Kidney Transplantation-8판

Offering practical guidance for all members of the transplant team, Kidney Transplantation, Principles and Practice,
8th Edition, provides the balanced, up-to-date information you need to achieve optimal outcomes for your patients. A
global team of internationally renowned surgeons and nephrologists, many new to this edition, offers fresh
perspectives
on everything from applied science and surgical techniques to immunosuppressive methods, outcomes, risks, and medical
considerations related to kidney transplantation, in both adults and children.

Offers state-of-the-art coverage of all areas of kidney transplantation such as
preservation of kidneys; mechanisms of rejection and the induction of tolerance; techniques of laparoscopic live donor
nephrectomy; and immunosuppression.

Contains up-to-date outcomes data and analysis of the evidence supporting current
practice in the field.

Includes new information on desensitization and considerable new data on the clinical
use of costimulation blockade.

Keeps you current with new chapters on kidney allocation policy that reflects the
ethical and societal values of different countries and populations; and biomarkers of kidney injury and rejection,
including the need for better monitoring tools to guide therapy and patient management.

Covers hot topics such as management of chronic allograft failure, the sensitized
patient and antibody-mediated rejection, and paired exchange principles.

Features hundreds of superb illustrations to help you visualize key concepts and
nuances
of renal transplantation.

Provides dynamic visual guidance with new real-time video coverage of ultrasound-guided
pancreas allograft biopsy; a new animation of calcineurin inhibitor mechanism of action animation; and videos that
demonstrate the formation of an immune synapse, 3-D rotational images of immune synapses, an NK cell killing its
target, peritoneal dialysis-catheter insertion techniques, laparoendoscopic single site (LESS) donor nephrectomy, and
more.

Enhanced eBook version included with purchase, which allows you to access all of the
text, figures, and references from the book on a variety of devices

Table of Contents
Copyright
Video Contents
Preface to the First Edition
Preface to the Eighth Edition
Contributors
1. Kidney Transplantation: A History
Early Experiments
Human Kidney Transplants
The Middle Years
Post World War II
Immunosuppression and the Modern Era
Chemical Immunosuppression
A Time of Optimism
Tissue Typing
The 1970s Plateau
Waiting for Xenografts
Conclusion
2. The Immunology of Transplantation
Introduction
Activation of the Immune System Peritransplant
Stimulation of Adaptive Alloimmunity
T Cell-Mediated Rejection
B Cell Activation and Antibody-Mediated Rejection
Transplant Tolerance
Factors Influencing Rejection Beyond the Graft뾗he Microbiome
Conclusion
3. Chronic Kidney Failure: Renal Replacement Therapy
Introduction
Definition and Timing Referral
Prevalence and Incidence
Etiology
Treatment of CKD5
Choice and Planning for the Individual Patient
Dialysis Posttransplant
Return to Dialysis After Transplant Failure
RRT Modality and Survival
Quality of Life
4. The Recipient of a Renal Transplant
The Patient with Chronic Kidney Disease
General Concepts
Counseling
Specific Medical Considerations
Preparation for Transplantation
Chapter 5. Access for Renal Replacement Therapy
Introduction
Fistulas and Synthetic Grafts
Peritoneal Dialysis
Conclusion
Chapter 6. Brain Death and Cardiac Death : Donor Criteria and Care of Deceased Donor
Introduction
Death by Neurologic Criteria (Brain Death)
Death by Cardiopulmonary Criteria (Cardiac Death)
Donor Management
Other Topics in Donor Management
Conclusion
7. Medical Evaluation of the Living Donor
History of Living Donation and Donor-Related Ethics
The Rationale for Living Donation
Medical Evaluation
Surgical Evaluation
Long-Term Outcomes After Living Donation
Financial Considerations
Living Donor Quality Initiatives
Chapter 8. Donor Nephrectomy
Deceased Donor Nephrectomy
Donation After Brain Death
Donation After Circulatory Death
Living Donor Nephrectomy
Anesthetic Management
Open Donor Nephrectomy
Laparoscopic Donor Nephrectomy
Right Donor Nephrectomy
Single-Port Donor Nephrectomy
Robotic Donor Nephrectomy
Complications
Summary
9. Kidney Preservation
Introduction
Organ Damage After Death
Cold Storage
Hypothermic Machine Perfusion
Normothermic Regional Perfusion
Normothermic Machine Perfusion
Future Directions
Chapter 10. Histocompatibility in Renal Transplantation
Historical Background
The HLA System
HLA Matching
HLA-Specific Allosensitization
Donor Crossmatch
Immunologic Risk Stratification
Strategies for Transplanting Sensitized and Highly Sensitized Patients
Antibody Removal
Paired Exchange
Posttransplant Monitoring
Future Directions
Concluding Remarks
11. Surgical Techniques of Kidney Transplantation
Preparation of Recipient
Preparation of Kidney
Site
Incision
Preparation of Operative Bed
Revascularization
Reconstruction of the Urinary Tract
Closure
Pediatric Recipient
Pediatric Donor
Double Kidney Transplant
Transplant Nephrectomy
12. Transplantation and the Abnormal Bladder
Assessment of Lower Urinary Tract Function and Pretransplant Workup
Special Pretransplant Issues
Posttransplant Issues
Results of Renal Transplantation into Reconstructed and Abnormal Bladders
Special Considerations for the Transplant Surgeon
Conclusion
13. Perioperative Care of Patients Undergoing Kidney Transplantation
Comorbidities in End-Stage Renal Disease
Preoperative Considerations
Intraoperative Considerations
Postoperative Care
Anesthesia for Patients After Kidney Transplantation
Kidney뻇ancreas Transplantation
14. Early Course of the Patient With a Kidney Transplant
Overview
Surgical Complications
Rejection During the Early Postoperative Period
Medical Complications
Summary
15. Azathioprine and Mycophenolates
Introduction
History
Mechanism of Action
Clinical Pharmacology and Blood Monitoring
Clinical Toxicities of Mycophenolates
Early Clinical Trials of Mycophenolates in Kidney Transplantation
Combination Therapy Utilizing MMF or Azathioprine in Kidney Transplantation
Use of Mycophenolates to Minimize or Avoid Other Immunosuppressants
Therapeutic Drug Monitoring
16. Steroids
Introduction
Mechanism of Action
Steroid Resistance
Dosage
Treatment of Acute Rejection
Side Effects
Steroid Withdrawal and Avoidance
Conclusions
17. Calcineurin Inhibitors
Cyclosporine
Tacrolimus
Mechanism of Action
Pharmacokinetic Properties
Pharmacogenetics
Absorption and Distribution
Metabolism and Elimination
Special Patient Populations
Clinical Studies in Kidney Transplantation
Clinical Studies in Kidney뻇ancreas Transplantation
Conclusion
18. mTOR Inhibitors: Sirolimus and Everolimus
Discovery
Mechanism of Action
Pharmacokinetics
Therapeutic Blood Monitoring
Pharmacogenetics
Drug Interactions
Use of mTOR Inhibitors
mTOR Inhibitors and Malignancy
Safety and Side Effects of mTOR Inhibitors
Summary and Conclusions
19. Antilymphocyte Globulin, Monoclonal Antibodies, and Fusion Proteins
Historical Perspective
Antibody Structure and Function
Fusion Protein Structure and Function
General Clinical Considerations for the Use of Antibody and Fusion Protein Preparations
Polyclonal Antibody Preparations
Specific Clinical Applications of Polyclonal Antibody Preparations
Monoclonal Antibody and Fusion Protein Preparations
Monoclonal Antibodies and Fusion Proteins in Clinical Transplantation Practice
Monoclonal Antibodies and Fusion Proteins in Clinical Transplantation Investigation
Other Experimental Antibodies and Fusion Proteins
Conclusion
20. Other Forms of Immunosuppression
Small Molecules
Total Lymphoid Irradiation
Photopheresis
Splenectomy
Plasmapheresis
21. Approaches to the Induction of Tolerance
Introduction
Understanding the Immunologic Mechanisms Behind Tolerance Induction
Strategies With the Potential to Induce Immunologic Tolerance to an Allograft
Leukocyte Depletion at the Time of Transplantation
Cell Therapy
22. Transplantation in the Sensitized Recipient and Across ABO Blood Groups
Sensitized Patients
Alloantibody Detection
Clinical Approaches to Sensitized Patients
Immunologic Risk
Therapeutic Approaches to Overcome Alloantibody
Mechanistic View of Antibody Production and Injury
ABO-Incompatible Transplantation
Conclusion
23. Paired Exchange Programs for Living Donors
Introduction
Finding Exchange Opportunities
Legality, Anonymity, Travel, and Expenses
Matching Algorithms
Nondirected Donors and Kidney Donor Chains
Outlook
24. Kidney Allocation
Two-Step Process
General Points of Allocation
United Kingdom
United States
Other Variations
Summary
25. Pathology of Kidney Transplantation
Renal Allograft Biopsy
Donor Kidney Biopsy
Hyperacute Rejection
Acute Renal Allograft Rejection
C4d Negative Antibody-Mediated Rejection
Late Graft Diseases
Protocol Biopsies
Acute Tubular Necrosis
Calcineurin Inhibitor Nephrotoxicity
Target of Rapamycin Inhibitor Toxicity
Drug-Induced Acute Tubulointerstitial Nephritis
Infections
Major Renal Vascular Disease
De Novo Glomerular Disease
Recurrent Renal Disease
Posttransplant Malignancy and Posttransplant Lymphoproliferative Disease
Future Directions in Biopsy Assessment
26. Biomarkers of Kidney Injury and Rejection
Definition of Biomarker and Surrogate Endpoint
New Technologies for Biomarker Assays
Biomarkers of Acute Kidney Injury
Biomarkers of Acute Rejection in Renal Transplantation
Potential Urinary Biomarkers
Potential Peripheral Blood Biomarkers of Acute Rejection
Biomarkers of Chronic Allograft Injury
Anti-HLA Antibodies as a Biomarker of Graft Loss
Development of Biomarkers for Studies of Tolerance
The Use of Biomarkers as an Enrichment Strategy for Randomized Trials of Immunosuppressive Therapy in Transplantation
Conclusion
27. Chronic Allograft Failure
Introduction
Pathophysiology of Chronic Allograft Damage
Mechanistic Theories of Chronic Allograft Injury
Time Course of Allograft Damage
Approach to a Failing Allograft
Treatment of a Failing Allograft
Summary
28. Vascular and Lymphatic Complications After Kidney Transplantation
Introduction
Technical Complications and Their Prevention
Hematoma
Vascular Thrombosis and Thrombophilia
Torsion
Vascular Access Thrombosis
Deep Vein Thrombosis
Vascular Causes of Ureteric Complications
Mycotic Aneurysm
Biopsy-Related Vascular Complications
Transplant Renal Artery Stenosis
Lymphocele
Conclusions
29. Urologic Complications After Kidney Transplantation
Ureteral Complications
Use of Prophylactic Ureteral Stents
Urinary Calculi in Transplant Recipients
Urinary Retention
Immunosuppression and Donor Selection
Erectile Dysfunction and Testosterone Replacement Therapy
Urologic Malignancies
30. Cardiovascular Disease in Renal Transplantation
Introduction
Background: CVD in CKD
Epidemiology of Posttransplant CVD
Novel and Transplant-Specific Risk Factors
Specific Risk Factors and Management
Hypertension and Uremic Cardiomyopathy
Phosphate and the FGF23-Klotho Axis
Vascular Stiffness and Calcification
Guidelines and Observed Patterns of Usage
Dyslipidemia
Renal Function
Smoking
New-Onset Diabetes After Transplantation
Obesity and the Metabolic Syndrome
Other Risk Factors and Interventions
Screening
Intervention and Secondary Prevention
Other Cardiovascular Conditions: Valvular Disease, Arrhythmia, and Stroke
Predicting Cardiovascular Risk
Trial Endpoints
Conclusion
31. Infection in Kidney Transplant Recipients
Overview
Risk of Infection
Timeline of Infection
Assessment of Infectious Diseases in Recipients and Potential Donors Before Transplantation
Selected Infections of Importance
Conclusions
32. Liver Disease Among Renal Transplant Recipients
Overview of Incidence and Clinicopathologic Associations
Combined Liver and Kidney Diseases
Specific Immunosuppressive Agents in Renal Transplantation and Hepatotoxicity
Hepatitis Viruses Associated With Renal Transplantation
Nonalcoholic Fatty Liver Disease and Renal Transplant
Hepatocellular Carcinoma After Renal Transplantation
Systemic Infections Resulting in Hepatitis and Liver Disease
33. Neurologic Complications after Kidney Transplantation
Neurologic Complications of Chronic Kidney Disease
Neurologic Complications After Kidney Transplantation
Summary
34. Cutaneous Disease in Kidney Transplantation Patients
Introduction
Cutaneous Malignancy in Renal Transplant Patients
Immunosuppressive Drug Considerations
Conclusion on Cutaneous Malignancy in OTRs
Immunosuppressive Drug Cutaneous Side Effects
Premalignant and Benign Cutaneous Tumors in Renal Transplant Patients
Infections and Inflammatory Cutaneous Findings in OTRs
Common Inflammatory Disorders
Conclusion
35. Cancer in Dialysis and Transplant Patients
Cancer in Dialysis Patients
Cancer in Kidney Transplant Recipients
Transplantation in Recipients with a History of Cancer
Screening for Cancer in Kidney Transplant Recipients
Survival in Kidney Transplant Recipients Who Develop Cancer
Conclusions
Chapter 36. Pancreas and Kidney Transplantation for Diabetic Nephropathy
History of Pancreas Transplantation
Recent Trends in Pancreas Transplantation
Indications and Patient Selection
Donor Selection and Management
Surgical Procedure
Postoperative Management of Common Complications
Surgical, Medical, and Urologic Complications
Induction and Maintenance Immunosuppression
Rejection Rates, Diagnosis, and Management
Pancreas Transplant Outcomes
Effect on Quality of Life and End-Organ Complications
Summary
37. Kidney Transplantation in Children
Introduction
Epidemiology of End-Stage Renal Disease in Children
Access to Transplantation
Timing of Transplantation
Patient and Graft Survival
Contraindications to Transplantation
Recurrence of Original Disease
Pretransplant Evaluation
Perioperative Management of Pediatric Renal Transplant Recipients
Immunosuppressive Protocols and Drugs
Acute Rejection in Pediatric Transplantation
Long-Term Management Posttransplant
38. Kidney Transplantation in Developing Countries
Introduction: The Role of Organ Transplantation in the Developing World
Perspectives on Transplantation in the Developing World in Relationship to the World Health Organization Objectives
The Need for Kidney Transplantation in the Developing World
Overview of Transplantation Activities in Africa
Minimum Requirements to Perform Transplantation
Partnerships and Training Options for African Clinicians
Going Forward: Needs and Strategies
39. Results of Renal Transplantation
Introduction
Renal Failure Treatments뾆ialysis Versus Transplantation
Kidney Donation
Factors Influencing Outcomes of Transplantation
Graft Survival
Cancer Risk
Pregnancy After Renal Transplantation
Renal Transplantation in Human Immunodeficiency Virus-Positive Patients
Prevalence of People Living with a Functioning Kidney Transplant
Re-Hospitalization
Long-Term Outcomes of Renal Transplantation
Quality of Life
Conclusion
40. Psychosocial Aspects of Kidney Transplantation and Living Kidney Donation
Pretransplant Dialysis
Kidney Transplantation
Living Kidney Donation
Conclusion
41. Ethical and Legal Aspects of Kidney Donation
Definitions
Introduction
Deceased Donor Organ Allocation
Expansion and Encouragement of Living Kidney Donation
Commercialization of Organs
Conclusion
42. Evidence in Transplantation
Introduction
Levels of Evidence
Searching the Literature
Randomized Controlled Trials
Nonrandomized and Observational Studies
Systematic Reviews
Meta-Analysis
Biomedical/Industrial Sponsorship
Conclusion
Index