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Infections are among the most common complications after transplantation and greatly increase the morbidity and mortality of transplantation and decrease graft survival. This chapter describes a timeline of infection after transplantation. Post-transplant infections can be mitigated by preventative methods, routine vaccinations, intake of clean food and water, preventative measures during times of outbreaks visits with travel medicine specialists prior to visiting high risk regions, safer sexual practices for non-monogamous recipients, and guidance on better tattoo acquisition. Hepatitis viruses are common causes for liver transplantation and also common complications after transplant, predominantly as reactivation of latent infections. Molecular diagnostics are emerging as a diagnostic methodology for bacterial infections. Invasive fungal diseases, particularly aspergillosis, are significant causes of morbidity and mortality in transplant recipients. Treatment of individual parasitic infections can involve medications that may interact with transplant medications, or have significant side effects, and should be used carefully.
The most common surgical approach used for cadaveric donor nephrectomy is the en bloc technique through a large abdominal incision. Transplantation using organs from cadaveric donors is always performed with the over-riding need to minimize the cold ischemic time of the organ. There are a number of techniques for anastomosing the ureter to the bladder. These include the Leadbetter-Politano or a direct vesico-ureteric anastomosis. Many patients with renal failure have significant atherosclerosis, with calcification resulting in noncompressible solid arteries that cannot be clamped. Careful preoperative assessment by computed tomography scanning should allow identification of calcified arteries before listing for transplantation. The preferred donor procedure is a laparoscopic nephrectomy, with mobilization of the kidney assisted by the use of a hand port, usually through a small infra-umbilical midline incision through which the kidney is removed. Late vascular complications are usually stenosis of the arterial anastomosis.
Organ Transplantation: A Clinical Guide covers all aspects of transplantation in both adult and pediatric patients. Cardiac, lung, liver, kidney, pancreas and small bowel transplantation are discussed in detail, as well as emerging areas such as face and pancreatic islet cell transplantation. For each organ, chapters cover basic science of transplantation, recipient selection, the transplant procedure, anesthetic and post-operative care, and long-term follow-up and management of complications. Important issues in donor selection and management are also discussed, including recruitment and allocation of potential donor organs and expanding the donor pool. Summary tables and illustrations enhance the text, and long-term outcome data are provided where available. Written by expert transplant surgeons, anesthetists and physicians, Organ Transplantation: A Clinical Guide is an invaluable multidisciplinary resource for any clinician involved in transplantation, providing in-depth knowledge of specialist areas of transplantation and covering the full range of management strategies.