Living Donor Organ Transplantation

2nd Edition - January 18, 2024
Editors: Rainer W.G. Gruessner, Enrico Benedetti
Language: English
Hardback ISBN:
9 7 8 - 0 - 4 4 3 - 2 3 5 7 1 - 9
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 2 3 5 7 2 - 6

Living Donor Organ Transplantation, Second Edition puts the entire discipline in perspective while guiding readers step-by-step through the most common organ transplant su… Read more

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Living Donor Organ Transplantation, Second Edition puts the entire discipline in perspective while guiding readers step-by-step through the most common organ transplant surgeries. This two-volume set is organized into five cohesive parts, and featuring numerous surgical illustrations, this sourcebook delivers an incisive look at every key consideration for general surgeons who perform transplantations, from patient selection to recipient workup and outcomes. The books emphasize the most humanitarian approaches and provide content on living donor uterus transplantation, new operative techniques, including the use of robotic and minimally invasive transplant procedures, new immunosuppressive regimens, new protocols of tolerance induction, including stem cell therapy and transplantation, and more.

Chapter authors are international leaders in their fields and represent institutions from four continents (Americas: USA, Argentina, Brazil, Canada; Europe: France, Germany, Italy, Spain, Sweden, UK; Asia: China, Japan, Korea, Taiwan; Australia).

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors to Volume 1
Contributors to Volume 2
Foreword
Preface
The international state-of-the-art conferences on living donor abdominal organ transplantation
Acknowledgments
Volume 1
Part I. General aspects of living donor organ transplantation
Chapter 1. Introduction and Rationale
Chapter 2. Cultural differences in living organ donation
Chapter 2.1. A global perspective
Chapter 2.2. The United States experience
Chapter 2.2.1. The experience in the United States of racial disparities in living donor organ transplantation: African Americans
Chapter 2.2.2. The experience in the United States of racial disparities in living donor organ transplantation: Hispanics
Chapter 2.3. The European East-West difference
Chapter 3. Ethical and legal issues
Chapter 3.1. The American perspective
Chapter 3.2. The Asian perspective
Chapter 3.3. The European perspective
Chapter 3.4. Ethical and legal issues - UNOS and living donation: present and future donor policies
Chapter 4. Donor counseling and consent
Chapter 4.1. Ethically teaching and testing living organ donors
Chapter 4.2. Informed consent
Chapter 4.3. Donor advocacy
Chapter 5. Nondirected donation
Introduction
The beginning of nondirected donation at University of Minnesota
Nondirected donation around the world
NDD candidate evaluation
NDD versus traditional directed donor acceptance or exclusion
Motivation
Psychosocial outcomes
Financial burden related to donation
NDD anonymity
NDDs with life-threatening or other diseases
Evolution of NDD at the University of Minnesota
Nondirected donors and paired exchange
Ethical concerns about NDDs, paired exchange, and the voucher system
Going forward
Chapter 6. Social issues in living donor organ transplantation
Trends in living donor kidney donor transplant
Informed consent requirements for living donors
Barriers and facilitators to living donation
Donor evaluation and surgical processes
Emotional experiences of becoming a living donor
Next steps to support expansion of living donation
Part II. Paid legal and illegal organ donation
Chapter 7. Current financial incentives
Chapter 7.1. Financial incentives in western countries
Chapter 7.2. Incentives in non-Western countries: the Iranian model
Chapter 7.3. Paid legal and illegal organ donation, current financial incentives: impact of government-sponsored financial reimbursement of expenses
Chapter 8. Paid legal organ donation
Chapter 8.1. PRO: the clinicians perspective
Chapter 8.2. PRO: the philosopher’s perspective
Chapter 8.3. Con: the clinician’s perspective∗
Chapter 8.4. Con: the ethicist’s perspective∗
Chapter 9. Paid organ donation: challenges for public health care policy
Failures of the current regulatory environment: introduction
Improving access to transplantation: the need to move beyond rhetoric
Justice, fairness, and exploitation
Markets, innovation, and excellence
Concluding reflections
Chapter 10. Who's got the knife? The role of surgeons in transplant trafficking
The growth of illicit networks in global transplantation
Conclusion
Part III. The role of social media
Chapter 11. Living donor organ transplantation: the role of public solicitation
Summary
What is solicitation?
Terminology
Why do people engage in public solicitation?
Why is public solicitation for living donor organs controversial?
Health care professionals' views and ethical issues
Social media
Dealing with public solicitation campaigns
National guidance regarding public solicitation (directed altruistic donation/solicited specified direct donation)
Recommendations
Chapter 12. The internet and social media's impact on paid legal and illegal organ donation
History of transplantation in the United States
Internet and social media use in the United States
National and international organ donation systems
Organ donation in the age of the Internet and social media
Laws governing the national transplant system
Legal and ethical implications of online organ solicitation
Future roles of the Internet and social media in organ donation
Organ-specific aspects of living donor abdominal organ transplantation
Section I. Kidney transplantation
Chapter 13. Kidney transplantation: personal reflections
Chapter 14. History of living donor kidney transplantation
December 23, 1954
After December 23, 1954
Well beyond December 23, 1954
Mid-1960s
Late 1960s
The 1970s and beyond
Chapter 15. Kidney transplantation: geographical differences
Introduction
United States and Canada
Europe
The Latin Americas
Australia and New Zealand
Conclusion
Chapter 16. Preemptive living donor transplantation: The ideal therapeutic modality for end-stage kidney disease
Introduction
The survival benefit of kidney transplantation
The deleterious association of pretransplant dialysis with outcomes posttransplantation
Incidence of preemptive wait-list placement and transplantation
Characteristics of preemptive living donor recipients
Summary
Chapter 17. Kidney transplantation: Assessment of the Kidney Donor Candidate
Chapter 17.1. Kidney transplantation: the donor selection and workup
Chapter 17.2. The marginal donor
Chapter 17.3. The hepatitis C-positive donor
Chapter 17.4. Infection transmission from donors, including COVID-19
Chapter 17.5. Immunologic evaluation and histocompatibility testing for live donor kidney transplantation
Chapter 17.6. Anesthesia management of the living kidney donor
Chapter 17.7. Surgical procedures
Chapter 17.7.1. Open standard nephrectomy
Chapter 17.7.2. Minimally invasive open donor nephrectomy ‘mini-nephrectomy’
Chapter 17.7.3. Transperitoneal laparoscopic nephrectomy
Chapter 17.7.4. Retroperitoneal laparoscopic nephrectomy
Chapter 17.7.5. Robotic nephrectomy
Chapter 17.7.6. Living donor nephrectomy techniques: comparative review and critical appraisal
Chapter 17.7.7. Vaginal donor nephrectomy
Chapter 17.8. Peri-operative care of the living kidney donor
Chapter 17.9. Morbidity and mortality
Chapter 17.10. Long-term medical outcomes
Chapter 17.11. Psychological aspects
Chapter 17.12. Long-term psychosocial outcomes
Chapter 17.13. International living donor registry
Chapter 17.14. Clinical trials of tolerance induction in living donor kidney transplantation
Chapter 18. Kidney transplantation: the recipient
Chapter 18.1. Recipient selection and workup
Chapter 18.2. Anesthetic management of the kidney recipient
Surgical procedures
Chapter 18.3.1. Open procedures
Chapter 18.3.2. Surgical procedures: robotic procedures
Chapter 18.3.3. Laparoscopic and robotic kidney transplantation with vaginal insertion of the graft
Chapter 18.4. Ischemia and reperfusion injury
Chapter 18.5. Perioperative care
Chapter 18.6. Posttransplant complications
Chapter 18.7. Immunosuppression for living donor kidney transplantation
Chapter 18.8. Immunobiology
Chapter 18.9. Molecular fingerprinting in living donation: a benchmark of organ viability
Chapter 18.10. Biomarkers of tolerant patients
Chapter 18.11. Recurrence of disease
Chapter 18.12. APOL1 and donor/recipient risk of graft failure
Chapter 18.13. Retransplantation
Chapter 18.14 Pediatric transplantation
Chapter 18.14.1. Medical aspects of the pediatric kidney recipient
Chapter 18.14.2. Surgical techniques and complications in pediatric kidney transplantation
Chapter 18.15. Long-term outcome
Chapter 18.16. Living donor kidney transplantation and malignancy
Chapter 18.17. Strategies to maximize the donor pool
Chapter 18.17.1. Living donor kidney paired exchange
Chapter 18.17.2. Desensitization protocols for high-PRA recipients
Chapter 18.17.3. ABO-incompatible kidney transplantation
Chapter 18.17.4. Auxiliary liver transplants for highly sensitized kidney recipients
Chapter 19. Economic review of living donor kidney transplantation
Introduction
Costs and outcomes in LDKT
Current issues affecting LDKT
Limits to LDKT expansion
Impact of worsening population health
Costs to donors and financial incompatibility
Donor compensation
Kidney exchange programs
Summary
Section II. Pancreas transplantation
Chapter 20. History of and rationale for pancreas transplantation
Chapter 20.1. History of living donor pancreas transplantation
Chapter 20.2. Rationale for living donor pancreas transplants
Chapter 21. Pancreas transplantation: the donor
Chapter 21.1. Selection and workup
Chapter 21.2. Surgical Procedures and Perioperative Care
Chapter 21.3. Morbidity, mortality, and long-term outcome
Chapter 22. Pancreas transplantation: the recipient
Chapter 22.1. Selection and workup
Chapter 22.2. Surgical procedures
Chapter 22.3. Perioperative care, immunosuppressive therapy, and posttransplant complications
Chapter 22.4. The identical twin transplant experience: recurrence of disease
Chapter 23. Living donor pancreas transplantation: the Asian experience
Introduction
History
Korea
Japan
Indication
Pretransplant evaluation
Surgical procedure
Perioperative management
Discharge and follow-up
Outcome
Postoperative complications
Effects of LDPT on diabetic complications and quality of life
Chapter 24. Living donor pancreas transplantation – The IPTR report
Donor–recipient relationship: US experience5
Recipient outcome: US experience5
Long-term graft survival
Chapter 25. Islet autotransplantation after pancreatectomy
Chapter 25.1. History and surgical techniques of total pancreatectomy with islet autotransplantation (TPIAT)
Chapter 25.2. Islet isolation
Chapter 25.3. Total pancreatectomy and islet autotransplantation: short-term and long-term outcomes
Chapter 26. Islet transplantation using living donors
Introduction
Background
Donor considerations
Recipient considerations
Conclusions
Volume 2
Section III. Liver transplantation
Chapter 27. Personal reflections and history of living donor liver transplantation
Chapter 28. The impact of the A2ALL study
Introduction
Donor outcomes
The A2ALL biorepository
Summary
Chapter 29. Regional variations of the living donor liver transplant experience in the United States
History
Current state of live donor liver transplantation in the United States
LDLT effects on wait-list mortality
Technical aspects
Future directions
Chapter 30. Institutional needs for living donor liver transplantation
Introduction
Background
Donor and recipient considerations
Medical and surgical infrastructure
Data collection
Future directions
Chapter 31. Split liver transplantation
Key points
Introduction
Chapter 32. Liver regeneration
Introduction
Rodent partial hepatectomy model
Molecular mechanisms of liver regeneration
Clinical factors influencing hepatic regeneration
Emerging therapies and applications
Conclusions
Chapter 33. Living donor liver transplantation: the donor
Chapter 33.1. The donor evaluation
Chapter 33.2. All in one MRI donor evaluation
Chapter 33.3. Anesthetic management for live donor hepatectomies
Chapter 33.4. Surgical procedures
Chapter 33.5. Perioperative care
Chapter 33.6. Donor morbidity and mortality
Chapter 33.7. Long-term donor outcomes
Chapter 33.8. Psychological aspects
Chapter 34. Liver transplantation: the recipient
Chapter 34.1. Recipient selection
Chapter 34.2. Anesthesia management of living-donor liver recipients
Chapter 34.3. Surgical procedures
Chapter 34.4. Liver ischemia-reperfusion injury
Chapter 34.5. Small-for-size grafts
Chapter 34.6. Perioperative care of the live donor liver recipient
Chapter 34.7. Perioperative care of the pediatric LD liver recipient
Chapter 34.8. Liver transplantation and complications
Chapter 34.9. Interventional therapies
Chapter 34.10. Immunosuppressive therapy in liver transplantation
Chapter 34.11. Immunobiology: the recipient
Chapter 34.12. Specific indications
Chapter 34.13. Domino liver transplantation
Chapter 34.14. Liver retransplantation
Chapter 34.15. Long-term outcome
Chapter 34.16. Strategies to maximize the donor pool
Chapter 35. Liver transplantation: cost analysis
Introduction
Cost of deceased donor liver transplantation
Factors associated with cost of DDLT
Costs of medical therapy posttransplant
Costs of living donor Liver transplantation
Summary and conclusions
Section IV. Intestinal transplantation
Chapter 36. History of living donor intestinal transplantation
Introduction
Precyclosporine era
Cyclosporine era
Tacrolimus era
Development of first standardized surgical technique, tacrolimus era
LD intestinal transplantation since development of an standardized surgical technique
Combined intestinal and liver transplants
Intestinal transplant registry reports and outcome studies
Comments and directions
Chapter 37. Indications for living donor intestinal (and liver) transplantation
Introduction
Chapter 38. Intestinal transplantation: the donor
Chapter 38.1. Selection and workup
Chapter 38.2. Surgical procedures and perioperative care
Chapter 39. Intestinal transplantation: the recipient
Chapter 39.1. Selection and workup
Chapter 39.2. Surgical procedures and perioperative care
Chapter 39.3. Sequential and simultaneous intestinal and liver transplants—indications, techniques and outcome
Chapter 39.4. Immunosuppressive therapy, immunobiology therapy, and postoperative complications
Chapter 39.5. Long-term outcomes
Chapter 39.6. Registry report
Section V. Uterus transplantation
Chapter 40. History of living donor uterus transplantation
Ethical considerations
Evolution to the present practice
Chapter 41. Uterus transplantation—the donor
Chapter 41.1. Selection and workup
Chapter 41.2. Surgical procedures, perioperative care, and postoperative complications
Chapter 41.3. Robotic and laparoscopic procedures
Chapter 42. Uterus transplantation—the recipient
Chapter 42.1. Indication, selection, and workup
Chapter 42.2. Psychosocial assessment
Chapter 42.3. Surgical procedures and perioperative care
Chapter 42.4. Immunosuppressive therapy and postoperative complications
Chapter 42.5. From living donor uterus transplantation to live birth obstetrical management
Chapter 42.6. Global results of living donor transplantation
Chapter 42.7. Should uterus transplants receive public funding? An ethics and policy analysis
Part V. Future developments and alternatives to living donor transplantation
Chapter 43. Dual-organ donation and transplantation
Introduction
Dual-organ transplants from the same living donor
Dual-organ transplants from different living donors
Conclusions
Chapter 44. Use of living donors for HIV-positive transplant candidates
Introduction: ethics of living donor transplantation in the HIV-positive recipient
Rationale for solid organ transplantation in the cART era
Increasing demand for solid organ transplants in HIV-positive recipients
Patient selection, donor issues, clinical management, and early outcomes in solid organ transplantation in people with HIV in the cART era
Posttransplant clinical management
Early outcomes in solid organ transplantation in people with HIV in the cART era
Conclusions
Chapter 45. New immunosuppressive protocols in living donor organ transplantation
Introduction
Costimulation blockade-based immunosuppression
Calcineurin inhibitor minimization and avoidance
Treatment of humoral rejection
Regulatory cell infusions to avoid rejection
What's in the pipeline?
Chapter 46. Strategies to induce tolerance
Introduction
Mechanisms of tolerance
Strategies to induce tolerance
Future directions
Summary
Chapter 47. Future developments: Xenotransplantation
Introduction
A brief history of xenotransplantation
Choice of the most appropriate donor species
Potential advantages of xeno- over allotransplantation
Immunologic barriers of xenotransplantation
Strategies to prevent xenograft rejection
Preparing the donor
Preparing the recipient
Conclusions
Chapter 48. Living donor organ transplantation—gene therapy
Introduction
Vectors
Therapeutic strategies in gene therapy
Immune responses to vectors
Gene therapy in solid organ transplantation
Immunosuppressive strategies
Gene therapy in tissue and cell transplantation
Future directions and challenges
Chapter 49. Organogenesis and related approaches for organ replacement
Introduction
Future demand for organ replacement
Characteristics of organogenesis
Application of organogenesis
Types and sources of cells for organogenesis
Some challenges associated with cell sources and types used in organogenesis
Organogenesis: a synthesis
Chapter 50. Consensus conferences on living donor organ transplantation
Chapter 50.1. The Declaration of Istanbul on organ trafficking and transplant tourism
Chapter 50.2. Commentary: the Amsterdam and Vancouver conferences on living organ donation
Chapter 51. Impact of the coronavirus pandemic on living-donor organ transplantation
Impact of COVID-19 in CKD and dialysis population
COVID-19 and organ transplantation
Practices, decision-making, and organization of living-donor activity during COVID-19
Immunosuppression regimen in COVID-19 living-donor kidney transplant recipients
SARS-CoV-2 vaccine in kidney transplant recipients
Chapter 52. The cumulative United States experience in living donor organ transplantation
Introduction
Statistical methods
Living donor transplant characteristics
Comments
Index
Index

Rainer W.G. Gruessner

Dr. Rainer W. G. Gruessner, MD, FACS, FICS, is Professor of Surgery at SUNY Downstate Health Sciences University. He formerly served as Chairmen of the Departments of Surgery at the University of Zurich, University of Arizona, and State University of New York. Dr. Gruessner is a nationally renowned surgeon and clinical innovator who has developed new surgical techniques for intestinal, pancreas, and liver transplants. He is prolific academic, a committed educator, and successful mentor to surgical and transplant faculty, residents and fellows. Dr. Gruessner’s academic accomplishments include more than 700 published manuscripts, review articles, book chapters, and published abstracts. Dr. Gruessner has been an invited speaker at over 170 institutions and meetings worldwide. He’s (co-) edited five textbooks: the standard textbooks on Transplantation of the Pancreas, Living Donor Transplantation, and Robotic Surgery and serving as senior editor of a textbook on Transplantation, Bioengineering and Regeneration of the Endocrine Pancreas and a textbook on Technological Advances in Surgery, Trauma and Critical Care. He has served as PI and co-investigator on over 20 research projects and clinical trials, supported by industry, foundations, and the NIH. Dr. Gruessner is a member of over 20 national and international professional societies, has organized many international congresses, is an editorial board member for about 10 journals and has served on many professional and societal committees. In 2019, he received the Richard C. Lillehei award from the International Pancreas and Islet Association (IPITA) for his lifetime achievements in the field of pancreas transplantation.

Affiliations and expertise

Professor and Former Chairman, Department of Surgery, University of Zurich, University of Arizona, and State University of New York, SUNY-Downstate Medical Center, Brooklyn, NY, USA

Enrico Benedetti

Enrico Benedetti, MD, FACS, Warren H. Cole Chair in Surgery, Professor and Head of the Department of Surgery and Medical Director, Abdominal Organ Transplant Program at the University of Illinois at Chicago. Enrico Benedetti was born in Perugia, Italy, on Oct. 3, 1960. Dr. Benedetti graduated cum laude from the medical school in the University of Florence in 1985 and completed a surgical residency at the same university by 1989. In 1989, he moved to Chicago to start a United States surgery residency at the University of Illinois at Chicago, which he completed in 1993. Dr. Benedetti earned a fellowship in transplant surgery at the University of Minnesota. Since 1994, Dr. Benedetti has been a transplant surgeon at the University of Illinois. He started as an Assistant Professor of Surgery and rose through the ranks first to Associate Professor in 1999 and then to Professor in 2005. Dr. Benedetti is currently the Head of Department of Surgery and the Director of the Abdominal Organ Transplant Program at the University of Illinois at Chicago. Dr. Benedetti is also the recipient of the Joseph Cardinal Bernardin Humanitarian of the Year Award. Dr. Benedetti has published more than 300 articles and more than 30 book chapters and is the editor of the seminal book, “Living Donor Organ Transplantation.” Included among his many surgical accomplishments are: • The first successful combined coronary artery bypass and liver transplant worldwide • The first robotic donor nephrectomy for living donor kidney transplant worldwide in 2000 • The first combined living donor liver/bowel transplant from adult to an infant worldwide in 2003 • The first robotic combined kidney/pancreas procurement for living donor kidney/pancreas transplant worldwide in 2005 • The largest series worldwide of living donor intestinal transplantation (32 of a total of 47 cases done in the world) • First robotic kidney transplant in obese recipient in 2009

Affiliations and expertise

Warren H. Cole Chair in Surgery, Professor & Head, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA

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