Abdominal Organ Transplantation E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 426

Veröffentlichungsjahr: 2013

Beschreibung

This book summarizes the latest developments in key areas of the fast moving field of abdominal organ transplantation. It covers such vital topics as living donation (both renal and liver), laparoscopic and robotic techniques, islet and pancreas transplantation, non-heart beating transplantation, blood group incompatible and highly sensitized transplantation, high risk transplants, tolerance, stem cell therapy and novel immunosuppressive techniques. Each chapter offers an overview of the available evidence by a world renowned expert, written in an accessible, easy-to-read manner.

Leseprobe

Table of Contents

Title Page

Copyright

List of Contributors

Foreword

Chapter 1: Living Donation: The Gold Standard

Introduction

Epidemiology

Advantages of living-kidney donation

Types of donor

Evaluation process for the live donor

Short-term and long-term risks of kidney donation

Conclusion

Chapter 2: New Surgical Techniques in Transplantation

Introduction

Live-donor nephrectomy: surgical techniques

Surgical advances in renal-transplantation techniques

Conclusion

Chapter 3: Living-donor Liver Transplantation

History

Donor evaluation

Recipient evaluation

Pediatric recipients

Adult-to-adult LDLT

Donor outcome

Recipient outcome

Conclusion

Chapter 4: Antibody-incompatible Transplantation

Introduction

Blood-group-incompatible transplantation

Principles of ABOi transplantation

HLA-incompatible transplantation

New developments in antibody-incompatible transplantation

Conclusion: what should we do with an antibody-incompatible recipient?

Chapter 5: Pancreas Transplantation

Introduction

Diabetes mellitus

Diabetes management

Pancreas transplantation: a routine technique?

Indications and contraindications for pancreas transplantation

Renal replacement therapy in diabetics

Expansion of the donor pool

Expansion of the recipient pool

Recipient pretransplant work-up

Choice of operation: SPK/PAK/PTA

Surgical aspects of pancreas transplantation

Postoperative management

Immunosuppression

Outcomes

The future

Chapter 6: Allotransplantation of Pancreatic Islets

Introduction

Rationale for islet transplantation

Historical background of islet transplantation

Donor selection and pancreas allocation

Pancreas retrieval and preservation

Islet isolation procedure

Islet recipient selection

Islet transplantation procedure

Post-transplant management

Immunosuppression

Summary of clinical outcomes

Ongoing challenges in islet transplantation

Chapter 7: Novel Cell Therapies in Transplantation

Introduction

Defined stem-cell populations for clinical application

Multipotent stromal cells

MSCs and solid-organ transplantation

How MSCs might work

Considerations for solid-organ transplantation

Pathfinder cells: an alternative to solid-organ pancreas transplantation?

Induced pluripotent stem cells

Neo-organogenesis for transplantation

Natural blueprints for stem cell–organ development: using fetal cells to grow an organ

The future

Chapter 8: Intestinal Transplantation

Introduction

Classification

Intestinal failure

Recipient selection

Deceased-donor graft procurement

Deceased-donor recipient operation

Living donors

Post-transplant care

Immunosuppression and rejection

Patient and graft outcome

Cost and quality of life

Summary and future directions

Chapter 9: Pediatric Renal Transplantation

Introduction

Pediatric ESRF

Pretransplantation work-up

Living-donor renal transplantation

Deceased-donor renal transplantation

Peritransplantation issues

Post-transplantation care

The future of pediatric transplantation

Chapter 10: Immunosuppressive Pharmacotherapy

Introduction

Immunosuppressive therapies

Treatment of acute rejection

Future immunosuppressive agents

Chapter 11: Conclusion

Index

This edition first published 2013, © 2013 by Blackwell Publishing Ltd.

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell's publishing program has been merged with Wiley's global Scientific, Technical and Medical business to form Wiley-Blackwell.

Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK

The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

111 River Street, Hoboken, NJ 07030-5774, USA

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services.

Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with the respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Abdominal organ transplantation : state of the art / edited by Nizam Mamode,

Raja Kandaswamy.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4443-3432-6 (cloth)

I. Mamode, Nizam. II. Kandaswamy, Raja.

[DNLM: 1. Abdomen– surgery. 2. Organ Transplantation– methods. WI 900]

617.5′5059– dc23

2012026232

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover design by : Nathan Harris

1 2013

List of Contributors

Adam D. Barlow

Specialist Registrar in General & Transplant Surgery

Department of Transplant Surgery

University Hospitals of Leicester

Leicester

UK

Anil Chandraker, MD, FASN, FRCP

Associate Professor of Medicine

Medical Director of Transplantation

Renal Division

Brigham and Women's Hospital

Harvard Medical School

Boston, MA

USA

Abhideep Chaudhary, MD, MBBS, MS

Clinical Fellow in Transplantation Surgery

University of Pittsburgh, Medical Center (UPMC)

Pittsburgh, PA

USA

Marc Clancy

Honorary Clinical Senior Lecturer

School of Medicine

University of Glasgow

Glasgow

UK

Chirag S. Desai, MD

Department of Surgery

University of Arizona College of Medicine

Tucson, AZ

USA

Steven Gabardi, PharmD, BCPS

Renal Division/Departments of Transplant Surgery and Pharmacy Services

Brigham and Women's Hospital and Department of Medicine

Harvard Medical School

Boston, MA

USA

Marc Gingell Littlejohn

Institute of Cancer Sciences

College of Medical, Veterinary and Life Sciences

University of Glasgow

Glasgow

UK

Rainer W.G. Gruessner, MD, FACS

Professor of Surgery and Immunology Chairman

Department of Surgery

University of Arizona College of Medicine

Tucson, AZ

USA

Abhinav Humar, MD

Professor of Surgery

University of Pittsburgh, Medical Center (UPMC)

Pittsburgh, PA

USA

Tun Jie, MD, MS, FACS

Assistant Professor of Surgery

General Surgery/Abdominal Transplant/Hepatopancreatic and biliary Surgery

Department of Surgery

University of Arizona College of Medicine

Tucson, AZ

USA

Paul R.V. Johnson, MBChB, MA, MD, FRCS(Eng +Edin), FRCS(Paed.Surg), FAAP

Professor of Paediatric Surgery University of Oxford

Director of DRWF Human Islet Isolation Facility and Oxford Islet Transplant Programme

Consultant Paediatric Surgeon

John Radcliffe Hospital

Fellow at St Edmund Hall

University of Oxford

Oxford

UK

Maciej T. Juszczak

Islet Transplant Programme, Oxford Centre for Diabetes, Endocrinology and Metabolism, and Islet Transplant Research Group

Nuffield Department of Surgical Sciences

University of Oxford

Oxford

UK

Raja Kandaswamy, MD, FACS

Professor and Vice-Chief, Division of Transplantation

Department of Surgery

University of Minnesota

Minneapolis, MN

USA

Khalid M. Khan, MBChB, MRCP

Associate Professor Director

Pediatric Liver & Intestine Transplant Program

University of Arizona

Tucson, AZ

USA

Nizam Mamode, BSc, MB ChB, MD, FRCS, FRCS(Gen)

Consultant Transplant Surgeon

Reader in Transplant Surgery

Guy's and St Thomas' Hospital

Great Ormond Street Hospital

London

UK

Stephen D. Marks, MD, MSc, MRCP, DCH, FRCPCH

Consultant Paediatric Nephrologist

Department of Paediatric Nephrology

Great Ormond Street Hospital for Children NHS Trust

London

UK

Michael L. Nicholson, MD, DSc, FRCS

Professor of Transplant Surgery

Department of Transplant Surgery

University Hospitals of Leicester

Leicester

UK

Leonardo V. Riella, MD, PhD

Instructor in Medicine

Transplant Research Center

Renal Division

Brigham and Women's Hospital

Harvard Medical School

Boston, MA

USA

Paul G. Shiels

Department of Surgery

University of Glasgow

Western Infirmary Glasgow

Glasgow

UK

Rajinder Singh

Consultant Transplant Surgeon

Guy's and St Thomas' Hospital

Great Ormond Street Hospital

London

UK

Karen S. Stevenson

Institute of Cancer Sciences

College of Medical, Veterinary and Life Sciences

Foreword

This miscellaneous collection of articles on new developments in organ transplantation will be of very considerable interest to organ transplant clinicians. The chapters range from living donation of the kidney and liver to intestinal and pancreas the kidney, with a very good chapter on new surgical techniques in transplantation. In addition there is a comprehensive chapter on ABO incompatible renal transplantation and transplantation in the patient that is highly sensitized to HLA. There is a short review of the current status of pancreatic islet transplantation as well as an extensive review of new developments in pancreas transplantation. Furthermore paediatric renal transplantation is well covered and there are interesting contributions on novel cell therapies in transplantation as well as on immunosuppressive therapies, concentrating on more recent developments in this area. The final chapter by the two editors reviews the status of renal, liver, pancreas and intestinal transplantation, but in particular outlines the problems that still have to be resolved. The editors recognise that the current one year graft survival rates are at a level that was not considered remotely possible even as little as 20 years ago but accept that the longer term outcomes are still disappointing despite the introduction of many new immunosuppressive strategies. But in general they are very optimistic about the future.

Overall this book will be considered a very good read by the transplant clinician.

Sir Peter J Morris AC, FRS Director, Centre for Evidence in Transplantation, Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine. Emeritus Nuffield Professor of Surgery, University of Oxford. Past President, Royal college of Surgeons. Honorary Professor, University of London.

Chapter 1

Living Donation: The Gold Standard

Leonardo V. Riella and Anil Chandraker

Renal Division, Brigham and Women's Hospital, Harvard Medical School, USA

Introduction

The first successful transplant occurred in Boston in 1954, when a surgical team under the direction of Joseph Murray removed a kidney from a healthy donor and transplanted it into his identical twin, who had chronic glomerulonephritis [1]. The organ functioned immediately and the recipient survived for 9 years, after which time his allograft failed from what was thought to be recurrent glomerulonephritis. More than 50 years have passed since that breakthrough achievement, and transplantation has progressed from an experimental modality to standard of care. The introduction of immunosuppressive drugs such as azathioprine, prednisone, and later calcineurin inhibitors has led to better outcomes and, along with technical breakthroughs, expanded the pool of organs available to deceased and human leukocyte antigen (HLA)-mismatched donors.

Kidney transplantation has become the preferred therapeutic option for patients with end-stage kidney disease (ESKD), leading to better patient survival and quality of life. It is also more cost-effective than dialysis [2–4]. Unfortunately, the incidence of ESKD has risen steadily in the past several decades, creating a shortage of available organs for patients on the kidney-transplant waiting list (Table 1.1).

Table 1.1 Waiting list for different organs in the USA. OPTN, Organ Procurement and Transplantation Network. Data from [5].

Waiting list candidates OPTN 2010

Number

All

107,075

Kidney

84,495

Pancreas

1,458

Kidney/Pancreas

2,182

Liver

15,948

Intestine

248

Heart

3,173

Lung

1,844

Heart/Lung

75

This growth in ESKD is related to the increased incidence of diabetes, obesity, and hypertension, combined with the improvement in treatment for concurrent health problems such as ischemic heart disease and stroke. The supply of organs from deceased donors has not followed the same upward trend, resulting in an ever-widening gap between eligible potential transplant recipients and available organs (Table 1.2).

Table 1.2 Growth of the kidney-transplant waiting list compared to donor type in the USA. Data from [5].