAFETY AND SIDE EFFECTS OF mTOR INHIBITORS | 276 | ||
| Infection | 276 | ||
| Lipids | 277 | ||
| Pneumonitis | 277 | ||
| Hemolytic Uremic Syndrome | 278 | ||
| Proteinuria | 278 | ||
| Delayed Recovery from Ischemia-Reperfusion Injury | 278 | ||
| Peripheral Edema | 278 | ||
| Wound Healing and Lymphocele Formation | 278 | ||
| Mouth Ulcers | 279 | ||
| Rash | 279 | ||
| Anemia, Thrombocytopenia, and Leukopenia | 280 | ||
| Gastrointestinal Symptoms | 280 | ||
| Thrombosis | 280 | ||
| Renal Tubular Effects: Hypokalemia and Hypophosphatemia | 281 | ||
| Bone Effects | 281 | ||
| Liver Function Abnormalities | 281 | ||
| Amenorrhea and Testicular Function | 282 | ||
| CONCENTRATION-CONTROLLED DOSING | 282 | ||
| SUMMARY AND CONCLUSIONS | 282 | ||
| REFERENCES | 282 | ||
| CHAPTER 20: ANTILYMPHOCYTE GLOBULIN, MONOCLONAL ANTIBODIES, AND FUSION PROTEINS | 287 | ||
| HISTORICAL PERSPECTIVE | 288 | ||
| ANTIBODY STRUCTURE AND FUNCTION | 289 | ||
| GENERAL CLINICAL CONSIDERATIONS FOR THE USE OF ANTIBODY PREPARATIONS | 290 | ||
| POLYCLONAL ANTIBODY PREPARATIONS | 292 | ||
| SPECIFIC CLINICAL APPLICATIONS OF POLYCLONAL ANTIBODY PREPARATIONS | 293 | ||
| Induction | 293 | ||
| Rescue | 293 | ||
| Administration and Adverse Effects | 294 | ||
| MONOCLONAL ANTIBODY PREPARATIONS | 295 | ||
| MONOCLONAL ANTIBODIES IN CURRENT CLINICAL TRANSPLANTATION PRACTICE | 295 | ||
| Muromonab (OKT3; Murine Anti-CD3) | 295 | ||
| Induction | 296 | ||
| Rescue | 296 | ||
| Interleukin-2 Receptor (CD25)-Specific Monoclonal Antibodies | 297 | ||
| Induction | 297 | ||
| Administration and Adverse Effects | 297 | ||
| Alemtuzumab (Humanized Anti-CD52) | 297 | ||
| Induction | 298 | ||
| Rescue | 298 | ||
| Administration and Adverse Effects | 298 | ||
| Rituximab (Humanized Anti-CD20) | 299 | ||
| Induction | 299 | ||
| Rescue | 299 | ||
| Administration and Adverse Effects | 299 | ||
| FUSION PROTEINS | 299 | ||
| Monoclonal Antibodies and Fusion Proteins in Clinical Transplantation Investigation | 299 | ||
| CD2-Specific Approaches | 300 | ||
| CD3-Specific Antibodies | 300 | ||
| CD4-Specific Antibodies | 300 | ||
| Costimulation-Based Therapies | 301 | ||
| Tumor Necrosis Factor- α -Based Approaches | 302 | ||
| Targeting Cell Adhesion | 302 | ||
| Targeting the T-Cell Receptor | 303 | ||
| Targeting Complement | 304 | ||
| Other Experimental Antibodies and Fusion Proteins | 304 | ||
| Targeting CD5 | 304 | ||
| Targeting CD6 | 304 | ||
| Targeting CD7 | 304 | ||
| Targeting CD8 | 304 | ||
| Targeting CD45 | 305 | ||
| Immunotoxins | 305 | ||
| CONCLUSION | 305 | ||
| REFERENCES | 306 | ||
| CHAPTER 21: BELATACEPT | 314 | ||
| INTRODUCTION: TWO SIGNALS | 314 | ||
| COSTIMULATORY PATHWAYS | 314 | ||
| COSTIMULATION BLOCKADE | 315 | ||
| Costimulation Blockade: CD28-B7 | 315 | ||
| Costimulation Blockade: CTLA-4 Ig | 316 | ||
| Rational Development of Belatacept (LEA29Y) | 316 | ||
| CLINICAL APPLICATION OF BELATACEPT | 316 | ||
| CONCLUSIONS | 318 | ||
| REFERENCES | 318 | ||
| CHAPTER 22: OTHER FORMS OF IMMUNOSUPPRESSION | 320 | ||
| SMALL MOLECULES | 320 | ||
| Leflunomide and Malononitrilamides | 320 | ||
| Chemical Structure and Pharmacology | 320 | ||
| Mechanism of Action | 321 | ||
| Experimental Experience | 321 | ||
| Clinical Experience | 321 | ||
| Toxicity | 322 | ||
| Conclusion | 322 | ||
| FTY720 or Fingolimod | 322 | ||
| Chemical Structure and Pharmacology | 322 | ||
| Mechanism of Action | 322 | ||
| Experimental Experience | 323 | ||
| Clinical Experience | 323 | ||
| Toxicity | 323 | ||
| Conclusion | 323 | ||
| 1,25-Dihydroxyvitamin D 3 and its Analogues | 323 | ||
| Chemical Structure and Pharmacology | 323 | ||
| Mechanism of Action | 323 | ||
| Experimental Experience | 324 | ||
| Clinical Experience | 324 | ||
| CHAPTER 23: APPROACHES TO THE INDUCTION OF TOLERANCE | 339 | ||
| INTRODUCTION | 339 | ||
| Historical Perspective | 339 | ||
| Definition of “Tolerance” | 339 | ||
| Need for Tolerance in Clinical Transplantation | 340 | ||
| UNDERSTANDING THE IMMUNOLOGIC MECHANISMS BEHIND TOLERANCE INDUCTION | 341 | ||
| Overview of T-Cell Activation | 341 | ||
| Mechanisms of Tolerance to Donor Antigens | 343 | ||
| Mechanisms of Tolerance Induction and Maintenance | 343 | ||
| Persistence of Donor Antigen | 343 | ||
| Deletion of Donor-Reactive Leukocytes | 343 | ||
| T cells | 343 | ||
| B cells | 344 | ||
| Regulation of Immune Responses | 345 | ||
| Regulatory T Cells | 345 | ||
| Regulatory B Cells | 346 | ||
| Regulatory Macrophages | 348 | ||
| Tolerogenic Dendritic Cells | 348 | ||
| Myeloid-Derived Suppressor Cells | 349 | ||
| Mesenchymal Stromal Cells | 350 | ||
| Information from Analyzing Tolerant Recipients | 350 | ||
| STRATEGIES WITH THE POTENTIAL TO INDUCE IMMUNOLOGIC TOLERANCE TO AN ALLOGRAFT | 351 | ||
| Mixed Chimerism | 351 | ||
| Costimulation Blockade | 352 | ||
| The B7:CD28/CTLA-4 Pathway | 352 | ||
| CD40-CD154 Pathway | 353 | ||
| Targeting CD3 and Accessory Molecules | 353 | ||
| LEUKOCYTE DEPLETION AT THE TIME OF TRANSPLANTATION | 354 | ||
| CELL THERAPY | 354 | ||
| Treg Cell Therapy | 354 | ||
| Regulatory Macrophage Cell Therapy | 354 | ||
| Mesenchymal Stromal Cell Therapy | 354 | ||
| Acknowledgments | 354 | ||
| REFERENCES | 354 | ||
| CHAPTER 24: TRANSPLANTATION IN THE SENSITIZED RECIPIENT AND ACROSS ABO BLOOD GROUPS | 360 | ||
| SENSITIZED PATIENTS | 360 | ||
| ALLOANTIBODY DETECTION | 360 | ||
| IMMUNOLOGICAL RISK | 361 | ||
| CLINICAL APPROACHES TO SENSITIZED PATIENTS | 362 | ||
| Deceased Donor Transplantation | 362 | ||
| Paired Donation | 362 | ||
| Living Donor Kidney Transplantation with DSA: Desensitization Protocols | 363 | ||
| Specific Issues Related to DSA | 363 | ||
| Hyperacute Rejection and Very High Levels of DSA | 363 | ||
| Early Acute Antibody-Mediated Rejection | 364 | ||
| Treatment of AMR | 365 | ||
| Prevention of AMR | 365 | ||
| CHRONIC ANTIBODY-MEDIATED INJURY | 365 | ||
| ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION | 366 | ||
| MECHANISTIC VIEW OF ANTIBODY PRODUCTION AND INJURY | 367 | ||
| CONCLUSION | 368 | ||
| REFERENCES | 369 | ||
| CHAPTER 25: KIDNEY PAIRED DONATION PROGRAMS FOR LIVING DONORS | 372 | ||
| BEGINNINGS OF KIDNEY PAIRED DONATION | 372 | ||
| THE ROLE OF HLA MATCHING | 372 | ||
| LEGAL RESTRICTIONS | 373 | ||
| ANONYMITY | 373 | ||
| DONOR TRAVEL AND ORGAN TRANSPORT | 373 | ||
| FINANCIAL ISSUES | 373 | ||
| EXPANSIONS BEYOND INCOMPATIBLE PAIRS | 373 | ||
| THE ROLE OF NON-DIRECTED DONORS | 374 | ||
| GOALS OF MATCHING | 374 | ||
| MATCHING ALGORITHMS | 374 | ||
| REGISTRY SIZE | 375 | ||
| BEYOND NATIONAL LINES | 375 | ||
| FUTURE OF KIDNEY PAIRED DONATION | 375 | ||
| REFERENCES | 375 | ||
| CHAPTER 26: PATHOLOGY OF KIDNEY TRANSPLANTATION | 377 | ||
| RENAL ALLOGRAFT BIOPSY | 377 | ||
| Optimal Tissue | 378 | ||
| Microscopy | 378 | ||
| Classification of Pathologic Diagnoses in the Renal Allograft | 378 | ||
| DONOR KIDNEY BIOPSY | 379 | ||
| HYPERACUTE REJECTION | 379 | ||
| ACUTE RENAL ALLOGRAFT REJECTION | 380 | ||
| Acute T-Cell-Mediated Rejection | 380 | ||
| Tubulointerstitial Rejection (Type I) | 380 | ||
| Endarteritis (Type II Rejection) | 381 | ||
| Glomerular Lesions | 382 | ||
| Atypical Rejection Syndromes | 382 | ||
| Differential Diagnosis | 383 | ||
| Acute Antibody-Mediated Rejection | 384 | ||
| Diagnostic Criteria | 384 | ||
| Pathologic Features | 385 | ||
| C4d Interpretation | 385 | ||
| Differential Diagnosis | 386 | ||
| Classification Systems | 386 | ||
| LATE GRAFT DISEASES | 387 | ||
| Chronic Antibody-Mediated Rejection | 387 | ||
| Peritubular Capillary and Tubulointerstitial Lesions | 389 | ||
| Transplant Arteriopathy | 389 | ||
| Accommodation | 389 | ||
| Longitudinal Studies. | 389 | ||
| C4d-Negative Antibody-Mediated Rejection | 389 | ||
| Chronic T-Cell-Mediated Rejection | 390 | ||
| Chronic Allograft Arteriopathy | 390 | ||
| Sequence of Arterial Lesions | 391 | ||
| Differential Diagnosis of Late Biopsies | 391 | ||
| Transplant Glomerulopathy | 391 | ||
| Arteriosclerosis | 391 | ||
| CHR | 391 | ||
| Polyomavirus | 392 | ||
| Interstitial Fibrosis | 392 | ||
| ACUTE TUBULAR INJURY | 392 | ||
| CALCINEURIN INHIBITOR NEPHROTOXICITY | 392 | ||
| Acute CNI Toxicity | 392 | ||
| Toxic Tubulopathy | 392 | ||
| Acute Arteriolar Toxicity and Thrombotic Microangiopathy | 393 | ||
| Differential Diagnosis | 393 | ||
| Chronic CNI Toxicity | 394 | ||
| CNI Arteriolopathy | 394 | ||
| Glomerular Lesions | 395 | ||
| Tubules and Interstitium | 395 | ||
| Differential Diagnosis | 395 | ||
| TARGET OF RAPAMYCIN INHIBITOR TOXICITY | 396 | ||
| DRUG-INDUCED ACUTE TUBULOINTERSTITIAL NEPHRITIS | 396 | ||
| INFECTIONS | 396 | ||
| Polyomavirus Tubulointerstitial Nephritis | 396 | ||
| Adenovirus | 397 | ||
| Acute Pyelonephritis | 397 | ||
| MAJOR RENAL VASCULAR DISEASE | 398 | ||
| DE NOVO GLOMERULAR DISEASE | 398 | ||
| Membranous Glomerulonephritis | 398 | ||
| Anti-GBM Nephritis | 398 | ||
| De Novo Podocytopathy in Congenital Nephrosis | 398 | ||
| Focal Segmental Glomerulosclerosis | 399 | ||
| RECURRENT RENAL DISEASE | 399 | ||
| Posttransplant Lymphoproliferative Disease | 400 | ||
| PROTOCOL BIOPSIES | 400 | ||
| FUTURE DIRECTIONS IN BIOPSY ASSESSMENT | 402 | ||
| Acknowledgments | 402 | ||
| REFERENCES | 402 | ||
| CHAPTER 27: CHRONIC ALLOGRAFT FAILURE | 411 | ||
| INTRODUCTION: THE PROBLEM OF GRAFT LOSS | 411 | ||
| PATHOPHYSIOLOGY OF CHRONIC ALLOGRAFT DAMAGE | 412 | ||
| Models of Chronic Kidney Transplant Injury | 412 | ||
| Mechanisms of Chronic Allograft Progression | 413 | ||
| Failure to Resolve Chronic Inflammation | 414 | ||
| Epithelial–Mesenchymal Transition-Induced Fibrosis | 414 | ||
| Donor Age and Replicative Senescence | 415 | ||
| Cortical Ischemia | 415 | ||
| Internal Structural Failure | 415 | ||
| TIME COURSE OF HISTOLOGICAL DAMAGE | 416 | ||
| Donor Abnormalities and Procurement Injury | 416 | ||
| Delayed Graft Function and Ischemic Injury | 417 | ||
| Early Tubulointerstitial Damage | 417 | ||
| Acute Rejection and Alloimmune Mechanisms | 418 | ||
| Subclinical Rejection | 418 | ||
| Tubulointerstitial Injury from BK Virus Nephropathy (see Chapters 29 and 32) | 419 | ||
| Progressive and Late-Stage Chronic Allograft Damage | 419 | ||
| Chronic T-Cell-Mediated Interstitial Rejection | 420 | ||
| Calcineurin Inhibitor Nephrotoxicity | 420 | ||
| Progressive Glomerular Abnormalities | 422 | ||
| Transplant Glomerulopathy and Chronic Antibody-Mediated Rejection | 423 | ||
| Recurrent Glomerular Disease | 424 | ||
| Late Acute Rejection and Intercurrent Illness | 424 | ||
| APPROACH TO A FAILING ALLOGRAFT | 425 | ||
| Monitoring of Renal Function | 425 | ||
| Proteinuria and Urinalysis | 425 | ||
| Renal Transplant Imaging | 425 | ||
| Immune Surveillance Tests | 425 | ||
| Urinary Diagnostics | 425 | ||
| Serum Immune Surveillance Markers | 426 | ||
| Kidney Transplant Biopsy | 426 | ||
| Principles Guiding Clinical Biopsy | 426 | ||
| Risk and Safety of Transplant Biopsies | 428 | ||
| Diagnostic Algorithm for a Chronically Failing Graft | 428 | ||
| TREATMENT OF A FAILING ALLOGRAFT | 428 | ||
| Long-Term Immunosuppression | 428 | ||
| General Treatment Principles | 429 | ||
| Treatment Approach by Specific Diagnosis | 429 | ||
| Interstitial Fibrosis and Tubular Atrophy | 430 | ||
| Approach to Calcineurin Inhibitor Nephrotoxicity | 430 | ||
| Chronic Antibody-Mediated Rejection | 430 | ||
| Chronic Active T-Cell-Mediated Rejection | 430 | ||
| Treatment of Acute Late Rejection | 431 | ||
| Treatment of Recurrent Disease | 431 | ||
| Recurrent focal segmental glomerulosclerosis. | 431 | ||
| Membranous Glomerulonephritis. | 431 | ||
| Other Recurrent Diseases. | 431 | ||
| Treatment of BK Virus Nephropathy | 431 | ||
| SUMMARY | 431 | ||
| Acknowledgments | 432 | ||
| REFERENCES | 432 | ||
| CHAPTER 28: VASCULAR AND LYMPHATIC COMPLICATIONS AFTER KIDNEY TRANSPLANTATION | 435 | ||
| INTRODUCTION | 435 | ||
| TECHNICAL COMPLICATIONS AND THEIR PREVENTION | 436 | ||
| Informed Consent | 436 | ||
| Preoperative Assessment | 436 | ||
| Right or Left Donor Kidney | 436 | ||
| Back Table Preparation | 437 | ||
| Transplant Renal Vein Anastomosis | 438 | ||
| Transplant Renal Artery Anastomosis | 439 | ||
| Reperfusion | 439 | ||
| Positioning the Kidney and Wound Closure | 441 | ||
| Postoperative Recovery | 441 | ||
| Drain Tube | 441 | ||
| Compartment Syndrome | 441 | ||
| HEMATOMA | 442 | ||
| VASCULAR THROMBOSIS AND THROMBOPHILIA | 443 | ||
| Thrombophilic Factors | 444 | ||
| Contribution of Immunosuppressive Agents | 444 | ||
| Renal Vein Thrombosis | 444 | ||
| Renal Artery Thrombosis | 445 | ||
| Segmental Arterial Thrombosis | 445 | ||
| Thrombosis Prevention Strategies | 446 | ||
| TORSION | 446 | ||
| VASCULAR ACCESS THROMBOSIS | 447 | ||
| DEEP VEIN THROMBOSIS | 447 | ||
| VASCULAR CAUSES OF URETERIC COMPLICATIONS | 448 | ||
| MYCOTIC ANEURYSM | 449 | ||
| BIOPSY-RELATED VASCULAR COMPLICATIONS | 449 | ||
| TRANSPLANT RENAL ARTERY STENOSIS | 451 | ||
| Definition and Incidence | 451 | ||
| Pathogenesis | 451 | ||
| Pathophysiology – “One Kidney, One Clip” | 453 | ||
| Imaging | 454 | ||
| Conservative Treatment | 456 | ||
| Angioplasty and Stenting | 456 | ||
| Surgical Correction | 456 | ||
| LYMPHOCELE | 459 | ||
| Incidence | 459 | ||
| Etiology | 459 | ||
| Presentation | 460 | ||
| Diagnosis | 460 | ||
| Treatment | 460 | ||
| Lymphocutaneous Fistula | 461 | ||
| CONCLUSIONS | 462 | ||
| REFERENCES | 462 | ||
| CHAPTER 29: UROLOGICAL COMPLICATIONS AFTER KIDNEY TRANSPLANTATION | 464 | ||
| URETERAL COMPLICATIONS | 464 | ||
| Ureteral Leak | 464 | ||
| Ureteral Stenosis | 466 | ||
| USE OF PROPHYLACTIC URETERAL STENTS | 467 | ||
| URINARY CALCULI IN TRANSPLANT RECIPIENTS | 469 | ||
| URINARY RETENTION | 469 | ||
| ERECTILE DYSFUNCTION | 469 | ||
| UROLOGIC MALIGNANCIES | 470 | ||
| REFERENCES | 470 | ||
| CHAPTER 30: CARDIOVASCULAR DISEASE IN RENAL TRANSPLANTATION | 472 | ||
| INTRODUCTION | 472 | ||
| BACKGROUND: CVD IN CKD | 472 | ||
| EPIDEMIOLOGY AND NATURE OF POSTTRANSPLANT CVD | 473 | ||
| NOVEL AND TRANSPLANT-SPECIFIC RISK FACTORS | 475 | ||
| SPECIFIC RISK FACTORS AND MANAGEMENT | 475 | ||
| HYPERTENSION AND UREMIC CARDIOMYOPATHY | 475 | ||
| OTHER SURROGATES: VASCULAR STIFFNESS AND CALCIFICATION | 477 | ||
| CHOICE OF ANTIHYPERTENSIVE AGENT | 477 | ||
| GUIDELINES AND OBSERVED PATTERNS OF USAGE | 479 | ||
| DYSLIPIDEMIA | 480 | ||
| RENAL FUNCTION | 481 | ||
| SMOKING | 482 | ||
| NEW-ONSET DIABETES AFTER TRANSPLANTATION | 482 | ||
| OBESITY AND THE METABOLIC SYNDROME | 484 | ||
| OTHER RISK FACTORS AND INTERVENTIONS | 484 | ||
| SCREENING | 485 | ||
| INTERVENTION AND SECONDARY PREVENTION | 485 | ||
| OTHER CARDIOVASCULAR CONDITIONS | 485 | ||
| PREDICTING CARDIOVASCULAR RISK | 485 | ||
| TRIAL END-POINTS | 486 | ||
| CONCLUSION | 487 | ||
| REFERENCES | 487 | ||
| CHAPTER 31: INFECTION IN KIDNEY TRANSPLANT RECIPIENTS | 491 | ||
| OVERVIEW | 491 | ||
| RISK OF INFECTION | 491 | ||
| Epidemiological Exposures | 492 | ||
| Donor-Derived Infections | 492 | ||
| Recipient-Derived Exposures | 492 | ||
| Community Exposures | 493 | ||
| Nosocomial Exposures | 494 | ||
| Net State of Immunosuppression | 494 | ||
| TIMELINE OF INFECTION | 494 | ||
| First Phase (0–4 Weeks after Transplantation) | 495 | ||
| Second Phase (1–12 Months after Transplantation) | 497 | ||
| Third Phase ( > 6–12 Months after Transplantation) | 497 | ||
| ASSESSMENT OF INFECTIOUS DISEASES IN RECIPIENTS AND POTENTIAL DONORS BEFORE TRANSPLANTATION | 498 | ||
| Transplant Donor | 498 | ||
| Deceased Donor Evaluation | 498 | ||
| Living Donor Evaluation | 498 | ||
| Special Infectious Risks and Organ Procurement | 498 | ||
| Tuberculosis | 498 | ||
| Parasites | 499 | ||
| Viral Infections Other than Cytomegalovirus | 499 | ||
| Transplant Recipient | 499 | ||
| SELECTED INFECTIONS OF IMPORTANCE | 500 | ||
| General Considerations | 500 | ||
| Viral Pathogens | 500 | ||
| Cytomegalovirus | 500 | ||
| Patterns of Transmission | 501 | ||
| Primary CMV Infection | 501 | ||
| Reactivation CMV Infection | 501 | ||
| CMV Superinfection | 501 | ||
| Pathogenesis of Infection | 501 | ||
| Diagnosis | 501 | ||
| Cytomegalovirus prevention | 502 | ||
| Treatment | 502 | ||
| Epstein–Barr Virus | 503 | ||
| Diagnosis | 504 | ||
| Management | 504 | ||
| Polyomaviruses | 504 | ||
| BK Polyomavirus Infection | 504 | ||
| Screening, Prevention, and Diagnosis | 504 | ||
| Treatment | 505 | ||
| JC Virus | 505 | ||
| Fungal Infections | 505 | ||
| Candida | 505 | ||
| Aspergillus | 506 | ||
| Central Nervous System Infections and Cryptococcus neoformans | 506 | ||
| Cryptococcus neoformans | 506 | ||
| Strongyloides stercoralis | 506 | ||
| Pneumocystis and Fever with Pneumonitis | 507 | ||
| Pneumocystis Pneumonia | 507 | ||
| Diagnosis, Therapy, and Prophylaxis | 507 | ||
| Urinary Tract Infection | 508 | ||
| CONCLUSIONS | 508 | ||
| REFERENCES | 508 | ||
| CHAPTER 32: LIVER DISEASE AMONG RENAL TRANSPLANT RECIPIENTS | 511 | ||
| OVERVIEW OF INCIDENCE AND CLINICOPATHOLOGICAL ASSOCIATIONS | 511 | ||
| COMBINED LIVER AND KIDNEY DISEASES | 512 | ||
| Polycystic Disease | 512 | ||
| Drug-Induced Hepatotoxicity | 513 | ||
| SPECIFIC IMMUNOSUPPRESSIVE AGENTS IN RENAL TRANSPLANTATION AND HEPATOTOXICITY | 513 | ||
| Azathioprine | 513 | ||
| Calcineurin Inhibitor-Induced Hepatotoxicity | 514 | ||
| Sirolimus | 515 | ||
| Mycophenolate Mofetil, Mycophenolic Acid | 515 | ||
| Monoclonal Antibodies | 515 | ||
| T-Cell Costimulatory Inhibitor | 515 | ||
| HEPATITIS VIRUSES ASSOCIATED WITH RENAL TRANSPLANTATION | 515 | ||
| Hepatitis B Virus | 515 | ||
| Viral Structure and Proteins | 515 | ||
| Tests for Detection of Hepatitis B ( Table 32-2) | 515 | ||
| Epidemiology of HBV | 516 | ||
| Routes of Transmission | 516 | ||
| Natural History of HBV Infection | 516 | ||
| Hepatitis B Infection in Patients Awaiting Renal Transplant on Dialysis | 516 | ||
| Pretransplant Management of Hepatitis B-Positive Dialysis Patients | 517 | ||
| Posttransplant Prognosis in Hepatitis B-Infected Recipients | 517 | ||
| De Novo HBV Infection after Kidney Transplantation | 518 | ||
| Antiviral Therapy of Chronic Hepatitis B in Renal Transplant Candidates/Recipients ( Table 32-3) | 518 | ||
| Specific Antiviral Agents for HBV Used in Renal Transplant Recipients | 521 | ||
| Lamivudine | 521 | ||
| Adefovir | 521 | ||
| Entecavir | 521 | ||
| Tenofovir | 521 | ||
| Interferon | 522 | ||
| Treatment of Fibrosing Cholestatic Hepatitis B in Renal Transplant Recipients | 522 | ||
| Summary | 522 | ||
| Hepatitis C Virus | 522 | ||
| Viral Structure | 522 | ||
| HCV Species | 522 | ||
| Clinical Manifestations of Hepatitis C Infection in Immunocompetent Hosts | 522 | ||
| Incidence/Prevalence and Transmission of Hepatitis C in Renal Transplant Patients | 523 | ||
| Allograft Transmission of HCV | 523 | ||
| Impact of Pretransplant HCV on Posttransplant Outcomes ( Table 32-4) | 523 | ||
| Patient and Graft Survival | 523 | ||
| HCV and Posttransplant Diabetes in the Renal Transplant Recipient | 524 | ||
| HCV and Posttransplant Nephropathy | 524 | ||
| Immunosuppressive Strategies in Renal Transplant Patients Infected with HCV | 524 | ||
| Hepatitis C Antiviral Therapy ( Table 32-5) | 525 | ||
| Pretransplant Antiviral Therapy | 525 | ||
| Protease Inhibitors | 525 | ||
| Posttransplant Antiviral Therapy for Hepatitis C | 528 | ||
| Hepatitis E | 528 | ||
| HEPATOCELLULAR CARCINOMA AFTER RENAL TRANSPLANTATION | 528 | ||
| SYSTEMIC INFECTIONS RESULTING IN HEPATITIS AND LIVER DISEASE | 528 | ||
| Liver Abscess | 528 | ||
| Mycobacterial Infection | 529 | ||
| Viral Infections | 529 | ||
| Herpesviruses | 529 | ||
| Cytomegalovirus | 529 | ||
| Epstein–Barr Virus | 530 | ||
| Herpes Simplex Virus | 530 | ||
| Varicella-Zoster Virus | 530 | ||
| Human Herpesviruses 6 and 7 | 530 | ||
| REFERENCES | 531 | ||
| CHAPTER 33: NEUROLOGICAL COMPLICATIONS AFTER KIDNEY TRANSPLANTATION | 537 | ||
| NEUROLOGICAL DISEASE PRECEDING RENAL TRANSPLANTATION | 538 | ||
| Systemic Disease | 538 | ||
| Uremia | 538 | ||
| Dialysis Dysequilibrium Syndrome and Dialysis Dementia | 538 | ||
| APPROACH TO THE RENAL TRANSPLANT PATIENT WITH NEUROLOGICAL DISEASE | 538 | ||
| Central Nervous System Dysfunction | 538 | ||
| Encephalopathy | 538 | ||
| Seizures | 538 | ||
| Peripheral Nervous System Dysfunction | 539 | ||
| IMMEDIATE NEUROLOGICAL COMPLICATIONS | 539 | ||
| Central Nervous System Dysfunction | 539 | ||
| Hypoxic-Ischemic Insult and Perioperative Sedation | 539 | ||
| Electrolyte Imbalance | 539 | ||
| Rejection Encephalopathy | 539 | ||
| Hypertensive Encephalopathy | 539 | ||
| Infection | 540 | ||
| Central Pontine Myelinolysis | 540 | ||
| Peripheral Nervous System Dysfunction | 540 | ||
| Femoral Neuropathy | 540 | ||
| Lumbosacral Plexopathy | 541 | ||
| Ulnar Neuropathy | 541 | ||
| SUBACUTE NEUROLOGICAL COMPLICATIONS | 541 | ||
| Central Nervous System Dysfunction | 541 | ||
| Tacrolimus | 541 | ||
| Cyclosporine | 541 | ||
| FKB12 Ligands: Sirolimus and Everolimus | 542 | ||
| Monoclonal Antibodies | 542 | ||
| Steroids | 542 | ||
| Peripheral Nervous System Dysfunction | 542 | ||
| Cyclosporine | 542 | ||
| Tacrolimus | 542 | ||
| Steroids | 543 | ||
| Guillain–Barré Syndrome | 543 | ||
| CHRONIC NEUROLOGICAL COMPLICATIONS | 543 | ||
| Infection (see Chapter 31) | 543 | ||
| Meningitis | 543 | ||
| Encephalitis | 544 | ||
| Focal Brain Infections | 544 | ||
| Progressive Dementia | 544 | ||
| Stroke (see Chapter 28) | 544 | ||
| Ischemic Stroke | 545 | ||
| Hemorrhagic Stroke | 545 | ||
| Primary Central Nervous System Lymphoma | 545 | ||
| SUMMARY | 546 | ||
| REFERENCES | 547 | ||
| CHAPTER 34: NON-MALIGNANT AND MALIGNANT SKIN LESIONS IN KIDNEY TRANSPLANT PATIENTS | 550 | ||
| INTRODUCTION | 550 | ||
| DRUG SIDE EFFECTS | 553 | ||
| Corticosteroids | 553 | ||
| Azathioprine | 554 | ||
| Cyclosporine | 554 | ||
| Mycophenolate Mofetil | 554 | ||
| Tacrolimus | 554 | ||
| Sirolimus | 554 | ||
| Management of Drug Side Effects | 554 | ||
| INFECTIONS | 555 | ||
| Bacterial Infections | 555 | ||
| Viral Infections | 555 | ||
| Herpesviruses | 555 | ||
| Human Papillomaviruses | 555 | ||
| Management of Cutaneous Viral Warts | 556 | ||
| Fungal Infections | 556 | ||
| Pityriasis Versicolor | 556 | ||
| Dermatophyte Infections | 556 | ||
| Candida | 557 | ||
| Parasitic Infestations | 557 | ||
| INFLAMMATORY AND NON-INFLAMMATORY CUTANEOUS FINDINGS | 557 | ||
| Seborrheic Dermatitis | 557 | ||
| Eczemas | 557 | ||
| Psoriasis | 557 | ||
| Seborrheic Keratoses | 557 | ||
| Skin Tags | 558 | ||
| Other Benign Cutaneous Changes | 558 | ||
| Nail Changes | 558 | ||
| PREMALIGNANT AND MALIGNANT SKIN CONDITIONS | 558 | ||
| Premalignant Skin Tumors | 559 | ||
| Actinic Keratosis | 559 | ||
| Bowen’s Disease | 560 | ||
| Porokeratosis | 560 | ||
| Malignant Skin Tumors | 560 | ||
| Keratoacanthoma | 560 | ||
| Squamous Cell Carcinoma | 560 | ||
| Basal Cell Carcinoma | 561 | ||
| Malignant Melanoma | 561 | ||
| Merkel Cell Carcinoma | 561 | ||
| Atypical Fibroxanthoma and Undifferentiated Pleomorphic Sarcoma | 561 | ||
| Risk Factors and Pathogenesis | 561 | ||
| Skin Phototype and Ultraviolet Exposure | 561 | ||
| Immunosuppressive Drugs | 562 | ||
| Human Papillomavirus | 562 | ||
| Genetic Factors | 562 | ||
| Voriconazole | 562 | ||
| Management | 562 | ||
| Topical Therapy | 563 | ||
| Topical 5-Fluorouracil | 563 | ||
| Topical Imiquimod | 563 | ||
| Photodynamic Therapy | 563 | ||
| Capecitabine | 563 | ||
| Systemic Retinoids | 563 | ||
| Altering the Immunosuppressive Regimen | 564 | ||
| Surgery | 564 | ||
| Role of Sentinel Lymph Node Biopsy | 564 | ||
| SUMMARY | 564 | ||
| REFERENCES | 565 | ||
| CHAPTER 35: CANCER IN DIALYSIS AND KIDNEY TRANSPLANT PATIENTS | 569 | ||
| CANCER IN DIALYSIS PATIENTS | 569 | ||
| Magnitude of the Cancer Risk in Dialysis Patients | 569 | ||
| Reasons for the Increased Risk of Cancer in Dialysis Patients | 571 | ||
| The Particular Problem of Renal Tract Malignancy in Patients with End-Stage Kidney Disease | 571 | ||
| Screening for Cancer in Dialysis Patients | 572 | ||
| Management of Cancer in Dialysis Patients | 572 | ||
| CANCER IN KIDNEY TRANSPLANT RECIPIENTS | 572 | ||
| Transmission of Cancer from the Donor | 574 | ||
| Development of De Novo Cancers in Kidney Transplant Recipients | 575 | ||
| Reasons for the Increased Risk of Cancer in Transplant Patients | 575 | ||
| Impaired Immune Surveillance | 575 | ||
| Oncogenic Viruses | 575 | ||
| Chronic Antigenic Stimulation and Immune Regulation | 575 | ||
| Environmental Factors | 576 | ||
| Direct Neoplastic Action of Immunosuppressive Drugs | 576 | ||
| Calcineurin Inhibitors (Cyclosporine and Tacrolimus) | 576 | ||
| Mammalian Target of Rapamycin Inhibitors (mTORi) | 576 | ||
| Corticosteroids | 576 | ||
| Azathioprine | 576 | ||
| Mycophenolate Mofetil | 576 | ||
| Lymphocyte-Depleting Agents | 576 | ||
| Types of Cancer in Kidney Transplant Recipients | 577 | ||
| Skin Malignancies | 577 | ||
| Posttransplant Lymphoproliferative Disorder | 577 | ||
| Kaposi’s Sarcoma | 577 | ||
| Time of Cancer Presentation | 578 | ||
| Management of Cancer in Kidney Transplant Recipients | 578 | ||
| TRANSPLANTATION IN PATIENTS WITH A HISTORY OF CANCER | 578 | ||
| PREVENTION AND EARLY DETECTION OF CANCER IN KIDNEY TRANSPLANT RECIPIENTS | 579 | ||
| SURVIVAL IN KIDNEY TRANSPLANT RECIPIENTS WHO DEVELOP CANCER | 579 | ||
| CONCLUSIONS | 580 | ||
| REFERENCES | 581 | ||
| CHAPTER 36: PANCREAS AND KIDNEY TRANSPLANTATION FOR DIABETIC NEPHROPATHY | 584 | ||
| HISTORY | 585 | ||
| INDICATIONS AND CATEGORIES | 586 | ||
| Indications | 586 | ||
| Recipient Categories | 586 | ||
| ALLOCATION | 587 | ||
| SPECIFIC RISK FACTORS | 588 | ||
| PROCEDURE | 589 | ||
| Surgical Techniques | 589 | ||
| Immunosuppression | 591 | ||
| MANAGEMENT | 591 | ||
| Intraoperative Care | 591 | ||
| Postoperative Care | 591 | ||
| Anticoagulation | 592 | ||
| Antimicrobial Prophylaxis | 592 | ||
| PANCREAS TRANSPLANT OUTCOMES | 593 | ||
| Changes over Time of Pancreas Transplant Outcomes | 593 | ||
| Improvements in Pancreas Transplant Outcomes by Era | 593 | ||
| Pancreas Transplant Outcome for Contemporary (2000–2005) US Cases | 595 | ||
| Outcome by Recipient and Donor Risk Factors | 597 | ||
| Survival Probabilities for Patients who Remained on the Waiting List | 598 | ||
| Expected Life-Year Gains from an Extra Deceased Donor | 598 | ||
| PANCREAS RETRANSPLANTS | 598 | ||
| LIVING DONOR PANCREAS TRANSPLANTS | 599 | ||
| QUALITY-OF-LIFE STUDY | 599 | ||
| LONG-TERM QUALITY OF LIFE | 600 | ||
| METABOLIC STUDIES | 600 | ||
| STUDIES OF DIABETIC SECONDARY COMPLICATIONS | 601 | ||
| Retinopathy | 602 | ||
| Nephropathy | 602 | ||
| Neuropathy | 602 | ||
| SUMMARY | 602 | ||
| REFERENCES | 603 | ||
| CHAPTER 37: RENAL TRANSPLANTATION IN CHILDREN | 606 | ||
| INTRODUCTION | 607 | ||
| EPIDEMIOLOGY OF END-STAGE RENAL DISEASE IN CHILDREN | 607 | ||
| Incidence | 607 | ||
| Etiology | 608 | ||
| ACCESS TO TRANSPLANTATION | 608 | ||
| TIMING OF TRANSPLANTATION | 609 | ||
| PATIENT AND GRAFT SURVIVAL | 610 | ||
| Incidence and Causes of Graft Failure | 611 | ||
| Prognostic Factors Influencing Graft Survival | 612 | ||
| Donor Source | 612 | ||
| Recipient Age | 612 | ||
| Donor Age | 612 | ||
| Recipient Race | 612 | ||
| HLA Matching | 612 | ||
| Presensitization | 613 | ||
| Delayed Graft Function and Technical Factors | 613 | ||
| Induction Therapy | 614 | ||
| Transplant Center Volume | 614 | ||
| CONTRAINDICATIONS TO TRANSPLANTATION | 614 | ||
| RECURRENCE OF ORIGINAL DISEASE | 614 | ||
| Primary Glomerulonephritis | 614 | ||
| Focal Segmental Glomerulosclerosis | 614 | ||
| Congenital Nephrotic Syndrome | 615 | ||
| Alport’s Syndrome | 616 | ||
| Membranoproliferative Glomerulonephritis | 616 | ||
| Dense Deposit Disease (Formerly MPGN II) | 617 | ||
| Secondary Glomerulonephritis | 617 | ||
| IgA and Henoch–Schönlein Purpura | 617 | ||
| Hemolytic-Uremic Syndrome | 617 | ||
| Membranous Nephropathy | 619 | ||
| Systemic Lupus Erythematosus (SLE) | 619 | ||
| c-ANCA and p-ANCA-positive Glomerulonephritis | 619 | ||
| Metabolic Disease | 620 | ||
| Primary Hyperoxaluria Type I (Oxalosis) | 620 | ||
| Nephropathic Cystinosis | 620 | ||
| PRETRANSPLANT EVALUATION | 620 | ||
| Evaluation of Potential Living Donor | 620 | ||
| Evaluation of Recipient | 620 | ||
| Medical Evaluation of Issues Related to ESRD | 620 | ||
| Cardiovascular Disease | 620 | ||
| GN of Unknown Etiology | 621 | ||
| Nephrotic Syndrome | 621 | ||
| Renal Osteodystrophy | 621 | ||
| Nutrition and Growth | 621 | ||
| Evaluation of Extrarenal Disease | 621 | ||
| Infections | 621 | ||
| Urinary tract infections | 621 | ||
| Cytomegalovirus (CMV) | 621 | ||
| Epstein–Barr Virus (EBV) | 621 | ||
| Hepatitis B and C | 622 | ||
| Immunization Status | 622 | ||
| Hemostasis | 622 | ||
| Prior Malignancy | 622 | ||
| Surgical Evaluation | 622 | ||
| Vascular Evaluation | 622 | ||
| Urological Evaluation | 622 | ||
| Native Nephrectomy | 623 | ||
| Neurodevelopment | 624 | ||
| Developmental Delay | 624 | ||
| Seizures | 624 | ||
| Psychosocial Issues | 624 | ||
| Psychoemotional Status | 624 | ||
| Non-adherence | 624 | ||
| Evaluation Updates | 624 | ||
| PERIOPERATIVE MANAGEMENT OF PEDIATRIC RENAL TRANSPLANT RECIPIENTS | 625 | ||
| Preoperative Management | 625 | ||
| Intraoperative Management | 625 | ||
| Postoperative Management | 625 | ||
| IMMUNOSUPPRESSIVE PROTOCOLS AND DRUGS | 626 | ||
| Induction Therapy Agents | 626 | ||
| Lymphocyte-Depleting Agents | 626 | ||
| OKT3 | 626 | ||
| Antithymocyte Globulin | 626 | ||
| Alemtuzumab | 627 | ||
| Non-Depleting Agents | 627 | ||
| Anti-IL2RA Antibodies | 627 | ||
| Maintenance Therapy | 627 | ||
| Corticosteroids | 628 | ||
| Steroid-Based Regimens | 628 | ||
| Steroid Withdrawal (Late) | 628 | ||
| Steroid Withdrawal (Early) | 629 | ||
| Steroid Avoidance | 629 | ||
| Calcineurin Inhibitors | 629 | ||
| mTOR Inhibitors | 630 | ||
| Antimetabolites | 630 | ||
| ACUTE REJECTION IN PEDIATRIC TRANSPLANTATION | 631 | ||
| Diagnosis of Acute Rejection | 631 | ||
| Treatment of Acute Rejection | 631 | ||
| Severe Rejection | 631 | ||
| Antibody-Mediated Rejection | 632 | ||
| LONG-TERM MANAGEMENT POSTTRANSPLANT | 632 | ||
| Hypertension and Cardiovascular Disease | 632 | ||
| Infections After Transplantation | 632 | ||
| Viral Infections | 632 | ||
| Cytomegalovirus | 632 | ||
| Epstein–Barr Virus | 633 | ||
| Polyomavirus | 633 | ||
| Bacterial Infections | 633 | ||
| Lower Urinary Tract Symptoms | 633 | ||
| Growth | 633 | ||
| Non-Adherence in Pediatric Transplantation | 634 | ||
| Adolescent Issues | 634 | ||
| Psychosocial Development | 634 | ||
| Puberty | 634 | ||
| Sexuality and Body Image | 634 | ||
| Transitional Care | 634 | ||
| REFERENCES | 635 | ||
| CHAPTER 38: KIDNEY TRANSPLANTATION IN DEVELOPING COUNTRIES | 643 | ||
| PREAMBLE | 643 | ||
| END-STAGE KIDNEY DISEASE IN DEVELOPING COUNTRIES | 645 | ||
| The Burden | 645 | ||
| The Patient | 645 | ||
| The Causes ( Figure 38-3) | 645 | ||
| The Resources | 645 | ||
| DIALYSIS IN DEVELOPING COUNTRIES ( Figure 38-6) | 647 | ||
| Hemodialysis | 647 | ||
| Peritoneal Dialysis | 649 | ||
| KIDNEY TRANSPLANTATION | 649 | ||
| Donors | 650 | ||
| Barriers to Transplantation Programs | 650 | ||
| Resources and Infrastructure | 650 | ||
| Sociological Factors | 652 | ||
| Public and Professsional Awareness and Attitudes | 652 | ||
| Legislation | 652 | ||
| Organ Trafficking and Transplant Tourism | 653 | ||
| The Vendors | 653 | ||
| The Recipients | 653 | ||
| TRANSPLANT ACTIVITY IN DIFFERENT DEVELOPING REGIONS OF THE WORLD | 653 | ||
| Latin America | 654 | ||
| Asia | 654 | ||
| China | 656 | ||
| Middle East and Afro-Arab Region | 657 | ||
| Sub-Saharan Africa | 659 | ||
| Central and Eastern Europe | 660 | ||
| IMMUNOSUPPRESSION | 660 | ||
| TRANSPLANT OUTCOMES ( Table 38-3) | 660 | ||
| POSTTRANSPLANT COMPLICATIONS | 662 | ||
| Infections | 662 | ||
| Bacterial Infections | 662 | ||
| Tuberculosis | 666 | ||
| Protozoan Infections | 666 | ||
| Malaria | 666 | ||
| Chagas’ Disease. | 666 | ||
| Visceral Leishmaniasis (Kala-Azar). | 666 | ||
| Helminthic Infestations | 667 | ||
| Schistosomiasis | 667 | ||
| Strongyloidiasis | 667 | ||
| Fungal Infections | 667 | ||
| Viral Infections | 667 | ||
| Herpesvirus Infections | 667 | ||
| Hepatitis Infections | 667 | ||
| Other Viral Infections | 668 | ||
| Malignancies ( Figure 38-16) | 668 | ||
| Kaposi’s Sarcoma | 668 | ||
| Posttransplantation Lymphoproliferative Disease | 669 | ||
| SPECIAL CONSIDERATIONS IN TRANSPLANTATION | 669 | ||
| Pregnancy and Contraception after Kidney Transplantation | 669 | ||
| Transplantation in Children | 669 | ||
| Importance of Early Detection and Prevention of Chronic Kidney Disease | 669 | ||
| References | 670 | ||
| CHAPTER 39: RESULTS OF RENAL TRANSPLANTATION | 676 | ||
| INTRODUCTION | 676 | ||
| RENAL FAILURE TREATMENTS – DIALYSIS VERSUS TRANSPLANTATION | 676 | ||
| KIDNEY DONATION | 677 | ||
| Expanded Criteria Donors | 677 | ||
| Donation after Cardiac Death | 677 | ||
| Recipient Pool | 679 | ||
| Factors Influencing Outcome | 680 | ||
| Donor Age | 680 | ||
| Recipient Age | 680 | ||
| Obesity | 680 | ||
| Race | 680 | ||
| HLA Mismatch and Prior Sensitization | 682 | ||
| Cold Ischemia Time | 683 | ||
| Expanded Criteria Donor Kidney Recipients | 684 | ||
| Living Donor Kidney Recipients | 684 | ||
| Immunosuppression | 684 | ||
| Adherence (Compliance) with Immunosuppressive Treatment | 685 | ||
| GRAFT SURVIVAL | 686 | ||
| Graft Survival for Expanded Criteria Donor Kidneys | 686 | ||
| Graft Survival among Living Donor Recipients ( Table 39-6) | 688 | ||
| Monozygotic Twins | 688 | ||
| Family Donors | 690 | ||
| Paired Kidney Donation and Living Unrelated Donor Outcomes | 690 | ||
| KIDNEY-ALONE VERSUS KIDNEY–PANCREAS TRANSPLANTATION FOR DIABETES | 690 | ||
| CANCER RISK | 690 | ||
| PREGNANCY AFTER RENAL TRANSPLANTATION | 690 | ||
| RENAL TRANSPLANTATION IN HUMAN IMMUNODEFICIENCY VIRUS-POSITIVE PATIENTS | 691 | ||
| PREVALENCE OF PEOPLE LIVING WITH A FUNCTIONING KIDNEY TRANSPLANT | 693 | ||
| LONG-TERM OUTCOMES OF RENAL TRANSPLANTATION | 693 | ||
| QUALITY OF LIFE | 693 | ||
| CONCLUSION | 694 | ||
| REFERENCES | 694 | ||
| CHAPTER 40: PSYCHOLOGICAL ASPECTS OF KIDNEY TRANSPLANTATION AND ORGAN DONATION | 698 | ||
| INTRODUCTION | 698 | ||
| QUALITY OF LIFE AND PSYCHOLOGICAL WELLBEING FOR RENAL TRANSPLANT PATIENTS | 699 | ||
| RENAL DISEASE – DIALYSIS AND PREOPERATIVE ADJUSTMENTS | 699 | ||
| HOPE OF A TRANSPLANT | 700 | ||
| IMMEDIATE POSTOPERATIVE PSYCHOLOGICAL ISSUES | 701 | ||
| IMMUNOSUPPRESSION REGIMENS AND PSYCHOLOGICAL REACTIONS | 702 | ||
| Medication Side Effects: Self-Esteem, Quality of Life, and Body Image | 702 | ||
| Psychological Distress and Adherence to Immunosuppression Regimens | 702 | ||
| FAMILY INTERACTIONS | 703 | ||
| GRAFT FUNCTION | 704 | ||
| Delayed or Poor Graft Function | 704 | ||
| Graft Failure | 705 | ||
| PSYCHOLOGICAL ASPECTS OF LIVING DONATION | 705 | ||
| Early Psychological Findings in Living Related Transplantation (1960s to 1970s) | 705 | ||
| Later Psychological Studies in Living Related Transplantation (Late 1980s, and 1990s) | 705 | ||
| More Recent Studies and Developments in Living Related Donation | 706 | ||
| LIVING UNRELATED DONORS | 707 | ||
| Paired Kidney Exchange | 707 | ||
| Altruistic (Non-Directed) Donation | 707 | ||
| PRE-EMPTIVE TRANSPLANTATION | 707 | ||
| PSYCHOLOGICAL ISSUES AND IMPLICATIONS FOR PRACTICE FOR LIVING DONOR PROGRAMS | 708 | ||
| Informed Consent | 708 | ||
| Donor Informed Consent: Anxieties and Fears | 708 | ||
| PSYCHOLOGICAL ASPECTS OF CADAVER ORGAN DONATION | 709 | ||
| Grief Process | 709 | ||
| Common Behavior Patterns in the Early Phase of the Grief Process | 709 | ||
| Anger, Anxiety, Depression, and Isolation | 710 | ||
| Healing Behaviors to Enable the Bereaved to Continue with Their Lives | 710 | ||
| High-Risk Groups – Intense Bereavement Reactions | 710 | ||
| Sudden or Traumatic Death | 710 | ||
| Brainstem Death | 710 | ||
| Option of Organ Donation | 711 | ||
| Multiple Organ Donation | 711 | ||
| When to Offer the Option of Donation | 711 | ||
| Who Should Approach Family Members | 712 | ||
| How to Approach Family Members | 712 | ||
| Staff Support | 713 | ||
| Viewing the Body after Death | 713 | ||
| Further Care | 713 | ||
| CONCLUSION | 713 | ||
| REFERENCES | 713 | ||
| CHAPTER 41: ETHICAL AND LEGAL ASPECTS OF KIDNEY DONATION | 715 | ||
| INTRODUCTION | 716 | ||
| DECEASED DONOR ORGAN ALLOCATION | 716 | ||
| Justice Versus Utility | 716 | ||
| Problems Caused by Utility | 716 | ||
| Problems Caused by Justice or Equity | 717 | ||
| Who Decides Between Justice and Utility? | 717 | ||
| Allocation of Marginal Donors | 717 | ||
| Extended Donor Criteria | 717 | ||
| Informed Consent | 717 | ||
| Absence of Conditionality | 718 | ||
| EXPANSION AND ENCOURAGEMENT OF LIVING KIDNEY DONATION | 718 | ||
| New Donor–Recipient Relationships | 718 | ||
| World Health Organization | 718 | ||
| Expansion of the Donor Pool | 718 | ||
| Ethical, Legal, and Psychosocial Aspects of Organ Transplantation | 718 | ||
| Alternative Living Donation Programs | 718 | ||
| The Welfare and Protection of the Live Donor | 719 | ||
| The Principle of Non-Maleficence | 719 | ||
| Risks Versus Benefits | 719 | ||
| Donor Risks in Living Kidney Donation | 719 | ||
| Legal Restrictions in Europe | 720 | ||
| Equal Donor Risks in Direct, Indirect, and Unspecified Living Organ Donation | 720 | ||
| Donor Autonomy | 720 | ||
| Subsidiarity | 720 | ||
| Encouraging Live Kidney Donation | 720 | ||
| Home-Based Education Programs | 721 | ||
| COMMERCIALIZATION OF ORGANS | 721 | ||
| The Rise of Organ Trade | 721 | ||
| Organ Scarcity | 721 | ||
| Organ Markets | 721 | ||
| Trends and Patterns | 721 | ||
| The Condemnation of Organ Trafficking, Transplant Commercialism, and Transplant Tourism | 721 | ||
| Universal Prohibition | 721 | ||
| The Declaration of Istanbul | 722 | ||
| Rewarded Gifting | 722 | ||
| The Iranian Model | 722 | ||
| Rewards for Deceased Organ Donation | 722 | ||
| Rewards for Living Kidney Donation | 723 | ||
| Ownership | 723 | ||
| Payment is Repugnant | 723 | ||
| Payment Undermines Human Dignity and Integrity | 723 | ||
| Payment Undermines Altruism | 723 | ||
| Payment Jeopardizes Free Will | 724 | ||
| Payment Exploits the Poor | 724 | ||
| To Die or Let Buy? | 724 | ||
| The Live Kidney Donor Contributes Financially to Society | 724 | ||
| What Works? | 725 | ||
| Conditions for Regulation | 725 | ||
| Organ Trafficking: Improving the Non-Legislative Response | 725 | ||
| CONCLUSION | 726 | ||
| Acknowledgments | 726 | ||
| REFERENCES | 726 | ||
| CHAPTER 42: EVIDENCE IN TRANSPLANTATION | 729 | ||
| INTRODUCTION | 729 | ||
| SEARCHING THE LITERATURE | 730 | ||
| Developing a Search | 730 | ||
| Searching | 730 | ||
| Keywords Versus Thesaurus | 730 | ||
| Limits | 731 | ||
| Boolean Operators | 731 | ||
| Available Resources | 731 | ||
| Google Scholar | 731 | ||
| PubMed | 731 | ||
| Embase | 731 | ||
| Cochrane Library | 731 | ||
| The Transplant Library | 732 | ||
| RANDOMIZED CONTROLLED TRIALS | 732 | ||
| Sources of Bias | 732 | ||
| Assessment of Risk of Bias | 732 | ||
| CONSORT Statement | 733 | ||
| Non-Randomized or Observational Studies | 734 | ||
| SYSTEMATIC REVIEWS | 734 | ||
| Introduction and Definitions | 734 | ||
| Stages of a Systematic Review | 734 | ||
| Framing a Question | 734 | ||
| Literature Search | 734 | ||
| Quality Assessment | 734 | ||
| Data Abstraction and Synthesis | 734 | ||
| Conclusions | 734 | ||
| META-ANALYSIS | 735 | ||
| Types of Meta-Analysis | 735 | ||
| The Forest Plot | 735 | ||
| Heterogeneity | 735 | ||
| Conclusions | 736 | ||
| BIOMEDICAL/INDUSTRIAL SPONSORSHIP | 736 | ||
| CONCLUSION | 736 | ||
| REFERENCES | 736 | ||
| Index | 737 |