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Organ Transplantation A Clinical Guide Organ Transplantation A Clinical Guide Edited by Andrew A. Klein Consultant, Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK Clive J. Lewis Consultant Cardiologist and Transplant Physician, Papworth Hospital, Cambridge, UK JorenC.Madsen Director of the MGH Transplant Center, Section Chief for Cardiac Surgery, and W. Gerald and Patricia R. Austen Distinguished Scholar in Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, S ˜ ao Paulo, Delhi, Tokyo, Mexico City Cambridge University Press e Edinburg Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/ 9780521197533 c  Cambridge University Press 2011 is publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2011 Printed in the United Kingdom at the University Press, Cambridge A catalogue record for this publication is available from the British Library. Library of Congress Cataloguing in Publication data Organ transplantation : a clinical guide / edited by Andrew Klein, Clive J. Lewis, Joren C. Madsen. p. ; cm. Includes bibliographical references and index. ISBN 978-0-521-19753-3 (hardback) 1. Transplantation of organs, tissues, etc. 2. Transplantation immunology. I. Klein, Andrew. II. Lewis, Clive J., 1968– III. Madsen, Joren C., 1955– [DNLM: 1. Organ Transplantation. 2. Transplantation Immunology. WO 660] RD120.7.O717 2011 617.9  5 – dc22 2011002165 ISBN 978-0-521-19753-3 Hardback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every eort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every eort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. e authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Contents List of contributors vii Foreword xi Preface xiii List of abbreviations xv Section 1 – General 1 Historical perspectives 1 John Dunning and Sir Roy Calne 2 Immunological principles of acute rejection 9 FadiG.Issa,RyoichiGoto,andKathrynJ.Wood 3 Immunosuppression: Past, present, and future 19 Vineeta Kumar and Robert S. Gaston 4A Major complications – cancer 31 Bimalangshu R. Dey and omas R. Spitzer 4B Major complications – pathology of chronic rejection 38 Yael B. Kushner and Robert B. Colvin 4C Major complications – infection 46 Camille Nelson Kotton 5 Organ donor management and procurement 53 Edward Cantu III and David W. Zaas Section 2 – Heart 6 Recipient selection 63 R.V. Venkateswaran and Jayan Parameshwar 7 Donor heart selection 70 KiranK.KhushandJonathanG.Zaro 8 Ventricular assist devices 76 DavidG.HealyandStevenS.L.Tsui 9 Surgical procedure 83 R.V. Venkateswaran and David P. Jenkins 10 Management during surgery 88 Kate Drummond and Andrew A. Klein 11 Postoperative care and early complications 94 Mandeep R. Mehra 12 Long-term management and outcomes 102 Hari K. Parthasarathy and Clive J. Lewis 13 Pediatric heart transplantation 112 Jacob Simmonds and Michael Burch Section 3 – Lung 14 Recipient selection 122 J.S. Parmar 15 Living donor lobar lung transplantation 128 Hiroshi Date 16 Surgical procedure 133 Faruk ¨ Ozalp, Tanveer Butt, and Stephan V. B . S c h u e l e r 17 Management during surgery 138 David Ip and Peter Slinger 18 Postoperative care and early complications 145 Vlad Vinarsky and Leo C. Ginns 19 Long-term management and outcomes 155 Paul Corris 20 Pediatric lung transplantation 164 Stuart C. Sweet and Samuel Goldfarb v Contents Section 4 – Liver 21 Recipient selection 173 Alex Gimson 22 Living donor liver transplantation 182 Koji Hashimoto, Cristiano Quintini, and Charles Miller 23 Surgical procedure 190 SimonJ.F.HarperandNevilleV.Jamieson 24 Peri-operative care and early complications 199 John Klinck and Andrew J. Butler 25 Long-term management and outcomes 212 William Gelson and Graeme J.M. Alexander 26 Pediatric liver transplantation 220 Hector Vilca-Melendez and Giorgina Mieli-Vergani Section 5 – Kidney 27 Recipient selection 231 Ernest I. Mandel and Nina E. Tolko-Rubin 28 Sensitization of kidney transplant recipients 238 Nick Pritchard 29 Live donor kidney donation 248 Arthur J. Matas and Hassan N. Ibrahim 30 Surgical procedure 253 Paul Gibbs 31 Peri-operative care and early complications 258 Lorna Marson and John Forsythe 32 Long-term management and outcomes 265 Sharon Mulroy and John D. Firth 33 Pediatric kidney transplantation 278 Khashayar Vakili and Heung Bae Kim Section 6 – Other abdominal organs 34 Pancreatic transplantation 286 Dixon B. Kaufman 35 Pancreatic islet transplantation 295 Heidi Yeh and James F. Markmann 36 Intestinal transplantation 303 Stephen J. Middleton, Simon M. Gabe, Neville V. Jamieson, and Andrew J. Butler Section 7 – Other 37 Composite tissue allotransplantation: Face transplantation 313 Maria Siemionow and Can Ozturk 38 Hematopoietic stem cell transplantation 320 Charles Crawley and omas R. Spitzer 39 Corneal transplantation 330 Yvonne H. Luo and D. Frank P. Larkin Section 8 – The transplant service 40 UK and European service – legal and operational framework 335 ChrisJ.RudgeandAxelO.Rahmel 41 US transplant service – legal and operational framework 347 Walter K. Graham, Richard S. Luskin, and Francis L. Delmonico 42 Conclusions 355 Clive J. Lewis Index 357 Color plate section falls between pages 181 and 182. vi Contributors Graeme J.M. Alexander, MA, MD, FRCP Consultant Hepatologist, Addenbrooke’s Hospital Cambridge, UK Heung Bae Kim, MD Assistant Professor of Surgery, Harvard Medical School, and Director, Pediatric Transplant Center, Children’s Hospital Boston, Boston, MA, USA Michael Burch Lead Transplant Consultant, Consultant Cardiologist, Great Ormond Street Hospital for Sick Children, London, UK Andrew J. Butler, MD Consultant, Department of Transplantation Surgery, Addenbrooke’s Hospital, Cambridge, UK Tanveer Butt, FRCS Department of Cardiopulmonary Transplantation, eNewcastleuponTyneHospitalsNHSFoundation Trust (NUTH), Freeman Hospital, High Heaton, Newcastle upon Tyne, UK Roy Calne, MD Yeah Ghim Professor of Surgery at the National University of Singapore, Singapore Edward Cantu III, MD Associate Surgical Director of Lung Transplantation, University of Pennsylvania, Philadelphia, PA, USA Robert B. Colvin, MD Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA Paul Corris, MB, FRCP Professor, Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK Charles Crawley Consultant, Department of Hematology, Addenbrooke’s Hospital, Cambridge, UK Hiroshi Date, MD Professor, Department of oracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan Francis L. Delmonico, MD Medical Director, New England Organ Bank, and Professor of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA Bimalangshu R. Dey, MD, PhD Bone Marrow Transplant Program, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA Kate Drummond, MD Fellow, Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK John Dunning, MD Consultant Cardiothoracic Surgeon, Papworth Hospital, Cambridge, UK John D. Firth, DM, FRCP Consultant Physician and Nephrologist, Cambridge University Hospitals Foundation Trust, Cambridge, UK John Forsythe, MD Consultant Transplant Surgeon, Royal Inrmary of Edinburgh, Edinburgh, UK Simon M. Gabe Lennard Jones Intestinal Failure Unit, St Mark’s Hospital, Northwick Park, Harrow, London, UK vii Contributors Robert S. Gaston, MD, MRCP Endowed Professor, Transplant Nephrology, and Medical Director, Kidney and Pancreas Transplantation, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA William Gelson, MD, MRCP Consultant Surgeon, Department of Transplant Surgery, Addenbrooke’s Hospital, Cambridge, UK Paul Gibbs Consultant Surgeon, Department of Transplant Surgery, Addenbrooke’s Hospital, Cambridge, UK Alex Gimson Consultant Physician, Department of Hepatology, Addenbrooke’s Hospital, Cambridge, UK Leo C. Ginns, MD Medical Director, Lung Transplantation, Massachusetts General Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, MA, USA Samuel Goldfarb, MD Attending Physician, Division of Pulmonary Medicine, Children’s Hospital of Philadelphia; Medical Director, Lung and Heart/Lung Transplant Programs, and Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Ryoichi Goto, MD Clinical Research Fellow, Nueld Department of Surgery, University of Oxford, Oxford, UK Walter K. Graham, JD Executive Director, United Network for Organ Sharing, Richmond, VA, USA Simon J.F. Harper Clinical Lecturer in Transplantation, University of Cambridge and Addenbrooke’s Hospital, Cambridge, UK Koji Hashimoto, MD, PhD Department of Surgery, Cleveland Clinic, Cleveland, OH, USA David G. Healy, PhD, FRCSI (C-Th) Honorary Fellow, Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK Hassan N. Ibrahim, MD Department of Medicine, University of Minnesota, Minneapolis, MN, USA David Ip, MBBS, FANZCA Anaesthesia Fellow, Toronto General Hospital, Toronto, ON, Canada Fadi G. Issa, MA, BMBCh, MRCS Clinical Research Fellow, Nueld Department of Surgery, University of Oxford, Oxford, UK Neville V. Jamieson Consultant Transplantation and HPB Surgeon, University of Cambridge and Addenbrooke’s Hospital, Cambridge, UK David P. Jenkins, MB BS, FRCS (Eng), MS (Lond), FRCS (CTh) Consultant Cardiothoracic Surgeon, Papworth Hospital, Cambridge, UK Dixon B. Kaufman, MD, PhD Professor and Chief, Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI, USA Kiran K. Khush, MD, MAS Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA Heung Bae Kim, MD Director, Pediatric Transplant Center, Department of Surgery, Children’s Hospital Boston, and Associate Professor of Surgery, Harvard Medical School, Boston, MA, USA Andrew A. Klein, MD Consultant, Cardiothoracic Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK John Klinck, MD Consultant Anesthetist, Addenbrooke’s Hospital, Cambridge, UK viii Contributors Camille Nelson Kotton, MD Clinical Director, Transplant and Immuno- compromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA Vineeta Kumar, MD Assistant Professor of Medicine and Director, Transplant Nephrology Fellowship Program, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA Yael B. Kushner, MD Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA D. Frank. P. Larkin, MD, FRCPI, FRCOphth2 Consultant Surgeon, Moorelds Eye Hospital, London, UK Clive J. Lewis, MB, BChir, MRCP, PhD Consultant, Department of Cardiology, Transplant Unit, Papworth Hospital, Cambridge, UK Yvonne H. Luo, MA, MRCOphth Specialist Registrar, Moorelds Eye Hospital, London, UK Richard S. Luskin President and CEO, New England Organ Bank, Waltham, MA, USA Ernest I. Mandel, MD Clinical Fellow in Medicine, Brigham and Women’s Hospital/Massachusetts General Hospital, Boston, MA, USA James F. Markmann, MD, PhD Chief, Division of Transplantation, Department of Surgery, and Clinical Director, Transplant Center, Massachusetts General Hospital, and Professor of Surgery, Harvard Medical School, Boston, MA, USA Lorna Marson Senior Lecturer in Transplant Surgery, University of Edinburgh, Edinburgh, UK Arthur J. Matas, MD Department of Surgery, University of Minnesota, Minneapolis, MN, USA Mandeep R. Mehra, MBBS, FACP, FACC Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA Stephen J. Middleton, MA, MD, FRCP, FAHE Consultant Physician, Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University, Cambridge, UK Giorgina Mieli-Vergani, MD, PhD, FRCP, FRCPCH Alex Mowat Professor of Paediatric Hepatology, Institute of Liver Studies, King’s College London School of Medicine, London, UK Charles Miller Director of Liver Transplantation, Cleveland Clinic, Cleveland, OH, USA Sharon Mulroy, MD Locum Consultant Nephrologist, Department of Renal Medicine, Addenbrooke’s Hospital, Cambridge, UK Faruk ¨ Ozalp, MRCS Department of Cardiopulmonary Transplantation, eNewcastleuponTyneHospitalsNHSFoundation Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK Can Ozturk, MD Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA Jayan Parameshwar, MD, MPhil, FRCP Consultant Cardiologist, Advanced Heart Failure and Transplant Programme, Papworth Hospital, Cambridge, UK J.S. Parmar, BM, PhD, FRCP Consultant Transplant Physician (Respiratory), Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, UK Hari K. Parthasarathy, MD, MRCP Transplant Unit, Papworth Hospital, Cambridge, UK Nick Pritchard, BSc, MBBS, PhD, FRCP Consultant Physician, Department of Renal Medicine, Addenbrooke’s Hospital, Cambridge, UK ix [...]... established, scientific interest in organ transplantation waned until effective immunosuppressive regimens were found Abdominal organ transplantation Transplantation of abdominal organs has been a longterm success story, with patients surviving 40 years with excellent function in their original grafted organs The success of clinical allograft transplantation began with transplantation of kidneys between... adversely affect the recipient The future of transplantation is, for the moment, secure and there is little doubt that the need for transplantation will continue to exceed the supply of organs Although many problems have been overcome, many challenges remain We are encouraged by the progress in immune tolerance, regenerative medicine, organ support, and even xenotransplantation However, there is much yet... race between perfecting the process of organ transplantation- fabrication on one hand and the curing of diseases that lead xiii Preface to organ failure and the need for transplantation on the other, is on Fortunately, however, no matter which side wins, it the patient who is ultimately the victor This book, with contributions from experts in the broad field of transplantation from all over the world,... lobar lung transplantation LDLT living donor liver transplantation LDLT LFA-1 LFA-1 LT LT LV LV LVAD LVEDP LVH MAC MAG3 MAP MAPK MBD MCSD MELD MHC MHV miH MMF MMR MPA MPGN MPSC MRI MRR MRSA mTOR NAPRTCS NFAT NF-␬B NHL NHS NHSBT NK NKT NO NOD NODAT living donor lung transplantation leukocyte function-associated antigen 1 lymphocyte-function associated antigen-1 liver transplantation lung transplantation. .. the proliferation of splenic lymphocytes than against other cell lines changed the face of transplantation r As transplantation has become more successful in terms of survival, quality of life, and cost benefit, the demand for donor organs has increased so that it is now greater than supply Transplantation of organs represents the pinnacle of medical achievement in so many different ways It epitomizes... companion for anyone involved in transplantation, especially those at the beginning of their careers It will be available as an e-book, and in the traditional print form I am sure that you will enjoy, Organ Transplantation – A Clinical Guide Thomas E Starzl, MD, PhD Professor of Surgery and Distinguished Service Professor, University of Pittsburgh xi Preface The field of solid organ transplantation has developed... death became accepted and methods of longdistance procurement were developed, together with donor organ- sharing networks, donor organs became more readily available, ensuring the continued practice of clinical transplantation Combined heart and lung transplantation Demikhov developed a method of heart–lung transplantation in dogs in the 1940s, but it was not revisited until 1953, when Marcus and colleagues... undergoing transplantation in 1983) En-bloc double lung transplantation was performed by Patterson in 1988 but was later superseded by sequential bilateral lung transplantation, described by Pasque and colleagues in 1990 Subsequently, Yacoub introduced live lung lobar transplantation in 1995 Indications and refinements There has been a steady growth in the number of transplants performed, and as transplantation. .. non–heart-beating donor for cardiac transplantation Organ transplantation may be supplemented or even replaced in due course using totally artificial organs The only implantable device that finds clinical use at present is the artificial heart The range of devices available and their apparent complexity underline the difficulties encountered in replacing a relatively simple biological organ with mechanical substitutes... initially as the only immunosuppressant in 34 recipients of cadaveric organs; 32 kidneys, 2 pancreases, and 2 livers Lancet 1979; 2: 1033–6 Calne RY, Williams R Liver transplantation in man Observations on technique and organization in five cases BMJ 1968; 4: 535–50 Hamilton D Kidney transplantation: a history In Morris, PJ (ed) Kidney Transplantation New York: Grune & Stratton, 1988, pp 1–13 Medawar PB . (hardback) 1. Transplantation of organs, tissues, etc. 2. Transplantation immunology. I. Klein, Andrew. II. Lewis, Clive J., 1968– III. Madsen, Joren C., 1955– [DNLM: 1. Organ Transplantation. 2. Transplantation Immunology Organ Transplantation A Clinical Guide Organ Transplantation A Clinical Guide Edited by Andrew A. Klein Consultant, Anaesthesia. Pediatric kidney transplantation 278 Khashayar Vakili and Heung Bae Kim Section 6 – Other abdominal organs 34 Pancreatic transplantation 286 Dixon B. Kaufman 35 Pancreatic islet transplantation