CURRENT CONCEPTS IN KIDNEY TRANSPLANTATION ppt

CURRENT CONCEPTS IN KIDNEY TRANSPLANTATION Edited by Sandip Kapur Current Concepts in Kidney Transplantation http://dx.doi.org/10.5772/3048 Edited by Sandip Kapur Contributors Cheguevara Afaneh, Choli Hartono, Leila Kamal, David Serur, Dhaval Patel, Jun Lee, Meredith J. Aull, Anthony Watkins, Sandip Kapur, Jim Kim, John R. Lee, Thangamani Muthukumar, Dinesh Kannabhiran, Michelle L. Lubetzky, Darshana Dadhania, Sarah A. Hosgood, James P. Hunter, Michael L. Nicholson, Mithat Tabaković, Nermin N. Salkić, Fahir Baraković, Senaid Trnačević, Taqi Toufeeq Khan, Mirza Anzar Baig, Joseph J. Del Pizzo, Wui-Chiang Lee, Shu-Yun Tsao, Che-Chuan Loong Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Romina Skomersic Typesetting InTech Prepress, Novi Sad Cover InTech Design Team First published December, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Current Concepts in Kidney Transplantation, Edited by Sandip Kapur p. cm. ISBN 978-953-51-0900-6 Contents Preface IX Section 1 Evaluation and Management of the Kidney Transplant Patient 1 Chapter 1 Evaluation of Kidney Transplant Candidates: An Update in 2012 3 Cheguevara Afaneh and Choli Hartono Chapter 2 Evaluation of Potential Living Kidney Donors 29 Leila Kamal and David Serur Chapter 3 Medical Management of the Kidney Transplant Recipient 55 Dhaval Patel and Jun Lee Chapter 4 Surgical Management of the Kidney Transplant Recipient 79 Cheguevara Afaneh, Meredith J. Aull, Anthony Watkins, Sandip Kapur and Jim Kim Section 2 Immunologic Considerations in Kidney Transplantation 97 Chapter 5 Immunologic Concepts in Kidney Transplantation 99 John R. Lee and Thangamani Muthukumar Chapter 6 Transplanting Against Histocompatibility Barriers 117 Dinesh Kannabhiran, Michelle L. Lubetzky and Darshana Dadhania Chapter 7 Modern Immunosuppression Regimens in Kidney Transplantation 145 Cheguevara Afaneh, Meredith J. Aull and Sandip Kapur Chapter 8 Complications of Kidney Transplantation: Effects of Over-Immunosuppression 169 Meredith J. Aull, Cheguevara Afaneh and Sandip Kapur VI Contents Chapter 9 BK Virus Infection in Renal Allograft Recipients 199 Darshana Dadhania Section 3 Selected Topics in Kidney Transplantation 215 Chapter 10 Cold Ischaemic Injury in Kidney Transplantation 217 Sarah A. Hosgood, James P. Hunter and Michael L. Nicholson Chapter 11 Hypertension After Renal Transplantation 243 Mithat Tabaković, Nermin N. Salkić, Fahir Baraković and Senaid Trnačević Chapter 12 Transplant Renal Artery Stenosis 259 Taqi Toufeeq Khan and Mirza Anzar Baig Chapter 13 Surgical Advances in Laparoscopic Donor Nephrectomy 273 Cheguevara Afaneh, Meredith J. Aull, Joseph J. Del Pizzo and Sandip Kapur Chapter 14 Higher Volume and Better Outcomes Relationship in Kidney Transplant 285 Wui-Chiang Lee, Shu-Yun Tsao and Che-Chuan Loong Chapter 15 Expanding Opportunities for Kidney Transplantation 301 Cheguevara Afaneh, Meredith J. Aull, Anthony Watkins, Jim Kim and Sandip Kapur Preface Although renal transplantation is a relatively young field in medicine, with the first successful kidney transplant occurring in 1954, the past 15 years have shown rapid advances in many areas within transplantation, and the next 15 hold great promise for further advancement. The armamentarium of immunosuppressive agents has grown significantly since the mid-to-late 1990’s, and currently, the immunosuppressive therapies available are potent enough to prevent rejection in the vast majority of low risk patients. Utilization of non-traditional immunosuppressive agents such as IVIG and rituximab has enabled successful transplantation of incompatible pairs (due to blood type or crossmatch incompatibility) in recent years as well. Rapid advances in kidney paired donation registries has reduced the need for incompatible transplantation in more recent years, although desensitization in the setting of kidney paired donation remains an important option for highly sensitized patients. However, with the use of potent immunosuppressive therapies, we must be cognizant of the balance needed to protect patients from the complications of over- immunosuppression. The need for tools to monitor transplant recipients and therapies to treat these patients for the complications of over-immunosuppression is an important target for research and development. The deceased donor organ shortage continues to be the major limiting factor in transplantation, particularly as the waiting list grows in the setting of an aging population. Successful transplant programs must work diligently to maximize opportunities for transplantation for their patients, which includes utilization of marginal donor organs, pediatric organs, and hepatitis C positive organs. By considering the use of such organs in carefully selected recipients, the organs that are available can be utilized to the greatest extent possible, with acceptable if not excellent outcomes. Medical management of kidney transplant recipients is also of utmost importance since the population is aging and often present with multiple co-morbidities that may complicate their care. Death with allograft function is the leading cause of kidney allograft loss, and the leading cause of death is cardiovascular death. Therefore, management of co-morbidities such as diabetes, hypertension, and hyperlipidemia are essential to success in maximizing both patient and graft survival. X Preface We hope that the reader finds this textbook to be a comprehensive resource on the topics mentioned above as well as others that can help you to offer transplantation to as many candidates as possible, and improve post-transplant outcomes in order to maximize the grafts that are donated. I would like to thank my assistant editors Cheguevara Afaneh, M.D. and Meredith J. Aull, Pharm.D. for their instrumental roles in the completion of this textbook. Dr. Sandip Kapur Department of Surgery, Division of Transplant Surgery New York - Presbyterian Hospital/Weill Cornell Medical College New York, NY, USA . CURRENT CONCEPTS IN KIDNEY TRANSPLANTATION Edited by Sandip Kapur Current Concepts in Kidney Transplantation http://dx.doi.org/10.5772/3048. materials, instructions, methods or ideas contained in the book. Publishing Process Manager Romina Skomersic Typesetting InTech Prepress, Novi Sad Cover InTech