Open Access Medical Books

CURRENT CONCEPTS IN KIDNEY TRANSPLANTATION

TRANSPLANTATION
Edited by Sandip Kapur ;

Although renal transplantation is a relatively young field in medicine, with the first 
successful kidney transplant occurring in 1954, the past 15 years have shown rapid 
advances in many areas within transplantation, and the next 15 hold great promise for 
further advancement. The armamentarium of immunosuppressive agents has grown 
significantly since the mid-to-late 1990’s, and currently, the immunosuppressive 
therapies available are potent enough to prevent rejection in the vast majority of low 
risk patients. Utilization of non-traditional immunosuppressive agents such as IVIG 
and rituximab has enabled successful transplantation of incompatible pairs (due to 
blood type or crossmatch incompatibility) in recent years as well. Rapid advances in 
kidney paired donation registries has reduced the need for incompatible 
transplantation in more recent years, although desensitization in the setting of kidney 
paired donation remains an important option for highly sensitized patients. However,
with the use of potent immunosuppressive therapies, we must be cognizant of the 
balance needed to protect patients from the complications of overimmunosuppression.
The need for tools to monitor transplant recipients and therapies 
to treat these patients for the complications of over-immunosuppression is an 
important target for research and development.
The deceased donor organ shortage continues to be the major limiting factor in 
transplantation, particularly as the waiting list grows in the setting of an aging 
population. Successful transplant programs must work diligently to maximize 
opportunities for transplantation for their patients, which includes utilization of 
marginal donor organs, pediatric organs, and hepatitis C positive organs. By 
considering the use of such organs in carefully selected recipients, the organs that are 
available can be utilized to the greatest extent possible, with acceptable if not excellent 
outcomes.
Medical management of kidney transplant recipients is also of utmost importance 
since the population is aging and often present with multiple co-morbidities that may 
complicate their care. Death with allograft function is the leading cause of kidney 
allograft loss, and the leading cause of death is cardiovascular death. Therefore, 
management of co-morbidities such as diabetes, hypertension, and hyperlipidemia are 
essential to success in maximizing both patient and graft survival.
We hope that the reader finds this textbook to be a comprehensive resource on the 
topics mentioned above as well as others that can help you to offer transplantation to 
as many candidates as possible, and improve post-transplant outcomes in order to 
maximize the grafts that are donated.
I would like to thank my assistant editors Cheguevara Afaneh, M.D. and Meredith J.
Aull, Pharm.D. for their instrumental roles in the completion of this textbook.

Dr. Sandip Kapur
Department of Surgery, Division of Transplant Surgery New York -
Presbyterian Hospital/Weill Cornell Medical College New York, NY,
USA

CONTENTS :

Chapter 1 Evaluation of Kidney Transplant Candidates: An Update in 2012 3
Cheguevara Afaneh and Choli Hartono

Chapter 2 Evaluation of Potential Living Kidney Donors 29
Leila Kamal and David Serur

Chapter 3 Medical Management of the Kidney Transplant Recipient 55
Dhaval Patel and Jun Lee

Chapter 4 Surgical Management of the Kidney Transplant Recipient 79
Cheguevara Afaneh, Meredith J. Aull, Anthony Watkins, Sandip Kapur and Jim Kim

Chapter 5 Immunologic Concepts in Kidney Transplantation 99
John R. Lee and Thangamani Muthukumar

Chapter 6 Transplanting Against Histocompatibility Barriers 117
Dinesh Kannabhiran, Michelle L. Lubetzky and Darshana Dadhania

Chapter 7 Modern Immunosuppression Regimens in Kidney Transplantation 145
Cheguevara Afaneh, Meredith J. Aull and Sandip Kapur

Chapter 8 Complications of Kidney Transplantation: Effects of Over-Immunosuppression 169
Meredith J. Aull, Cheguevara Afaneh and Sandip Kapur

Chapter 9 BK Virus Infection in Renal Allograft Recipients 199
Darshana Dadhania

Chapter 10 Cold Ischaemic Injury in Kidney Transplantation 217
Sarah A. Hosgood, James P. Hunter and Michael L. Nicholson

Chapter 11 Hypertension After Renal Transplantation 243
Mithat Tabaković, Nermin N. Salkić, Fahir Baraković and Senaid Trnačević

Chapter 12 Transplant Renal Artery Stenosis 259
Taqi Toufeeq Khan and Mirza Anzar Baig

Chapter 13 Surgical Advances in Laparoscopic Donor Nephrectomy 273
Cheguevara Afaneh, Meredith J. Aull, Joseph J. Del Pizzo and Sandip Kapur

Chapter 14 Higher Volume and Better Outcomes Relationship in Kidney Transplant 285
Wui-Chiang Lee, Shu-Yun Tsao and Che-Chuan Loong

Chapter 15 Expanding Opportunities for Kidney Transplantation 301
Cheguevara Afaneh, Meredith J. Aull, Anthony Watkins, Jim Kim and Sandip Kapur .


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