CURRENT ISSUES AND FUTURE DIRECTION IN KIDNEY TRANSPLANTATION Edited by Thomas Rath Current Issues and Future Direction in Kidney Transplantation http://dx.doi.org/10.5772/45909 Edited by Thomas Rath Contributors Farzad Kakaei, Silvio Tucci Jr, Wai Hon Lim, Hung Do Nguyen, Rebecca Williams, Germaine Wong, Bhadran Bose, Jean- Paul Squifflet, Slawomir Dariusz Szajda, David William Mudge, Kimberley Oliver, Siddharth Sharma, Philippe Saas, Jamal Bamoulid, Cécile Courivaud, Béatrice Gaugler, Didier Ducloux, Stefan Reuter, Mihai Lucan, Phuong-Thu Pham, Rashad Hassan Rashad Hassan, Ahmed Akl, Shyam Dheda, Siew Chong, Katrien De Vusser, Rubina Naqvi, Marco Antonio Ayala-Garcia, Beatriz Gonzalez Yebra, Eduardo Guani Guerra, Éctor Jaime Ramírez Barba, Iris Lee, Mythili Ghanta, Jeanne Dreier, Raji Jacobs, Abdul Razack Amir, Salwa Sheikh, Rawan Amir, Thomas Rath, Maria Jose Herrero, Ana Luisa Robles Piedras, Minarda De La O Arciniega, Josefina Reynoso Vázquez Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 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. 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Publishing Process Manager Danijela Duric Technical Editor InTech DTP team Cover InTech Design team First published February, 2013 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 Issues and Future Direction in Kidney Transplantation, Edited by Thomas Rath p. cm. ISBN 978-953-51-0985-3 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Section 1 Diagnostic Methods in Renal Transplantation 1 Chapter 1 Medical Evaluation of the Adult Kidney Transplant Candidate 3 Phuong-Thu Pham, Son V. Pham, Phuong-Anh Pham and Phuong- Chi Pham Chapter 2 Imaging in Kidney Transplantation 25 Valdair Francisco Muglia, Sara Reis Teixeira, Elen Almeida Romão, Marcelo Ferreira Cassini, Murilo Ferreira de Andrade, Mery Kato, Maria Estela Papini Nardin and Silvio Tucci Jr Chapter 3 Utility of Urinary Biomarkers in Kidney Transplant Function Assessment 61 Alina Kępka, Napoleon Waszkiewicz, Sylwia Chojnowska, Beata Zalewska-Szajda, Jerzy Robert Ładny, Anna Wasilewska, Krzysztof Zwierz and Sławomir Dariusz Szajda Chapter 4 Non-Invasive Diagnosis of Acute Renal Allograft Rejection − Special Focus on Gamma Scintigraphy and Positron Emission Tomography 89 Alexander Grabner, Dominik Kentrup, Uta Schnöckel, Michael Schäfers and Stefan Reuter Chapter 5 Detection of Antibody-Mediated Rejection in Kidney Transplantation and the Management of Highly Sensitised Kidney Transplant Recipients 105 Shyam Dheda, Siew Chong, Rebecca Lucy Williams, Germaine Wong and Wai Hon Lim Section 2 Clinical Aspects of Renal Transplantation 133 Chapter 6 Policies and Methods to Enhance the Donation Rates 135 Lucan Mihai, Lucan Valerian Ciprian and Iacob Gheorghiță Chapter 7 Kidney Transplantation Techniques 167 Farzad Kakaei, Saman Nikeghbalian and Seyed Ali Malekhosseini Chapter 8 Renal Aging and Kidney Transplantation 185 Katrien De Vusser and Maarten Naesens Chapter 9 Comparison of Renal Transplantation Outcomes in Patients After Peritoneal Dialysis and Hemodialysis – A Case Control Study and Literature Review 193 Thomas Rath and Stephan Ziefle Chapter 10 Overview of Immunosuppression in Renal Transplantation 205 M. Ghanta, J. Dreier, R. Jacob and I. Lee Chapter 11 Hepatitis C Infection in Kidney Transplantion 233 A.A. Amir, R.A. Amir and S.S. Sheikh Chapter 12 Kidney and Pancreas Transplantation: The History of Surgical Techniques and Immunosuppression 249 Jean-Paul Squifflet Chapter 13 Pregnancy Post Transplant 277 Rubina Naqvi Chapter 14 Practical Pharmacogenetics and Single Nucleotide Polymorphisms (SNPs) in Renal Transplantation 287 María José Herrero, Virginia Bosó, Luis Rojas, Sergio Bea, Jaime Sánchez Plumed, Julio Hernández, Jose Luis Poveda and Salvador F. Aliño Chapter 15 Clinical Pharmacology and Therapeutic Drug Monitoring of Immunosuppressive Agents 309 Ana Luisa Robles Piedras, Minarda De la O Arciniega and Josefina Reynoso Vázquez ContentsVI Section 3 Advances in Transplantation Immunology 343 Chapter 16 The Evolution of HLA-Matching in Kidney Transplantation 345 Hung Do Nguyen, Rebecca Lucy Williams, Germaine Wong and Wai Hon Lim Chapter 17 Transplantation Antigens and Histocompatibility Matching 371 Bhadran Bose, David W. Johnson and Scott B. Campbell Chapter 18 CD4 T Lymphopenia, Thymic Function, Homeostatic Proliferation and Late Complications Associated with Kidney Transplantation 391 Philippe Saas, Jamal Bamoulid, Cecile Courivaud, Jean-Michel Rebibou, Beatrice Gaugler and Didier Ducloux Chapter 19 Current and Future Directions in Antibody-Mediated Rejection Post Kidney Transplantation 417 Rashad Hassan and Ahmed Akl Chapter 20 Advances in Antibody Mediated Rejection 445 Siddharth Sharma, Kimberley Oliver and David W Mudge Chapter 21 Tolerance in Renal Transplantation 463 Marco Antonio Ayala-García, Beatriz González Yebra, Éctor Jaime Ramirez Barba and Eduardo Guaní Guerra Contents VII Preface Renal transplantation is the treatment of choice for patients with end-stage renal disease and until now half a million renal transplants are done by surgeons, nephrologists, immunolo‐ gists, nurses and patients. This open-access book covers diagnostic methods as well as clinical aspects and advances in transplantation immunology. The area covered spans from imaging methods, impact of do‐ nor factors, clinical comorbidities to recent developments in HLA-Matching and Antibody- Mediated rejection. The authors are all experienced clinicians and scientists from different regions of the world. So, this book may help us all by giving useful information to improve care for our patients. Dr. med. Thomas Rath Department of Nephrology and Transplantation Medicine Westpfalz-Klinikum, Kaiserslautern, Germany [...]... indications Intractable hypertension2 Acquired renal cystic disease3 Indicated for massively enlarged kidneys, recurrently infected or bleeding, intractable pain 1 Should be individualized 2 When there is suspicion for adenocarcinoma 3 Table 6 Indications for pretransplant native nephrectomy 17 18 Current Issues and Future Direction in Kidney Transplantation 3 Evaluation of risk factors related to specific... reassess their candidacy Most transplant programs attempt to see transplant candidates on an annual basis to update their overall heatlh and demographic issues although older candidates may require more frequent visits at the discretion of the transplant physician During the follow-up visit, routine health maintenance status and cancer screening 19 20 Current Issues and Future Direction in Kidney Transplantation. .. reproduction in any medium, provided the original work is properly cited 4 Current Issues and Future Direction in Kidney Transplantation Absolute contraindications Active malignancy Active infection Severe irreversible extrarenal disease Life expectancy < 2 years Liver cirrhosis1 (unless combined liver and kidney transplant) Primary oxalosis (unless combined liver and kidney transplant) Limited, irremediable... problems facing transplant centers Periodic reassessment of transplant candidates’ medical and psychosocial issues entails ongoing communication between the dialysis units, patients, and transplant coordinators and transplant programs In the event of a significant intercurrent illness that may necessitate delisting or placing candidates on hold, pertinent medical records should be obtained and reviewed... III; Level of Evidence B) (Lentine et al., 2012) In patients with established CVD or in those at risk for CV events, aggressive risk factor modification and treatment per ACC/AHA guidelines (Pearson et al., 2002) are recommended The cardioprotective effects of statins, aspirin, ACE inhibitors, and/ or β blockers have been 9 10 Current Issues and Future Direction in Kidney Transplantation Figure 1 Suggested... advised against transplantation Table 5 Malignancy and renal transplantation1 ,2 15 16 Current Issues and Future Direction in Kidney Transplantation 2.7 Specific gastrointestinal evaluation There has been no consensus on whether all asymptomatic renal transplant candidates should be screened for cholelithiasis Screening is warranted, however, in diabetics and patients with a history of cholecystitis Pretransplant... physicians Screening for covert cardiovascular disease and occult malignancy, and careful assessment of infectious risk in older prospective transplant candi‐ dates are crucial and mandatory Currently, the waiting time for a deceased donor transplant in the United States is such that many wait-listed older transplant candidates die while awaiting transplantation from a standard deceased donor kidney Furthermore,... re-addressed Currently, in an effort to maximize the utilization of living kidney donors, our program has implemented an algorithm to evaluate crossmatch positive and ABO-incompatible donor-recipient pairs Patients are advised of living donor options including paired exchange transplantation, positive crossmatch and ABO incompatible transplantation through desensitization protocols, and living donor kidney. .. reactivation and replication and progression of liver disease Similar to HBV infection, liver biopsy is essential in the evaluation of transplant candidate with HCV because clinical and biochemical findings are unreliable indicators of the severity of liver disease in the dialysis population The presence of minimal to mild chronic hepatitis (stages I and II) does not preclude transplantation Pretransplantation... C (HCV) cirrhosis and hepatic portal venous gradient (HPVG) of less than 10 mmHg In a 13 14 Current Issues and Future Direction in Kidney Transplantation single center study consisting of 37 kidney alone HCV positive transplant recipients (n=9 with cirrhosis and n= 28 with no cirrhosis), none developed decompensation of their liver disease at 3-year follow-up although one patient in the non-cirrhosis . CURRENT ISSUES AND FUTURE DIRECTION IN KIDNEY TRANSPLANTATION Edited by Thomas Rath Current Issues and Future Direction in Kidney Transplantation http://dx.doi.org/10.5772/45909 Edited. Grading Current Issues and Future Direction in Kidney Transplantation8 it should also be noted that in ESKD patients both myocardial perfusion study (MPS) and DSE have reduced sensitivity and. these barriers Table 1. Contraindications for renal transplantation Current Issues and Future Direction in Kidney Transplantation4 1.2.2. Psychiatric evaluation Coexisting psychiatric disorders have