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In response to persistent donor organ shortages, organs from marginal donors, such as expanded criteria donors (ECD) and donation after cardiac death (DCD) donors, are now accepted and have been successfully transplanted, reducing the waiting times for transplantation. Especially in Japan, transplantation of DCD kidneys has a relatively long history because of the difficulty or lack of national consensus in accepting brain death, which has made it possible to accumulate considerable clinical experience. Thus, the current organ shortage has stimulated interest in the use of marginal donors for transplantation. On the other hand, however, it is known that these organs have a high rate of delayed graft function and a more complicated postoperative course. These drawbacks have created the greatest clinical challenge in transplantation to date because of the current shortage and limitations of donors using ECD and DCD. This book, prepared by distinguished authorities in their fields, is intended for clinicians and researchers. It highlights the use of marginal donors as a comparatively novel source of transplantation organs and provides a thorough overview of marginal donors from their historical origins to recent clinical applications, including the state-of-the-art science of organ/donor management, procurement, and preservation. Also provided is valuable information on ABO-incompatible donors which extend the availability of donor sources. Each chapter offers an individual analysis of the optimal requirements for the safe management and preservation of organs, including the heart, lung, liver, kidney, pancreas, and pancreatic islets.
Textbook of Transplantation and Mechanical Support for End-Stage Heart and Lung Disease Comprehensive textbook covering all aspects of the care of patients with advanced heart or lung disease Transplantation and Mechanical Support for End-Stage Heart and Lung Disease is the most comprehensive and contemporary textbook available that addresses the medical and surgical treatment options for patients with end-stage heart and lung disease. All facets of these complex and resource-intensive therapies are covered by leading experts — including the basics of transplant immunology, databases, regulatory and ethical aspects of transplantation and conventional and new modalities of donor organ harvest. Transplantation and Mechanical Support for End-Stage Heart and Lung Disease includes further information on topics such as: Historical developments that facilitated heart and lung transplantation; engineering advances in continuous flow technologies Transplant organizations, oversight, structure, process, databases and registries in the thoracic transplants and MCS field Current strategies in immune modulation, desensitization protocols and mechanisms of allograft rejection and tolerance/immunosenescence Detailed descriptions of donor and recipient surgical procedures as well as comprehensive implantation techniques for all available short- and long-term mechanical circulatory support devices, including ECMO Organ allocation and prioritization, donor evaluation, high risk donors, marginal donors, and risk assessment Richly enhanced with summary tables and color illustrations to provide an engaging and supportive learning experience, the book will serve as a highly valuable source of contemporary knowledge for medical students, residents, nurses, perfusionists, physicians and surgeons involved in the care of these desperately ill group of patients. “This comprehensive book covers all aspects of advanced heart and lung failure treatment, including shock, short-term and durable mechanical assistance, as well as transplantation. The in-depth information will be welcome by newcomers in the field as well as seasoned veterans.” —Andreas Zuckermann, M.D Vice-Chair, Department of Cardiac Surgery, Director of Cardiac Transplantation Program, Medical University of Vienna, Vienna General Hospital “This comprehensive tour-de-force compendium covers practical issues of clinical administration, program development, care pathways, ongoing challenges and opportunities in each treatment area as a must go-to reference for guidance in the rapidly evolving fields of mechanical circulatory support and transplantation.” —Mandeep R. Mehra, MBBS, MSc, FRCP Executive Director, Center for Advanced Heart Disease, Brigham and Women’s Hospital, Harvard Medical School “This unique textbook authored by key opinion leaders is a refreshing ???wind of change??? in our field, one that will well serve all professionals involved in the care of end-stage heart and lung patients for many years to come.” —Marcelo Cypel MD, MSc, FACS, FRCSC Surgical Director Ajmera Transplant Centre at UHN , University of Toronto
Leading clinicians and scientists in solid organ transplantation review the current status of the field and describe cutting-edge techniques for detecting the immune response to the allografted organ. The authors present the latest techniques for HLA typing, detecting HLA antibodies, and monitoring T-cell response, and examine more specialized methods utilizing proteomics, laser dissection microscopy, and real-time polymerase chain reaction. The area of tolerance induction and reprogramming of the immune system is also covered, along with a discussion of up-to-date methods of organ preservation, of today's optimal immunosuppressive drug regimens, as well as the difficulty of mimicking chronic rejection in experimental models. Introductory chapters provide a theoretical update on current practices in renal, liver, islet, and lung transplantation and on the pathways of antigen presentation and chronic rejection.
Leading physicians summarize in this easy-to-use and eminently practical handbook the day-to-day management of transplant donors and recipients at Columbia-Presbyterian Medical Center. Topics covered range from surgical techniques, pathology, and immunosuppression, to posttransplant management, pediatric heart transplantation, surgical alternatives, and mechanical circulatory assistance as a bridge to transplantation. The authors also discuss congenital transplant techniques, state-of-the-art perioperative management techniques and protocols, and UNOS regulation and nurse coordination.
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It gives us great pleasure to contribute a short introduction outstanding book. This comprehensive work provides an to this important volume. immense fund of information, and will be an invaluable The transplantation of thoracic organs - heart,heart source of knowledge to physicians, surgeons, and scientists lung, lung - is a field of surgery that is expanding annually. for many years to come. The use of mechanical assist devices and artificial hearts to support patients awaiting transplantation is also developing rapidly, and further advances in this field may eventually April 1990 Christiaan Barnard lead to a totally implantable device that will function Cape Town, South Africa successfully for many years. It is therefore timely that such a volume as this should be made available to those who wish to be brought up-to date with the current state of knowledge in these related fields. The editors have done us all a great service in bringing together experts in every aspect of heart and Nazih Zuhdi lung transplantation and replacement to contribute to this Oklahoma City, USA Xl Preface The fields of the transplantation and replacement of thoracic Refinements in bioengineering have enabled mechanical organs have expanded immensely since the first human assist devices and the total artificial heart to support patients to-human heart transplant was performed in 1967. This successfully until a suitable donor becomes available.
This work provides a one-of- a-kind volume that includes all aspects of heart transplantation from its historic beginning to its current day standards which now make the procedure a long-term treatment option for heart failure patients. The subjects covered include technical aspects of the procurement and implant procedures, as well as the medical nuances of pre-operative preparation and post-transplant immunosuppression management; the current day multi-disciplinary make up of the transplant team along with information on the keys to building and running a successful transplant program; regulatory standards and listing policies and the impact of the growing mechanical circulatory support technologies on the transplant field; and emerging technologies and future possibilities. All chapters are written by experts in the field and include the most up-to-date peer reviewed studies and clinical guidelines. This book gives an ever-changing reference that will become the text of choice for those beginning or continuing their transplant careers.