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Cambridge University Press 978-0-521-19753-3 - Organ Transplantation: A Clinical Guide Edited by Andrew A. Klein, Clive J. Lewis and Joren C. Madsen Index More information

Index

Note: Page numbers followed by f refer to figures; page numbers followed by t refer to tables.

A1-antitrypsin deficiency, 140t, 140, treatment, 26 (See also portal venous, 195f, 194–5, 201, 221, 222t Immunosuppression; specific 196 Abdominal organ transplantation drugs and drug classes) reperfusion, bile duct, 196–8 history, 3–4 Acute viral hepatitis, 223 Angiotensin-converting enzyme ABO incompatibility Adaptive immune system effector (ACE) inhibitors, 273t desensitization protocols, response, 13–14 Angiotensin receptor blocker (ARB) 232 Adaptive immunity. See Acute inhibitors, 273t kidney transplantation recipient rejection Antibodies in transplant arteriopathy sensitization, 244–5 Adult-to-Adult Living Donor Liver 40–1 living donor liver transplantation, Transplantation Cohort Study Antibody induction 188 (A2ALL), 183 immunosuppression, 21, 22–3, pediatric heart transplantation, 116, AEB071 (sotrastaurin), 27–9 25t, 24–5, 97 117t Age Antibody-mediated rejection (AMR) ACE (angiotensin-converting enzyme) heart transplantation recipient chronic, 267–8, 271 inhibitors, 273t selection, 66 donor-specific antibody (DSA) in Activator protein 1 (AP-1), 12, as infection factor, 66 development of, 239, 242t, 13 kidney transplantation recipient 242–3 Acute liver failure (ALF), 223t, 223, selection, 237t, 236–7 kidney transplantation, 263 224 as lung transplantation comorbidity, outcome following desensitization, Acute rejection 124–5 247 adaptive immune system effector Alagille syndrome, 222t, 221–2 overview, 99f, 98–9 response, 13–14 Alcohol-related malignancy, 36. See pathology, 13–14 allorecognition pathways, 11f, 10–11 also Smoking, alcohol abuse risk assessment, crossmatch/ antibody-mediated rejection (AMR) Alefacept, 29–30 antibody screening based, 240, (See Antibody-mediated Alemtuzumab (Campath) 241t, 242t rejection (AMR)) desensitization protocol, 246 treatment, 26, 159 CD4+ T cells in, 11f, 13 historical applications of, 21 Antigen-presenting cells (APCs), 11f, CD8+ T cells (cytotoxic T intestinal transplants, 308t 10–11 lymphocytes (CTLs)) in, 11f, 13, islet transplantation trials, 300 Antihypertensive medications, 259, 14 in maintenance 273t clinical presentation, 152 immunosuppression, 25 Anti-lymphocyte globulin (ALG), costimulation pathways, 11–12 mechanism of action, 16 19–20 in heart recipient mortality, 104, overview, 22, 97 Antimetabolites mechanism of action, 105t trends in, 4 16 HLA, non-HLA antibodies clinical ALG (anti-lymphocyte globulin), Anti-proliferative agents ADRs, 264 relevance, 240t, 239–40 19–20 Anti-thymocyte globulin (ATG, rATG) immunological synapse, 12 Allograft transplantation history historical applications of, 19–20 immunosuppression (See abdominal organs, 3–4 in maintenance Immunosuppression) cardiothoracic, 4–6 immunosuppression, 25 initiation, 11f, 10–11, 13 combined heart/lung, 6–7 overview, 22, 97 innate immune system effector future directions, 8 AP-1 (activator protein 1), 12, 13 response, 14–15 lung, 7 ARB (angiotensin receptor blocker) interleukin-17 (IL-17) in, 11f, 14 overview, 1–3 inhibitors, 273t leukocyte recruitment, 12 Alloway, 26–7 Artificial Heart Program, 76–7 lipid rafts, 12 Alpha blockers, 273t Aspergillus infection, 50–1, 153–4, 158, memory cells, 12–13 Anastomoses 228 overview, 9 donor lung, 142 ATG. See Anti-thymocyte globulin prophylaxis, 25t, 24–5, 26 hepatectomy, caval, 194f, 193–4 (ATG, rATG) re-transplantation, 68 hepatic artery, 196, 197f ATGAM trial, 19–20 Th2 cells in, 13–14 historical applications, 2, 5, 7 Atherosclerosis, 326t

357

© in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-19753-3 - Organ Transplantation: A Clinical Guide Edited by Andrew A. Klein, Clive J. Lewis and Joren C. Madsen Index More information

Index

Atraumatic intracranial bleeds (aICB), drug interactions, 23t definition, 38 74 mechanism of action, 16 glomerular basement membrane Autograft transplantation history, 2 overview, 23t, 23, 273t duplication in, 42f, 41–2 Autoimmune hepatitis (AIH), 222 reduction, withdrawal, 270b, 270, heart, 43, 44f Avascular necrosis, 326t 271b, 271 liver, 43f, 42–3, 215–16 Azathioprine side effects, ADRs, 263–4, 270, lung, 44f, 43–4 historical applications of, 3, 6, 19–20 276–7 overview, 38 mechanism of action, 16 Calcium channel blockers, 273t transplant arteriopathy (See overview, 97–8 Campath. See Alemtuzumab Transplant arteriopathy) reduction, withdrawal, 270b, 270, (Campath) transplant glomerulopathy, 42f, 271b, 271 Cancer. See Malignancy 41–2 side effects, ADRs, 276–7 Candida infection, 50–1, 153–4, 158, treatment, reversibility, 44–5 Azithromycin, 160–1 228 Clevian classification system, 185t Carbon monoxide poisoning, 71 Coagulopathy, 92–3 Basal cell carcinoma (BCC), 32 Cardiac allograft vasculopathy Coccidioidomycosis, 228 Basiliximab clinical presentation, diagnosis, Collaborative Transplant Study, 73 islet transplantation trials, 300 107t, 107 Combined heart-kidney, heart-liver in maintenance outcomes, 108f, 107–8 recipient selection, 68 immunosuppression, 25 overview, 43, 44f, 106t, 106 Combined heart/lung transplantation mechanism of action, 16 pathophysiology, 106–7 historically, 6–7 overview, 22–3, 97 pediatric heart transplantation, recipient selection, 127 Belatacept, 29, 300 118f, 118–19 surgical procedure, 135–6 Benzodiazepines, 90 treatment, 108, 109t Complement cascade in acute Beta blockers, 273t Cardiothoracic transplantation, 4–6, rejection, 14–15 B7 family, 11–12 31. See also under Combined Composite tissue allotransplantation Biliary atresia, 221, 222t, 226 heart/lung transplantation; (CTA), 313–14 Biologics, 29. See also Monoclonal Heart transplantation; Lung Corneal transplantation antibodies transplantation anatomy, 330f, 330–1 BK virus CD28, 11–12 donor cornea processing, 331 management, 268–9, 271 CD80/86, 11–12 history, 1–2, 330 overview, 48–9 CD154, 11–12 immune privilege in, 331–2 Bladder transplantation, 31 CD27/CD70, 11–12 outcomes, 333t, 333–4 Bortezomib, 29 CD279/CD274, 11–12 rejection clinical features, treatment, BOS. See Bronchiolitis obliterans CD8+ T cells (cytotoxic T 333f, 333 syndrome (BOS) lymphocytes (CTLs)), 11f, 13, rejection immunology, 332–3 Brain, brainstem death physiology 14 surgical techniques, 331, 331t, 331f cardiovascular changes, 54–5 Cell-based therapies, 356. See also Corticosteroids. See also specific drugs endocrine changes, 55–6 Hematopoietic stem cell desensitization protocol, 246 inflammatory, immunological transplantation graft rejection management, 100 changes, 56 Cerebral oximetry, 89 historical applications of, 3, 19–20 overview, 53–4 Chemokines in acute rejection, 12 intestinal transplants, 308t pulmonary changes, 55 Chemotherapy. See also specific drugs as lung transplantation comorbidity, temperature regulation, historical applications of, 6 124 consumptive coagulopathy, 56 PTLD treatment, 35 in maintenance Bronchiolitis obliterans syndrome trends in, 4 immunosuppression, 25 (BOS) usage historically, 3 mechanism of action, 15 in children, 168, 172 Child-Pugh scores, 175t, 175–6 pediatric liver transplantation, development, comorbidities, 157, Chlorpheniramine, 308t 225–6 160t Cholangiocarcinoma, 177t reduction, withdrawal, 270b, 270, overview, 159–61 Cholangitis, recurrent, 177t 271b, 271 severity criteria, 160t Chronic allograft nephropathy, 267t, side effects, ADRs, 264, 276–7 in stem cell transplantation, 326t 266–7, 270, 272f, 284 Crigler-Najjar syndrome, 225 Burkholderia spp., 123, 165–6 Chronic hepatic encephalopathy, 177t Cryptococcus infection, 228 Byetta (exenatide), 299 Chronic obstructive pulmonary CTA (composite tissue disease (COPD) allotransplantation), 313–14 Calcineurin inhibitors (CNIs). See also lung transplantation recipient CTLA-4, 11–12, 29 Cyclosporine; Tacrolimus selection, 125, 126t, 140t, 140 Cutaneous transplantation. See Skin (FK-506, Fujimycin) as stem cell complication, 326t transplantation clinical study data, 23, 97–8 Chronic rejection pathology Cyclophosphamide, 3, 322

358

Index

Cyclosporine Diuretic-resistant ascites, 177t Face, scalp transplantation, 313–19 in combination therapy, 24 Dobutamine, 91, 95 Familial amyloidosis, 177t historical applications of, 4, 20–1 Donation after brain death (DBD) Fentanyl, 90 mechanism of action, 16 cardiovascular management, 57f, FK-506. See Tacrolimus (FK-506, monitoring, 98, 157 58–9 Fujimycin) overview, 23t, 23, 97–8 definition of death (UK, Europe), Focal segmental glomerulosclerosis reduction, withdrawal, 270b, 270, 335–6, 340t (FSGS), 268, 284 271b, 271 euvolemic donor vasoactive drug 4-IBB, 11–12 side effects, ADRs, 276–7 support, 58–9 Fujimycin. See Tacrolimus (FK-506, trends in, 4 hormone replacement therapy, 59 Fujimycin) Cystic fibrosis initial resuscitative measures, 56 Future liver remnant, 184 evaluation of, 126, 126t kidney transplantation surgical infections and, 152–3 procedure, 256 Gastroesophageal reflux (GERD, intra-operative ventilation, 140–1 post-consent donor management, GORD) as living donor lung transplant 57f, 56–7 as absolute contraindication, 123, indication, 130 respiratory management, 59 124 nutrition and, 148 Donation after cardiac death (DCD) as BOS risk factor, 160 overview, 140t heart transplantation, 60–2 Glomerular basement membrane in pediatric lung transplants, 164–5, lung transplantation surgical duplication, 42f, 41–2 166t, 171 procedure, 136 Glomerulonephritis, recurrent, 268 Cytokine levels, post-brain, brainstem Donor organs. See under Organ Gondal failure/infertility, 326t death, 56 donation Graft rejection Cytomegalovirus Donor-specific antibody (DSA), 239, acute (See Acute rejection) in children, 169 242t, 242–3. See also antibody-mediated, 40–1 overview, 48–9, 153, 158 Antibody-mediated rejection antibody-mediated rejection (AMR) pediatric liver transplantation, 228 (AMR) (See Antibody-mediated prophylaxis, 96–7, 104–5, 147–8, DVT (deep venous thrombosis) rejection (AMR)) 260t, 260 prophylaxis, 259 chemotherapy usage historically, 3 Dyslipidemia, 162, 274–5 classification, 99–100 Daclizumab history, 1–2, 6 islet transplantation trials, 300 EBV-specific cytotoxic T-Cells, 34 management, 100 mechanism of action, 16 Eculizumab, 30 monitoring, 99, 100f overview, 97 Edmonton protocol, 300 Tcellmediated(See Tcellmediated DAG (diacylglycerol), 12 Efalizumab, 29, 300 rejection) Dead donor rule (Europe), 336 Efficacy Limiting Toxicity Elimination types, 99f, 98–9 Deep venous thrombosis (DVT) (ELITE) – Symphony study, Graft to recipient body weight ratio, prophylaxis, 259 24–5 184 Demikhov, 5, 6–7 Eisenmenger syndrome, 166t Dendritic cells (antigen-presenting Empyema, 150 Heart transplantation cells (APCs)), 11f, 10–11 Enoximone, 91 allocation, UK/Europe, 344 Desensitization, 242t, 243t, 245t, Epoprostenol, 143–4 cardiac valves, vessels, 356 244–5, 246f, 246 Epstein-Barr virus chronic rejection pathology, 43, Diabetes mellitus. See also Pancreas as immunosuppression marker, 156 44f transplantation; Pancreatic islet overview, 48–9 combined heart/lung (See transplantation pediatric liver transplantation, 228 Combined heart/lung heart transplantation postoperative in PTLD, 33–4, 36 (See also transplantation) management, 96 Post-transplant donation after cardiac death (DCD), hyperglycemia, 109 lymphoproliferative disorder 60–2 kidney transplantation recipient (PTLD)) donor organ demand, 7–8 selection, 236 Eptacog alpha activated (recombinant history, 4–6, 20 lung transplantation long-term factor VIIa), 204 indications, contraindications, 64t, management, 162 Escherichia coli, 276 63–4, 64t new onset diabetes after Etanercept, 299 Mann preparation, 5 transplantation (NODAT), 274t, Etopside, 322 overview, 63 274 Everolimus pediatric (See Pediatric heart post-liver transplantation, 214t, 214 mechanism of action, 16 transplantation) pre-transplant, 274 monitoring, 98, 157 Heart transplantation donor selection, Diacylglycerol (DAG), 12 overview, 24 70–5 Di George Syndrome, 356 Exenatide (Byetta), 299 in recipient mortality, 104

359

Index

Heart transplantation long-term reduced intensity conditioning, 323, Immediate blood mediated management 324f inflammatory reaction (IBMIR), complications sources, 322t, 321–2 298, 302 cardiac allograft vasculopathy Hemolyticuremicsyndrome(HUS), Immunoglobulin (IVIg) (See Cardiac allograft 268, 284 antibody-mediated rejection vasculopathy) Hemothorax, 150 therapy, 26 chronic renal dysfunction, 110 Hepatic artery thrombosis desensitization protocol, 245–6 late cardiac allograft dysfunction, in children, 226 polyoma virus management, 271 110–11 post-liver transplantation, 208t, 209, Immunology history, 2, 3 malignancy, 110t, 110 217 Immunosuppression. See also specific metabolic syndrome, 108–9 Hepatitis drugs and drug classes; specific overview, 106, 106t acute viral, 223 procedures mortality, 104f, 103–4, 105t, 105 autoimmune, post liver acute rejection prophylaxis, 25t, post-first year survival, 106t, 105–6 transplantation, 217 24–5, 26 (See also Acute quality of life, 111 in heart donor selection, 70–1 rejection) survival rates, 102, 103f in heart recipient selection, 67 antibody induction, 21, 22–3, 25t, Heart transplantation management kidney transplant recipient 24–5, 97 during surgery, 88–93 selection, 234 antivirals, antifungals generally, 21 Heart transplantation postoperative living donor liver transplantation, calcineurin inhibitors (CNIs) (See management 183 Calcineurin inhibitors (CNIs)) atrioventricular arrhythmias, 96 overview, 48–9 clinical principles, 97–8 diabetes mellitus, 96 post liver transplantation, 216 desensitization protocol, 246 early allograft-related hemodynamic Hepatoblastoma, 222–3 drug interactions, 23t events, 94–5 Hepatocellular carcinoma, 32t, 35–6, future directions, 27, 28f hemodynamic stability 179, 183 generic drugs, 26–7 maintenance, 95–6 Hepatopulmonary syndrome, 177t, history, 4, 6, 19–21 immediate, 87 201 maintenance, 23, 25t, 25, 156–7 immunosuppression principles, Hereditary haemorrhagic malignancy with, 275–6 97–8 (See also telangiectasia, 177t mechanism of action, 15f, 15 Immunosuppression) Herpes virus negative selection (chimerism) in, infection prophylaxis, 96–7 overview, 48–9, 153 17–18 overview, 94 pediatric liver transplantation, 228 non-nephrotoxic, 271 rejection (See Graft rejection) prophylaxis, 104–5 overview, 19, 21–2 renal failure, 96 HIV infection, 67, 71, 234 pediatric lung growth rates and, 171 therapeutic drug monitoring, 98 Human leukocyte antigen (HLA) side effects, ADRs, 276–7 Heart transplantation recipient allorecognition mediation by, 10–11 small molecules, 27 selection, 63–8 clinical relevance, 240t, 239–40 T-cell depleting induction, 300 Heart transplantation surgical HUS (hemolytic uremic syndrome), tolerance induction generally, 16–17 procedure, 83–7 268, 284 Treg in, 17 Hematopoietic stem cell Hyperlipidemia, 109, 177t, 214t, trends in, 4 transplantation 214 Inducible T cell costimulator (ICOS, complications Hypertension CD278), 11–12 early, 323–4, 325t anti-hypertensive agents, 273t Infection graft vs. host disease (GvHD), causes of, 273t as absolute contraindication, 123 326t, 326–7 management, 272f, 273t, 272–3, 273t age as factor, 66 hemorrhagic cystitis, 324 post-liver transplantation, 214t, 214 bacterial, 49–50, 152–3 infections, 324, 325f pulmonary (See Pulmonary donor-derived, 47–8 late, 326t hypertension) fungal, 50–1, 104–5, 153–4, 158, venooclusive disease, 180t, Hypothermia historical applications, 5 228 324–6 Hypothyroidism, 326t in heart recipient mortality, 104–5 conditioning principles, 323 Kaposi’s sarcoma, 32–3 definitions, 321 Idiopathic pulmonary arterial kidney transplantation recipient donor lymphocyte infusions, hypertension (IPAH), 126t, 126, selection, 234–5 327 140t overview, 46–8 donors, 321–2 Idiopathic pulmonary fibrosis (IPF), parasitic, 51–2, 104–5 indications, 328f, 327–8, 329 126t, 126–7, 140t prophylaxis, 96–7, 235, 260 organisations, 329 Idiopathic pulmonary hypertension, pulmonary, 123, 147–8 outcomes, 327–9 166t risk management, 47, 104–5 principles, rationale, 320–1 IgA nephropathy, 268 sepsis, 70

360

Index

timeline, 47f, 46–7 antibody induction new onset diabetes after viral, 48–9, 67, 70–1, 104–5, 153, 158 chemotherapy usage historically, 3 transplantation (NODAT), 274t, Infertility/gondal failure, 326t donor organ demand, 7–8 274 Inositol triphosphate (IP3), 12 history, 2, 20 non-adherence, 271–2 Interleukin-2 (IL-2), 12 live donor (See Living donor kidney overview, 265 Interleukin-17 (IL-17), 11f, 14 donation) polyomavirus associated Intestinal transplantation maintenance immunosuppression, nephropathy, 268–9, 271 combined kidney, 307 25 pregnancy, 277 complications malignancy recurrence in, 31 pre-transplant diabetes, 274 acute rejection, 309–11 pediatric (See Pediatric kidney PTLD (See Post-transplant infection prophylaxis, 308 transplantation) lymphoproliferative disorder systemic sepsis treatment, 310t, skin, lip, 32 (PTLD)) 311 twins historically, 3 recurrent glomerulonephritis, 268 thrombosis prophylaxis, 308 Kidney transplantation complications renovascular disease, 268 graft type selection, 306 acute rejection, 262–3 transplant bone disease, 276 immunosuppression, 308t, 307–8 antibody-mediated rejection transplant glomerulopathy, 267, 271 indications, 305t, 307 (AMR), 263 (See also urinary tract infection (UTI), 276 intercurrent surgery, 312 Antibody-mediated rejection Kidney transplantation perioperative nutrition, 308–9 (AMR)) care outcomes, 303–4 delayed graft function, 261 antihypertensive medications, 259, pediatric, 305t, 307 graft thrombosis, 262 273t physiotherapy, 309 immunosuppression, 263–4 antiplatelet, anticoagulation therapy, post-discharge management, 311 lymphocele formation, 262 259 postoperative mortality, 311f, 311 postoperative hemorrhage, 261–2 consent, 260 pregnancy, 312 T-cell mediated rejection, 263t, 263 dialysis, 259 preoperative management, 307 urological, 262 evaluation, 258–9 process, requirements of, 305–6 wound, 261 fluid management, 260–1 recipient selection, management, Kidney transplantation long-term immunosuppression, 259 304, 305t management oliguric/anuric patient evaluation, renal function, 308 anti-proteinuric measures, 272 261 salt, water balance, 308 atypical hemolytic uremic syndrome postoperative analgesia, 261 splenectomy, 307 (HUS), 268 postoperative early phase, 260–1 surgical procedure, 307 cardiovascular morbidity, mortality prophylaxis, 260t, 259–60 timing of, 304–5 prevention, 272 Kidney transplantation recipient tissue typing, 311 chronic allograft nephropathy, 267t, selection travel, 312 266–7, 270, 272f ABO incompatibility, trends in, 303f, 303 chronic antibody mediated desensitization protocols, 232 Intra vascular ultrasound (IVUS), 107 rejection, 267–8, 271 age, 237t, 236–7 IP3 (inositol triphosphate), 12 chronic graft dysfunction, 267t, cardiovascular disease, 233 IPAH (idiopathic pulmonary arterial 266–7, 270, 272f combined liver/kidney, 179–81 hypertension), 126t, 126, 140t chronic kidney disease, 277 contraindications, 232t, 232 IPF (idiopathic pulmonary fibrosis), CNIs (See Calcineurin inhibitors diabetes, 236 126t, 126–7, 140t (CNIs)) hypercoagulable states, 233–4 Islet transplantation. See Pancreatic death with functioning graft, 266 infection, 234–5 islet transplantation dyslipidemia, 274–5 ischemic heart disease, 233 Isoproterenol, 91, 95 focal segmental glomerulosclerosis, list management, 237 268, 284 malignancy, 235 Janus kinases (Jak), 27 graft, patient survival, 265–6 obesity, 236 JC virus graft function improvement overview, 231 management, 268–9, 271 strategies, 267t, 269t, 269, 270 paired exchange, kidney list overview, 48–9 graft loss, causes, 266t, 266, 266f donation, 232–3 hypertension, 272f, 273t, 272–3, panel reactive antibody (PRA), 232 Kaposi’s sarcoma, 32t, 32–3 273t peripheral vascular disease, 233 Keratoconjunctivitis sicca, 326t IgA nephropathy, 268 preoperative evaluation, 231 Ketamine, 90 immunosuppression with primary renal disease, 236 Kidney transplantation malignancy, 275–6 psychiatric, cognitive, psychosocial acute rejection prophylaxis, 25t, infection, 276 evaluation, 237 24–5, 26 malignancy, 275f, 275f, 275–6 (See recurrence, 236 allocation, UK/Europe, 344 also Malignancy) structural heart disease, 233

361

Index

Kidney transplantation recipient donor organ demand, 7–8 electrolyte, acid-base changes, 205, selection (cont.) future directions, 219 206 timing of referral, 231 hepatitis, 216 fluids, 204 tissue typing, histocompatibility, 232 history, 3–4, 20 glucose control, 205–6 tobacco use, 233 living donor (See Living donor liver hepatopulmonary syndrome, urologic disease, 235 transplantation) 201 Kidney transplantation recipient pediatric (See Pediatric liver ICU care, 208–9 sensitization transplantation) immediate preoperative ABO incompatibility, 244–5 quality of life, 218–19 preparation, 203 acceptable mismatch programs, 244 tobacco, alcohol-related malignancy, immunosuppression, 209–10 causes of, 239 36 monitoring, 203–4 definitions, 238 Liver transplantation complications obstructive airways disease, 201 desensitization, 242t, 243t, 245t, acute rejection, 208t, 210, 215–16 post ICU care, 209–10 244–5, 246f, 246 autoimmune hepatitis, 217 postoperative care, 207–8 HLA, non-HLA antibodies clinical bile leak, 208t, 210 post-reperfusion syndrome, 206 relevance, 240t, 239–40 diabetes, 214t, 214 preoperative assessment, 200t, HLA incompatibility, 242t, 245 graft deterioration, 208t, 210 199–200, 202 options for, 243–6 hemorrhage, 208t, 209 cardiovascular function, 199–200 outcome following desensitization, hepatic artery thrombosis, 208t, 209, hematological, 201–2 247 217 metabolic, 202 paired kidney donation, 244 hyperlipidemia, 214t, 214 nutritional impairment, 202 postoperative protocols, 245t, 246–7 hypertension, 214t, 214 pulmonary, 201 quantization, 238–9 metabolic syndrome, 214t, 213–14 renal impairment, 202 risk assessment, crossmatch/ obesity, 214t, 214 pulmonary hypertension, 201, antibody screening based, 240, overview, 208t, 214t 206–7 241t, 242t primary biliary cirrhosis, 217 renal function changes, 207 virtual cross-matching, 243t, 240–3 primary non-function (PNF), 208t, respiratory function changes, 207 Kidney transplantation surgical 209 vascular access, 203 procedure primary sclerosing cholangitis, 217 veno-venous bypass, 207 cadaveric donor nephrectomy, sepsis, 208t, 210 Liver transplantation recipient 253–4 structural, 217 selection cold ischemia, 254 Liver transplantation long-term acute liver failure, 178t, 179 complications, 256–7 management clinical endpoints, 174 DCD donors, 256 autoimmune hepatitis, 217 combined liver/kidney, 179–81 en bloc, 256 conception, pregnancy, 219 contraindications, 181 Leadbetter–Politano, 255 disease recurrence, 216–17 delisting criteria, 181 live donor (See Living donor kidney follow-up, 218f, 217–18 disease severity scores, 175t, 175–6 donation) immunosuppression, 213 disease-severity selection criteria, overview, 253 malignancy, 214t, 215 176t, 176 pediatric (See Pediatric kidney metabolic syndrome, 213–14 ethical standpoints, 175t, 174–5 transplantation) mortality, 212f, 212, 213t, 213 hepatocellular carcinoma, 179 perioperative care, 255 osteoporosis, 215 overview, 173–4 standard cadaveric, 254–5 primary biliary cirrhosis, 217 re-transplantation, 179–81, 218 transplant nephrectomy, 257 primary sclerosing cholangitis, 217 variant syndromes (exceptional Kohler and Milstein, 20 quality of life, 218–19 diagnoses, MELD exceptions), rejection, 215–16 177t, 176–7, 179 Late cardiac allograft dysfunction renal impairment, 214–15 Liver transplantation surgical arrhythmia, 110–11 re-transplantation, 179–81, 218 procedure cardiac allograft failure, 111 structural complications, 217 donor tricuspid regurgitation, 111 Liver transplantation perioperative post-brainstem death, 191f, Legal issues. See under Organ donation management 190–1, 192 Leishmania, 51–2 acute liver failure, multiorgan post-cardiac death, 192 Liberase HI, 297 failure, 202–3 overview, 190 Lip, skin malignancy, 32t, 32 anesthetic technique, 203 preparation of liver, 192–3 Liver transplantation blood replacement, 204 recipient allocation, UK/Europe, 344 cardiovascular changes, 206–7 hepatectomy, caval anastomosis, chronic rejection pathology, 43f, coagulopathy, 204–5 194f, 193–4 42–3, 215–16 complications (See Liver hepatic artery anastomosis, 196, conception, pregnancy, 219 transplantation complications) 197f

362

Index

portal venous anastomosis, 195f, donor organ demand, 7–8 complications 194–5, 196 donor organ procurement, 59 cardiovascular, hemodynamic, reperfusion, bile duct historically, 7, 20, 122, 123t 151 anastomosis, 196–8 living-donor lobar (See early airway, 150–1 Living donor kidney donation Living-donor lobar lung gastrointestinal, 151 deceased vs., 248, 249f transplantation) infections, 152–4 donor evaluation, 249–50, 255 malignancy recurrence in, 31 of operation, 149 donor quality of life, 251 overview, 127 overview, 148–9 donor surgical risks, 250 tobacco, alcohol-related malignancy, pleural, 150 future directions, 252 36 reimplantation response, PGD, graft survival post-dialysis, 248, 249f Lung transplantation long-term 149–50 long-term donor outcome, 250–1 management rejection, 152 pregnancy following, 251–2 acute rejection, surveillance renal, 152 surgical procedure, 255–6 biopsies, 159t, 158–9 fluid management, hemodynamics, Living donor liver transplantation infection, 157–8 (See also Infection) 146–7 ABO-incompatible, 188 maintenance immunosuppression, immunosuppression, 148 complications 156–7 nutrition, 148 biliary, 187 malignancy, 162 overview, 145 donor, 184–5, 185t metabolic syndrome (diabetes, pulmonary edema, 146–7 rejection, 188 dyslipidemia), 162 pulmonary hypertension, 146 small-for-size syndrome (SFSS), nephrotoxicity, 161–2 ventilation, 145 186–7 osteoporosis, 162 Lung transplantation recipient vascular, 187–8 outcomes, 162f, 163f, 162–3 selection donor evaluation, 183, 184f overview, 155 absolute contraindications, 123t, donor operation, 184, 185f patient, 156 122–3, 124 dual graft, 188 post-transplant lymphoproliferative BODE index calculation, 126t graft, patient survivals, 186 disorder (See Post-transplant chronic obstructive pulmonary graft types, 184, 185f lymphoproliferative disorder disease (COPD) (See Chronic hepatitis C, 183 (PTLD)) obstructive pulmonary disease hepatocellular carcinoma, 183 surveillance, 155–6 (COPD)) indications, 182–3 venous thromboembolism (VTE), cystic fibrosisSee ( Cystic fibrosis) left vs. right lobe, 186 162 historically, 122 overview, 182 Lung transplantation management IPAH (idiopathic pulmonary paired donor exchange, 189 during surgery arterial hypertension), 126t, recipient operation, 185–6 cardiopulmonary bypass, 141–2 126, 140t recipient outcomes, 186 monitoring, vascular access IPF (idiopathic pulmonary fibrosis), rejection, 188 anesthesia maintenance, 141t, 126t, 126–7, 140t special recipient indications, 183 141 Lung transplantation surgical Living-donor lobar lung induction, 140t, 139–40 procedure transplantation obstructive disease, 140t, 140 bilateral, 134–5, 141 cadaveric vs., 131–2 overview, 139 combined heart/lung, 135–6 donor selection, size matching, 130t, pulmonary hypertension, 141 dissection, removal of native lung, 129–30 restrictive disease, 140 142 outcomes, 130, 131f, 131 suppurative disease, 140–1 donation after cardiac death (DCD), overview, 128, 129f TEE, 139 136 pediatric, 167 patient assessment, 138 donor lung anastomosis, 142 postoperative management, 131 premedication, 138 graft reperfusion, 142–3 recipient selection, 130, 131t primary graft dysfunction (PGD), overview, 133 surgical technique, 129f, 128–9 143–4 single lung, 133–4, 141 Lung transplantation RV failure, 142 Lymphoma allocation, UK/Europe, 344 single vs. bilateral, 141 diagnosis, 34 BOS (See Bronchiolitis obliterans stages of surgery (See Lung Epstein-Barr virus in, 33–4 syndrome (BOS)) transplantation surgical malignancy recurrence in, 31 chronic rejection pathology, 44f, procedure) pediatric heart transplant, 118 43–4 thoracic epidural analgesia, prevalence data, 32t combined heart/lung (See 139 treatment, 34–5 Combined heart/lung Lung transplantation postoperative transplantation) care Major histocompatibility complex comorbidities, 124–5, 126t antimicrobial prophylaxis, 147–8 (MHC), 11f, 10–11

363

Index

Malignancy Midazolam, 90 Obesity as absolute contraindication, 123 Milan criteria, 179 heart transplantation recipient in children, 36 Milrinone, 91 selection, 67 de novo types, 32t, 32 Minor histocompatibility (miH) kidney transplantation recipient donor transmission of, 31, 36 antigens, 10–11, 12 selection, 236 extracranial, 71 Mitral, tricuspid valve regurgitation, as lung transplantation comorbidity, hepatocellular carcinoma, 32t, 95 125 35–6 Monoclonal antibodies. See also post-liver transplantation, 214t, 214 immunosuppression with, 275–6 specific drugs Obliterative bronchiolitis, 44f, 43–4 Kaposi’s sarcoma, 32t, 32–3 historical applications of, 20 Obstructive airways disease, 201 kidney transplantation recipient in maintenance OKT3, 16, 20–1 selection, 235 immunosuppression, 25 Opioids, 90 liver transplantation recipient mechanism of action, 16 Organ donation (UK, Europe) selection, 177t overview, 22–3, 28f, 29, 97 allocation, 343–4 management, 37 PTLD treatment, 34–5 Bone Marrow Donors Worldwide, miscellaneous, 36 MRSA (methicillin-resistant 321 overview, 31–2, 37 Staphylococcus aureus), 152–3 critical care, emergency medicine post-transplant lymphoproliferative mTOR (mammalian target of roles, 339–40 disorder (See Post-transplant rapamycin) inhibitors, 16, 98 dead donor rule (Europe), 336 lymphoproliferative disorder Mucormycosis, 228 donor, transplant rates, 341t, 341–2 (PTLD)) Mycobacteria spp., 123 donor coordination, 338–9 prevalence data, 31–2 Mycophenolate mofetil (MMF) donor safety, quality, 342t, 342–3 recurrence, 31 in combination therapy, 25 legal issues renalcellcarcinoma,36 desensitization protocol, 246 consent, 336–7 skin, lip, 32t, 32 historical applications of, 21 definition of death, 335–6, 340t in stem cell transplantation, islet transplantation trials, 300 living donor, 337–8 326t mechanism of action, 16 overview, 335 tobacco, alcohol-related, 36 overview, 23–4, 97–8 potential for, 340t, 340–1 treatment, 37 reduction, withdrawal, 270b, 270, regulation, oversight, 343 vulva, perineum, 32t, 36 271b, 271 tracking, 345 Mammalian target of rapamycin side effects, ADRs, 276–7 transplant registries, 345–6 (mTOR) inhibitors, 16 Mycophenolate sodium (EC-MPS), Organ donation (US) MAP kinase (MAPK), 12 23–4 allocation, 352f, 351–2 Medical record review (MRR), Bone Marrow Donors Worldwide, 340–1 National Kidney Allocation Scheme, 321 Melanoma prevalence data, 32. See also 344 donor demand, 7–8, 53 Malignancy National Liver, Heart and Lung history, 347–8 MELD score, 175t, 176 Allocation Schemes, 344 listing requirements, 351 6-mercaptopurine National Pancreas Allocation Scheme, living donor, 353 historical applications of, 3 344 management, procurement mechanism of action, 16 Natural killer (NK) cells abdominal organs, 60 Metabolic syndrome in acute rejection, 12, 14–15 brain, brainstem death physiology drug-induced, 162 in transplant arteriopathy, 41 (See Brain, brainstem death hyperglycemia (diabetes mellitus), Neonatal hemochromatosis, 223–4 physiology) 109 New onset diabetes after donation after brain death (See hyperlipidemia, 109 transplantation (NODAT), 274t, Donation after brain death overview, 108, 213–14 274 (DBD)) systemic hypertension, 108–9 NF-␬B, 12 euvolemic donor vasoactive drug Methicillin-resistant Staphylococcus Nitric oxide, 143 support, 58–9 aureus (MRSA), 152–3 NK cells. See Natural killer (NK) cells hormone replacement therapy, 59 Methotrexate, 3 Non-cirrhotic metabolic liver non-heart beating donors, 60–2 Methylprednisolone disorders, 221, 222t organization, 59–60 acute rejection regimen, 26 Non-Hodgkins lymphoma, 33–4 overview, 53 historical applications of, 3, 6 Nutrition Organ Procurement and intestinal transplants, 308t cystic fibrosis, 148 Transplantation Network organ donor hemodynamic impairment, 202 (OPTN), 350f, 348–50, 350f, instability, 59 intestinal transplantation, 308–9 350 MHC (major histocompatibility lung transplantation postoperative recipient identification, 352 complex), 11f, 10–11 care, 148 successes, challenges, 353–4

364

Index

transplant program requirements, Pediatric heart transplantation, Pruritis, persistent, 177t evaluation, 353 112–120 Pulmonary hypertension United Network for Organ Sharing Pediatric kidney transplantation, 256, idiopathic, 166t (UNOS), 348f, 348–9, 350f, 351 278–285 IPAH, 126t, 126, 140t Organ Procurement and Pediatric liver transplantation liver transplantation perioperative Transplantation Network complications, 220–228 management, 201, 206–7 (OPTN), 350f, 348–50, 350f, Pediatric lung transplantation lung transplantation, 141, 146 350 allocation, 166–7 pediatric liver transplantation, 221 Orthotopic transplantation history, BOS (See Bronchiolitis obliterans portopulmonary, 177t 5–6 syndrome (BOS)) Osteoporosis complications, 168 Radiation therapy, 3, 35 as lung transplantation comorbidity, future considerations, 172 RATG. See Anti-thymocyte globulin 125 growth, 171 (ATG, rATG) overview, 326t indications/contraindications, 165f, Recombinant factor VIIa (eptacog post-lung transplantation, 162 164–5, 166t, 166 alpha activated), 204 treatment, 215 management, 168–70 Recurrent glomerulonephritis, 268 Ovary transplantation, 355 outcomes, 169f, 170f, 170–1 Renal cell carcinoma, 36 OX40, 11–12 overview, 164, 165f Renal transplantation. See Kidney quality of life, 171–2 transplantation Paired donor exchange, 189 re-transplantation, 170 Renovascular disease, 268 Pancreas transplantation surgical procedure, 167–8 Respiratory viruses, 48–9 allocation, UK/Europe, 344 Perineum, vulvar malignancy, 32t, 36 Restrictive lung disease, 326t allograft rejection, 292–3 Phosphodiesterase III inhibitors, 91 Rituximab cadaveric donor selection, 289t, Plasmapheresis (TPEX), 26 antibody-mediated rejection 288–9 Pleural effusions, 150 therapy, 26 candidate evaluation, 288 Pneumocystis jiroveci (carinii), 50–1, desensitization protocol, 245–6 complications 147, 260 mechanism of action, 16 bladder-drained patient, 291–2 Pneumothorax, 125, 150 PTLD treatment, 34–5 enteric-drained patient, 292 Polycystic liver disease (PLD), 177t hemorrhage, 291 Polyomavirus associated nephropathy, Sepsis, 70 surgical, 290 268–9, 271 SFSS (small-for-size syndrome), 177t, thrombosis, 291 Portal hypertensive bleeding, 177t 186–7 transplant pancreatitis, 291 Portal vein thrombosis (PVT), 226 Sirolimus (rapamycin) diabetes type 1, 287 Portopulmonary hypertension, 177t in combination therapy, 24, 25–6 history, 3–4 Post-reperfusion syndrome, 206 historical applications of, 21 immunosuppression, 292 Post-transplant lymphoproliferative mechanism of action, 16 indications, contraindications, 287, disorder (PTLD) monitoring, 98, 157 289 in children, 36, 169–70 overview, 24, 97–8 malignancy recurrence in, 31 diagnosis, 34 reduction, withdrawal, 270b, 270, organ allocation, 288 non-nephrotoxic 271b, 271 outcomes, 293 immunosuppression, 271 SIRS (systemic inflammatory response rationale in diabetes patients, 286–7 overview, 32t, 33–4 syndrome), 297 surgical techniques, 289f, 290f, pediatric liver transplantation, 228 Skin, lip malignancy, 32t, 32 289–90, 290f, 290 post lung transplant, 161t, 161 Skin transplantation Pancreatic islet transplantation treatment, 35f, 34–5, 275 history, 1, 2–3 auto-transplant, 301–2 WHO classification, 161t malignancy recurrence in, 31 engraftment, function, 299 PRA (panel reactive antibody), 232, Small-for-size syndrome (SFSS), 177t, future directions, 302 238–9 186–7 IBMIR, 298, 302 Prednisolone, 3, 124 Smoking, alcohol abuse. See also immunosuppression, 299–300 Prednisone, 100 Substance abuse infusion, 298f, 297–8, 299 Pregnancy post-transplantation as absolute contraindication, 123–4 living donor allo-transplant, 302 intestinal, 312 heart donor selection, 74 overview, 295 kidney, 277 heart transplantation recipient post-transplant monitoring, 300–1 live donor kidney donation, 251–2 selection, 67 processing, 296–7 liver, 219 kidney transplantation recipient recipient selection, 296 Primary graft dysfunction (PGD), selection, 233 Panel reactive antibody (PRA), 232, 143–4 Smoking, alcohol-related malignancy, 238–9 Primary hyperoxaluria type 1, 284–5 36 Parvovirus B19, 48–9 Prostaglandins, 143–4 Sotrastaurin (AEB071), 27–9

365

Index

Squamous cell carcinoma (SCC), 32 Tcells Treg, 17 Staphylococcus aureus (MRSA), 152–3 in acute rejection (See Acute Tricuspid regurgitation, 111 Starzl, T. E., 3–4, 190 rejection) Tricyclic antidepressants, 71 Statins, 98 CD8+ (cytotoxic T lymphocytes Tuberculosis, 234 Strongyloides stercoralis, 51–2 (CTLs)), 11f, 13, 14 Tumor necrosis factor (TNF)/TNF Substance abuse. See also Smoking, CD4+ in acute rejection, 11f, 13 receptor (TNFR) family, 11–12 alcohol abuse depleting induction heart donor selection, 74 immunosuppression, 300 UK Code of Practice, 336 heart transplantation donor memory, 12–13, 239 UKELD score, 175t, 176 selection, 74 sensitization of, 239 United Network for Organ Sharing heart transplantation recipient in transplant arteriopathy, 40 (See (UNOS), 348f, 348–9, 350f, 351 selection, 67 also Transplant arteriopathy) Urinary tract infection (UTI), 276 Surfactant deficiencies, 166t Teplizumab, 300 Uterus transplantation, 355 SV40 virus management, 268–9, 271 Thiazide diuretics, 273t Systemic hypertension, 108–9 Thymoglobulin, 21 Vanishing bile duct syndrome, 43f, Systemic hypotension, 95 Thymus transplantation, 356 42–3 Systemic inflammatory response T3 levels post-brain, brainstem death, Varicella zoster virus (VZV), 48–9 syndrome (SIRS), 297 55–6 Vascular anastomoses techniques TNF (tumor necrosis factor)/TNF donor lung, 142 Tacrolimus (FK-506, Fujimycin) receptor (TNFR) family, 11–12 hepatectomy, caval, 194f, 193–4 in combination therapy, 24, 25, 27–9 Toxoplasma gondii, T. cruzi, 51–2 hepatic artery, 196, 197f desensitization protocol, 246 TPEX (plasmapheresis), 26 history, 2, 5, 7 historical applications of, 21 Transesophageal echocardiography, 92 portal venous anastomosis, 195f, mechanism of action, 16 Transplant arteriopathy 194–5, 196 monitoring, 98, 157 chronic humoral rejection in kidney, reperfusion, bile duct, 196–8 overview, 23t, 23, 97–8 41f, 42f, 41–2 Vascular surgery history, 2 pediatric liver transplantation, defined, 38–9 Veno-venous bypass, 207 225–6 pathogenesis, experimental models, Ventricular assist devices (VADs), reduction, withdrawal, 270b, 270, 39–41 76–82, 89 271b, 271 pathologic diagnosis, 39f, 39, 40f Virtual cross-matching, 243t, 240–3 Tasocitinib (CP-690, 550), 27 Transplant bone disease, 276 Vulva, perineum malignancy, 32t, 36 Tcellmediatedrejection,239, 247, Transplant glomerulopathy 263t chronic rejection pathology, 42f, Wilson’s disease, 224 T cell receptor (TCR), 11f, 10–11, 41–2 12 long-term management, 267, 271 Xenograft transplantation history, 2

366