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17 results

  • Section 5 - Kidney
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 231-285
  • View extract

    Summary

    The preoperative evaluation of kidney transplant candidates involves transplant surgeons, nephrologists, mental health professionals, social workers, dieticians, financial coordinators, and transplant coordinators. There are several absolute and relative contraindications to kidney transplantation. Immunologic evaluation begins with a thorough history of potential antigen exposure, including prior transplantation of any kind, blood product transfusion, and, in female candidates, prior pregnancy. Cardiovascular disease is the leading cause of death, and therefore graft loss, in the first year post transplant. Depending on the malignancy, a disease-free period of between 2 and 5 years is generally accepted as adequate. As the transplanted kidney usually drains into the native lower urinary tract, underlying urologic disease can affect the transplant outcome. In the future, diabetes management via islet cell transplantation, coupled with kidney transplantation, may be considered. A multi-disciplinary approach considering cognitive and other psychosocial factors is necessary to ensure successful transplantation.
  • Section 4 - Liver
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 173-230
  • View extract

    Summary

    A stringent process of selection of appropriate candidates for liver transplantation is necessary for a number of reasons. This chapter discusses deceased organ transplantation in adults. In liver transplant practice, a distinction needs to be made between the process of selection of appropriate candidates for transplant, which is the main focus of the chapter, and that of organ allocation for those candidates who have been placed on the waiting list for the procedure. Both of these processes are underpinned by similar considerations with respect to the relevant clinical end points and ethical standpoints. The practice of candidate selection and organ allocation is predicated on two fundamental ethical principles: justice (or equity) and utility. Most liver transplant programs have adopted the Milan criteria for selecting patients with hepatocellular carcinoma (HCC) for transplantation. Rarely, patients with heart and liver failure will be considered for combined heart-liver or heart-lung-liver transplant.
Organ Transplantation
  • Organ Transplantation
  • A Clinical Guide
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Published online: 07 September 2011
  • Print publication: 11 August 2011
  • View description
    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.
  • Section 7 - Other
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 313-334
  • View extract

    Summary

    In recent years, face transplantation has become a clinical reality and in the future may become a standard procedure. Composite tissue allotransplantation (CTA) is a new developing field of modern plastic and reconstructive surgery. A series of cadaver dissections were performed in preparation for face transplantation. Using computer-based models, the face looks neither like the donor nor the recipient prior to injury, but carries more of the characteristics of the recipient skeleton than of the donor soft tissues. Imaging is required to analyze the details of the facial defect and determine necessary structures for allotransplantation. To date there have been two scalp transplants and 14 facial allotransplantation cases reported in the literature and in media. Functional MRI, electromyography studies, and volumetric analysis are objective measures of motor recovery of facial units, whereas temperature testing and Semmes-Weinstein monofilament tests are used to monitor the sensory recovery of the facial allograft.
  • Section 6 - Other abdominal organs
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 286-312
  • View extract

    Summary

    A successful pancreas transplant produces a normoglycemic and insulin-independent state virtually immediately after revascularization. There are important considerations of pancreas transplantation that currently precludes it as therapy for all patients with type 1 diabetes mellitus (DM1). Vascular thrombosis is a very early complication typically occurring within 48 hours. Transplant pancreatitis occurs to some degree in all patients. Bleeding from the vascular anastomotic site or cut surfaces of the pancreatic graft will result in an intra-abdominal hematoma. Peri-pancreatic infections can result in development of a mycotic aneurysm at the arterial anastomosis, which may rupture, and requires allograft pancreatectomy. The outcome of pancreas transplantation with respect to graft survival and rejection rates is dependent on the choice of immunosuppression agents used. The durability of the transplanted endocrine pancreas has been established with the demonstration that normalization of HbA1c is maintained for as long as the allograft functions.
  • Section 8 - The transplant service
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 335-356
  • View extract

    Summary

    This chapter describes the legal and operational frameworks that are necessary at a national or supra-national level in order to support and regulate organ donation and transplantation. Although there are differences in detail between countries, all those with a well established donation program have in place a legal framework, a national donation system, and processes to ensure quality and safety of organs. The UK Code of Practice is based on the essential prerequisite that the cause of the patient's deep coma must be known. In all European countries, organ transplantation is guided by the overarching ethical requirement known as the dead donor rule which states that patients must be declared dead before the removal of any vital organ for transplantation. Organ allocation rules vary substantially between the different European countries. There are several specific databases in the UK, such as that on antibody-incompatible transplants and the paired-exchange living donor program.
  • Section 3 - Lung
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 122-172
  • View extract

    Summary

    This chapter focuses on how to select patients who will gain maximum benefit from lung transplantation (LT). It outlines the general considerations and exclusions pertaining to all potential recipients and focuses on disease specific guidance for the major recipient groups: chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), idiopathic pulmonary fibrosis (IPF), and idiopathic pulmonary arterial hypertension (IPAH). Pulmonary infections with highly resistant bacteria have been shown to have poorer outcomes in comparison with non-infected patients. The presence of fungus in the native lungs can cause problems after LT and needs careful assessment in each individual. The presence of comorbidities outside of the failing respiratory system is important considerations that can impact patient outcomes. COPD accounts for approximately 40% of LTs performed, with CF and IPF accounting for 20% each. In the current era there remains a critical shortage of donor organs, and thus unfortunately, recipient selection remains extremely important.
  • Section 1 - General
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 1-62
  • View extract

    Summary

    Transplantation of organs represents the pinnacle of medical achievement in so many different ways. This chapter presents historical perspectives of organ transplantation such as abdominal organ transplantation, cardiothoracic transplantation, combined heart and lung transplantation and lung transplantation. The area of skin grafting became of greater importance for the treatment of war burns and other injuries, and the death from kidney disease also provided impetus to focus once more on kidney transplantation. The successful intrathoracic transplantation of the heart without interrupting the circulation led to the idea that a cardiac allograft might be able to assume some of the normal circulatory load. The indications for transplantation are widening, and although kidney, liver, heart, and even lung transplantation is now seen as routine, the necessary skills are being developed to transplant other organs, such as the small intestine, pancreas, face, hand, and uterus.
  • Section 2 - Heart
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book: Organ Transplantation
  • Published online: 07 September 2011
  • Print publication: 11 August 2011, pp 63-121
  • View extract

    Summary

    Heart transplantation (HT) remains the best treatment for selected patients with advanced heart failure (HF). Patients with New York Heart Association (NYHA) class IIIB and class IV HF are best discussed with the local HF/transplant center to optimize medical management and to consider high-risk non-transplant surgery where appropriate. Patients who require HT may have severe ventricular dysfunction. Exercise capacity is known to correlate with prognosis in advanced HF. Chronic HF is associated with a high left ventricular end-diastolic pressure (LVEDP), which in turn leads to pulmonary venous and pulmonary arterial hypertension. The best studied scoring system in the context of predicting the need for HT is the HF Survival Score (HFSS). Older patients run a higher risk of post-transplant malignancy and renal dysfunction as compared with younger recipients. Combined heart-liver transplantation has been increasingly performed, but data on patient and graft outcomes remain limited.