Current Clinical Urology
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1 Current Clinical Urology Eric A. Klein, MD, Series Editor Professor of Surgery Cleveland Clinic Lerner College of Medicine Head, Section of Urologic Oncology Glickman Urological and Kidney Institute Cleveland, OH For other titles published in this series, go to
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3 Kidney and Pancreas Transplantation A Practical Guide Edited by T.R. Srinivas and Daniel A. Shoskes
4 Editors T.R. Srinivas, MD Cleveland Clinic Glickman Urological and Kidney Institute 9500 Euclid Avenue Cleveland, OH USA Daniel A. Shoskes Cleveland Clinic Glickman Urological and Kidney Institute 9500 Euclid Avenue Cleveland, OH USA ISBN e-isbn DOI / Springer New York Dordrecht Heidelberg London Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, c/o Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Humana Press is part of Springer Science+Business Media (
5 Preface Kidney transplants are the most frequently performed solid organ transplants. Pancreas transplantation offers unique survival and quality of life benefits to selected diabetics with or without concomitant renal failure. The growing trend in the transplant community is that patients with kidney and pancreas transplants are cared for by a multidisciplinary team led by transplant surgeons and physicians. The complexity of clinical transplantation is further compounded by the competitive and regulatory landscape that transplant programs have to operate in. Given this scenario, the knowledge base that is required of the transplant physicians and surgeon encompasses not only medical aspects of patient care but also a sound grasp of issues related to the administration of programs and monitoring finance and outcomes. We offer a textbook devoted to kidney and pancreas transplantation that is well grounded in scientific principles, quantitative clinical reasoning, clinical pharmacology, tested clinical practices and overall clinical applicability. Also addressed are key aspects in the initiation, maintenance and sustained growth of viable clinical programs in kidney and pancreas transplantation. The intended audience includes medical and surgical fellows who intend to pursue an interest in transplantation and the practicing transplant physician. The editors acknowledge the valuable contributions of the authors and the inspiration provided by their fellows and trainees. v
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7 Contents The Immune Response to Transplanted Organs... William M. Baldwin III, Anna Valujskikh, Peter N. Lalli, and Robert L. Fairchild 1 The Histocompatibility Laboratory in Clinical Transplantation... Diane J. Pidwell and Peter N. Lalli 23 Immunosuppressive Therapy in Kidney and Pancreas Transplantation... George Thomas, Saul Nurko, and Titte R. Srinivas 49 Clinical Pharmacologic Principles and Immunosuppression... Patricia West-Thielke and Bruce Kaplan 87 Pathology of Kidney and Pancreas Transplants Lillian Gaber and Byron P. Croker Design, Conduct, and Report of Clinical Trials of Immunosuppressive Regimens in Solid Organ Transplantation Agnes Costello and D. Scott Batty, Jr. Outcomes of Kidney and Pancreas Transplantation Titte R. Srinivas, Herwig-Ulf Meier-Kriesche, and Jesse D. Schold Medical and Surgical Evaluation of the Adult Kidney Transplant Candidate Richard A. Fatica, Stuart M. Flechner, and Titte R. Srinivas Selection and Preparation of the Pancreas Transplant Recipient Ho-Yee Tiong and Venkatesh Krishnamurthi Kidney Transplant Recipient Surgery Daniel A. Shoskes Issues and Surgical Techniques to Expand the Pool of Kidneys Available for Transplantation Charles S. Modlin III and Charles S. Modlin, Jr. vii
8 viii Contents Pancreas Transplantation: Surgical Techniques Alvin C. Wee and Venkatesh Krishnamurthi Laparoscopic Living Kidney Donation Wesley M. White and Jihad H. Kaouk Perioperative and Anesthetic Management in Kidney and Pancreas Transplantation Management Jerome F. O Hara Jr. and Samuel A. Irefin Surgical Complications after Kidney Transplantation Stuart M. Flechner Urologic Complications After Kidney Transplantation Islam A. Ghoneim and Daniel A. Shoskes Medical Management of Kidney Transplant Recipients Vidya Vootukuru and Brian Stephany Infectious Complications: Prevention and Management Robin K. Avery, Michelle Lard, and Titte R Srinivas Living Kidney Donation: Pre-and Postdonation Evaluation and Management Jonathan Taliercio and Emilio D. Poggio Psychology, Quality of Life, and Rehabilitation After Kidney and Pancreas Transplantation Kathy L. Coffman Kidney Allocation System for Deceased Donor Kidneys in the United States Islam A. Ghoneim and David A. Goldfarb Ethics of Transplantation David A. Goldfarb and Jerome F. O Hara, Jr. World-Wide Long-Term (20 40 Years) Renal Transplant Outcomes and Classification of Long-Term Patient and Allograft Survivals William E. Braun, Sankar Navaneethan, and Deborah Protiva Quantitative Aspects of Clinical Reasoning: Measuring Endpoints and Performance Jesse D. Schold The Business of Transplantation Art Thomson Index
9 Contributors Robin K. Avery, M.D. Department of Infections Disease, Medicine Institute, The Cleveland Clinic, USA William M. Baldwin, III Department of Immunology, Donald Scott Batty, Jr. M.D. Genzyme Corporation, Cambridge, MA USA William E. Braun, M.D. Glickman Kidney & Urological Institute, Department of Neurology Q7, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA Kathy L. Coffman, M.D., FAPM Cleveland Clinic Transplant Center, 9500 Elucid Ave/P-57, Cleveland, OH 44195, USA Agnes Costello, PharmD, MS Transplant Business Unit, Genzyme Corporation, 500 Kendall Street, Cambridge, MA, 02142, USA Byron P. Croker, M.D., Ph.D. Pathology and Laboratory Medicine Service, NF/SG Veterans Health System, Gainesville, FL 32608, USA Robert L. Fairchild Glickman Urological and Kidney Institute and Department of Immunology, Cleveland Clinic, Cleveland, OH, USA Richard A. Fatica, M.D. Stuart M. Flechner, M.D. FACS. Professor of Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave/Q10, Cleveland, Ohio Islam A. Ghoneim, M.D., Ph.D Cleveland Clinic, Glickman Urological & Kidney Institute Q10, 9500 Euclid Avenue, Cleveland, OH, USA, ix
10 x Contributors David A. Goldfarb, M.D. Cleveland Clinic, Glickman Urological & Kidney Institute Q10, 9500 Euclid Avenue, Cleveland, OH USA, Samuel A. Irefin, M.D. Jihad H. Kaouk, M.D. Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH, USA Bruce Kaplan, M.D University of Arizona, Tucson, AZ, USA Venkatesh Krishnamurthi, M.D. Department of Urology, Glickman Urological and Kidney Institute, 9500 Euclid Avenue Q10, Cleveland, OH, 44195, USA Peter N. Lalli, Ph.D. Allogen Laboratories, Michelle Lard, CNP Herwig-Ulf Meier-Kriesche, M.D. Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA Charles S. Modlin, III Glickman Urological & Kidney Institute, Section of Renal Transplantation, Cleveland Clinic, Cleveland, OH, USA Charles S. Modlin, Jr. Glickman Urological & Kidney Institute, Section of Renal Transplantation, Cleveland Clinic, Cleveland, OH, USA Saul Nurko, M.D Sankar Navaneethan, M.D. Glickman Kidney & Urological Institute, Department of Neurology Q7, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA Jerome F. O Hara, Jr. M.D. Department of Anesthesia, Diane J. Pidwell, Ph.D. Allogen Laboratories, Cleveland Clinic, 9500 Euclid Ave. C100, Cleveland, OH, USA Deborah Protiva, B.S.N. Cleveland Clinic Transplant Center, Cleveland, OH, USA Emilio D. Poggio, M.D Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Eluclid Avenue Cleveland, OH 44195, USA Jesse D. Schold, Ph.D. Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
11 Contributors Daniel A. Shoskes, M.D., MSc., FRCS(C) Cleveland Clinic, Glickman Urological and Kidney Institute, Q10, 9500 Euclid Avenue, Cleveland, OH 44195, USA Titte R. Srinivas, M.D. Cleveland Clinic, Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA Brian Stephany, M.D. Department of Nephrology and Hypertension, 9500 Euclid Ave., Q7 Cleveland, OH 44195, USA Jonathan Taliercio, D.O. George Thomas, M.D Art Thomson, M.A. Cleveland Clinic, General Surgery & Transplant Center, A100, 9500 Euclid Avenue, Cleveland, OH, 44195, USA Anna Valujskikh Glickman Urological and Kidney Institute and Department of Immunology, Srividya Vootukuru, M.D. Department of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA Alvin C. Wee, M.D. Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH, USA Patricia West-Thielke, PharmD, BCPS Clinical Sciences Building, Suite 402, University of Illinois at Chicago, Chicago, IL, 60612, USA Wesley M. White, M.D. Division of Urology, University of Tennessee Medical Center, Knoxville, TN, USA xi
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