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Book Details
Abstract
An important review on transplantation for the general surgeon! Topics include: kidney transplant, left lobe liver transplants, advances in lung transplantation, stem cell and cellular transplants, pancreatectomy, management of organ failure, transplant immune suppression, antibody mediated rejection, cardiac assist devices, organ perfusion and preservation, weight reduction therapy, organ allocation and distribution, and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Current Topics inTransplantation | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Forthcoming Issues | x | ||
| Current Topics in Transplantation | xi | ||
| Current Topics in Transplantation | xv | ||
| A Surgeons’ Guide to Renal Transplant Immunopathology, Immunology, and Immunosuppression | 1293 | ||
| Key points | 1293 | ||
| Clinical manifestations of transplant rejection | 1295 | ||
| Rejection classification | 1295 | ||
| Design of immune suppression protocols | 1296 | ||
| Biological agents | 1296 | ||
| Maintenance immunosuppression | 1297 | ||
| The lymphocyte cell cycle | 1297 | ||
| Calcineurin inhibitors (CNIs) | 1297 | ||
| T-cell signaling and calcineurin inhibition | 1297 | ||
| mTOR inhibitors | 1298 | ||
| T-cell signaling and mTOR inhibition | 1299 | ||
| The antimetabolic agents | 1299 | ||
| Corticosteroids | 1299 | ||
| Belatacept | 1299 | ||
| The histology of graft rejection | 1300 | ||
| Acute Cell-mediated Rejection | 1300 | ||
| Acute Vascular Rejection | 1301 | ||
| Antibody-Mediated Rejection | 1302 | ||
| Immunosuppressant Nephrotoxicity | 1303 | ||
| BK Nephropathy | 1303 | ||
| Chronic Allograft Changes | 1304 | ||
| References | 1304 | ||
| Robotic-Assisted Kidney Transplantation | 1309 | ||
| Key points | 1309 | ||
| Selection and pretransplant evaluation | 1310 | ||
| Special Considerations | 1311 | ||
| Age | 1311 | ||
| Malignancy | 1311 | ||
| Infectious disease | 1311 | ||
| Coronary artery disease | 1312 | ||
| Immunologic risk | 1312 | ||
| Obesity | 1312 | ||
| Lifestyle modification and psychosocial issues | 1312 | ||
| Surgical approach | 1313 | ||
| Surgical procedure | 1314 | ||
| Backbench Preparation of the Graft | 1314 | ||
| Patient Positioning and Port Placement | 1314 | ||
| Vascular Exposure | 1315 | ||
| Graft Implantation and Reperfusion | 1315 | ||
| Ureter Cystoneostomy | 1316 | ||
| Immediate postoperative care | 1317 | ||
| Long-term posttransplantation management | 1318 | ||
| Clinical results in the literature | 1321 | ||
| References | 1322 | ||
| Left Lobe Liver Transplants | 1325 | ||
| Key points | 1325 | ||
| Introduction | 1325 | ||
| Preoperative planning | 1326 | ||
| Consent | 1329 | ||
| Anesthesia management | 1330 | ||
| Donor hepatectomy | 1330 | ||
| Recipient hepatectomy and implantation | 1333 | ||
| Postoperative management (donor) | 1334 | ||
| Postoperative management (recipient) | 1334 | ||
| Complications (donor) | 1335 | ||
| Complications (recipient) | 1335 | ||
| Discussion | 1336 | ||
| Summary | 1340 | ||
| References | 1340 | ||
| General Surgery Considerations in the Era of Mechanical Circulatory Assist Devices | 1343 | ||
| Key points | 1343 | ||
| Introduction | 1344 | ||
| History | 1344 | ||
| First Generation: Arrival of the LVAD | 1344 | ||
| Second Generation: Improved and Established Outcomes | 1345 | ||
| Third Generation: Size, Efficiency, and Durability Optimized | 1346 | ||
| General surgery considerations | 1346 | ||
| Overview | 1346 | ||
| Patient Selection | 1347 | ||
| Surgical Planning | 1347 | ||
| General surgery consults and operations | 1349 | ||
| Outcomes | 1350 | ||
| Anticoagulation | 1351 | ||
| Summary | 1354 | ||
| Acknowledgments | 1355 | ||
| References | 1355 | ||
| Bariatric Surgery and End-Stage Organ Failure | 1359 | ||
| Key points | 1359 | ||
| Scope of the problem | 1359 | ||
| Incidence of obesity in the United States, in CKD, and in kidney transplantation | 1360 | ||
| Treatments for obesity in kidney disease | 1360 | ||
| Risk factors for obesity in kidney transplant recipients | 1364 | ||
| Obesity and liver disease | 1365 | ||
| Bariatric surgery in cirrhotic or pretransplant patients | 1366 | ||
| Bariatric surgery during liver transplant | 1367 | ||
| Bariatric surgery after liver transplant | 1367 | ||
| Summary | 1368 | ||
| References | 1369 | ||
| Advances in Lung Preservation | 1373 | ||
| Key points | 1373 | ||
| Lung shortage and potential alternatives to expand the donor pool | 1373 | ||
| Conventional lung preservation | 1374 | ||
| EVLP | 1375 | ||
| Current EVLP technique at Toronto General Hospital | 1377 | ||
| Single-Lung EVLP | 1378 | ||
| The EVLP Circuit | 1378 | ||
| Initiation and Steady State | 1379 | ||
| Assessment Mode | 1380 | ||
| Termination of Perfusion | 1381 | ||
| Clinical experience with EVLP | 1382 | ||
| The Toronto Technique | 1382 | ||
| The Lund Technique | 1384 | ||
| The Portable Ex Vivo Technique | 1385 | ||
| Therapeutic opportunities: EVLP as a targeted injury-specific treatment platform | 1385 | ||
| Edema | 1385 | ||
| Infection | 1385 | ||
| Inflammation | 1386 | ||
| Gene therapy | 1386 | ||
| Stem cell therapy | 1386 | ||
| Aspiration | 1386 | ||
| Pulmonary Embolism | 1387 | ||
| Donation After Cardiac Death | 1387 | ||
| The future | 1388 | ||
| Specialized EVLP Centers | 1388 | ||
| Biomarkers in EVLP | 1388 | ||
| Summary | 1389 | ||
| References | 1389 | ||
| The Kidney Allocation System | 1395 | ||
| Key points | 1395 | ||
| Introduction | 1396 | ||
| Limitations of the current kidney allocation system | 1396 | ||
| A call for change | 1397 | ||
| System goals | 1398 | ||
| Composition of the waiting list | 1399 | ||
| Estimated posttransplant survival | 1400 | ||
| Kidney donor profile index | 1402 | ||
| The proposed system | 1402 | ||
| Sequence A: Top 20% KDPI Kidneys to Top 20% EPTS Candidates | 1404 | ||
| Sequence B: Kidneys with KDPI Between 20% and 35%, Pediatric Candidates | 1404 | ||
| Sequence C: Kidneys with KDPI from 20% to 85% | 1404 | ||
| Sequence D: Kidneys with KDPI Greater than 85%, Revamped ECD | 1405 | ||
| Critique | 1405 | ||
| Summary | 1406 | ||
| Acknowledgments | 1406 | ||
| References | 1406 | ||
| Kidney Paired Donation and Its Potential Impact on Transplantation | 1407 | ||
| Key points | 1407 | ||
| Introduction: nature of the problem | 1407 | ||
| Kidney paired donation: a solution to the shortage of organs for transplant? | 1408 | ||
| Kidney paired donation models | 1408 | ||
| Kidney Exchange | 1408 | ||
| List Exchange | 1409 | ||
| Domino Paired Donation | 1409 | ||
| Nonsimultaneous Extended Altruistic Donation | 1412 | ||
| Active kidney paired donation programs in North America | 1412 | ||
| Multicenter KPD in the United States | 1412 | ||
| Single-Center KPD in the United States | 1413 | ||
| Multicenter KPD in Canada | 1413 | ||
| Clinical outcomes | 1413 | ||
| What factors have driven the increase in paired donation–facilitated transplants? | 1413 | ||
| Keys to Success | 1413 | ||
| Participation of nondirected donors | 1413 | ||
| Large pool size | 1413 | ||
| Mathematical modeling software/matching algorithm | 1414 | ||
| Virtual crossmatch | 1414 | ||
| Willingness to combine KPD with desensitization protocols | 1414 | ||
| Transplant center dedication of resources to KPD program | 1415 | ||
| Ongoing ethical issues and controversies | 1415 | ||
| Loss of Donor Ability to “Back Out” | 1415 | ||
| Participation of Nondirected Donors | 1416 | ||
| Disadvantage to ABO O Recipients | 1416 | ||
| Reneging of Donor/Simultaneous Versus Nonsimultaneous Surgeries | 1416 | ||
| Travel of Donor Versus Donor’s Kidney | 1417 | ||
| Donor and Organ Quality | 1417 | ||
| Participation of Compatible Donor/Recipient Pairs in Kidney Paired Donation | 1417 | ||
| Should Donors and Recipients Meet? | 1417 | ||
| Payment Structure for KPD | 1418 | ||
| NewYork-Presbyterian/Weill Cornell experience with KPD through participation in the National Kidney Registry | 1418 | ||
| Summary | 1419 | ||
| References | 1419 | ||
| Management of Hepatocellular Carcinoma | 1423 | ||
| Key points | 1423 | ||
| Introduction | 1423 | ||
| Epidemiology | 1424 | ||
| Risk factors | 1424 | ||
| Viral Hepatitis | 1424 | ||
| Natural history of viral hepatitis | 1424 | ||
| Pathogenesis of HCC secondary to viral hepatitis | 1425 | ||
| Alcoholic (Laennec) Cirrhosis | 1425 | ||
| Obesity and Diabetes | 1425 | ||
| FLD | 1425 | ||
| Iron Storage Disease | 1426 | ||
| Biliary Disease | 1426 | ||
| Schistosomiasis | 1426 | ||
| Venous Occlusive Disease | 1426 | ||
| Liver Adenoma | 1426 | ||
| Aflatoxin | 1426 | ||
| Tobacco | 1426 | ||
| Surveillance | 1426 | ||
| Diagnosis | 1427 | ||
| Staging | 1429 | ||
| Treatment options | 1429 | ||
| Liver Resection | 1430 | ||
| Liver Transplantation | 1432 | ||
| Tumor Ablation | 1434 | ||
| Radiofrequency ablation | 1434 | ||
| Alcohol injection | 1435 | ||
| Microwave | 1435 | ||
| Laser | 1435 | ||
| Cryoablation | 1435 | ||
| TACE | 1436 | ||
| Radiation Therapy | 1436 | ||
| Transarterial radiotherapy | 1437 | ||
| Three-dimensional conformal radiotherapy | 1437 | ||
| Proton beam radiotherapy | 1437 | ||
| Combined Locoregional Therapies | 1438 | ||
| Systemic Chemotherapy | 1438 | ||
| Molecular Targeted Therapies | 1439 | ||
| Select inhibitors of the angiogenic pathway | 1439 | ||
| Future therapies under investigation | 1439 | ||
| Select Approaches of Molecular Targeted Therapies | 1439 | ||
| c-MET inhibitors | 1439 | ||
| Epidermal growth factor receptor inhibitors | 1440 | ||
| Irreversible Electroporation (NanoKnife) | 1440 | ||
| Gene Therapy | 1440 | ||
| Circulating Tumor Cells | 1441 | ||
| Summary | 1441 | ||
| References | 1441 | ||
| Management of Antibody-Mediated Rejection in Transplantation | 1451 | ||
| Key points | 1451 | ||
| Introduction | 1451 | ||
| Diagnosis and classification of AMR | 1452 | ||
| AMR treatment modalities | 1453 | ||
| Antibody Removal | 1453 | ||
| Plasmapheresis | 1453 | ||
| Immunoadsorption | 1453 | ||
| IVIg | 1454 | ||
| B-Cell–Specific Agents | 1454 | ||
| Rituximab | 1454 | ||
| Plasma Cell–Depleting Agents | 1456 | ||
| Bortezomib | 1456 | ||
| Complement-Specific Agents | 1458 | ||
| Eculizumab | 1458 | ||
| AMR Rescue by Splenectomy | 1459 | ||
| Chronic AMR Treatment | 1462 | ||
| Future AMR clinical trials | 1462 | ||
| Summary | 1462 | ||
| References | 1463 | ||
| The Transplant Center and Business Unit as a Model for Specialized Care Delivery | 1467 | ||
| Key points | 1467 | ||
| Introduction | 1468 | ||
| Transplantation as a hospital-based service: finances and the cost report | 1468 | ||
| Managing the transplant center | 1469 | ||
| Regulatory compliance in transplantation | 1470 | ||
| Defining the transplantation and organ-failure businesses | 1471 | ||
| The transplant center and service line | 1473 | ||
| Understanding and benchmarking the transplant business | 1473 | ||
| Patient-centered outcomes | 1473 | ||
| References | 1475 | ||
| Index | 1479 |