RENAL TRANSPLANTATION – UPDATES AND ADVANCES Edited by Layron Long Renal Transplantation – Updates and Advances Edited by Layron Long Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Publishing Process Manager Adriana Pecar Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Renal Transplantation – Updates and Advances, Edited by Layron Long p. cm. ISBN 978-953-51-0173-4 Contents Preface IX Chapter 1 Preservation of Renal Allografts for Transplantation 1 Marco Antonio Ayala-García, Miguel Ángel Pantoja Hernández, Éctor Jaime Ramírez-Barba, Joel Máximo Soel Encalada and Beatriz González Yebra Chapter 2 Renal Transplantation from Expanded Criteria Donors 17 Pooja Binnani, Madan Mohan Bahadur and Bhupendra Gandhi Chapter 3 Donor Nephrectomy 27 Gholamreza Mokhtari, Ahmad Enshaei, Hamidreza Baghani Aval and Samaneh Esmaeili Chapter 4 Renal Transplantation and Urinary Proteomics 35 Ying Wang, Li Ma, Gaoxing Luo, Yong Huang and Jun Wu Chapter 5 Renal Explantation Techniques 49 Marco Antonio Ayala- García, Éctor Jaime Ramírez-Barba, Joel Máximo Soel Encalada, Beatriz González Yebra Chapter 6 Renal Transplantation in Patient with Fabry’s Disease Maintained by Enzyme Replacement Therapy 75 Taigo Kato Chapter 7 Polymorphism of RAS in Patients with AT1-AA Mediated Steroid Refractory Acute Rejection 85 Geng Zhang and Jianlin Yuan Chapter 8 Soluble CD30 and Acute Renal Allograft Rejection 101 Koosha Kamali, Mohammad Amin Abbasi, Ata Abbasi and Alireza R. Rezaie Chapter 9 Role of Cytomegalovirus Reinfection in Acute Rejection and CMV Disease After Renal Transplantation 119 Kei Ishibashi and Tatsuo Suzutani VI Contents Chapter 10 Pharmacogenetics of Immunosuppressive Drugs in Renal Transplantation 143 María Galiana, María José Herrero, Virginia Bosó, Sergio Bea, Elia Ros, Jaime Sánchez-Plumed, Jose Luis Poveda and Salvador F. Aliño Chapter 11 Pharmacokinetics and Pharmacodynamics of Mycophenolate in Patients After Renal Transplantation 163 Thomas Rath and Manfred Küpper Chapter 12 Malignant Neoplasms in Kidney Transplantation 179 S. S. Sheikh, J. A. Amir and A. A. Amir Chapter 13 Osteonecrosis of Femoral Head (ONFH) After Renal Transplantation 205 Yan Jie Guo and Chang Qing Zhang Chapter 14 Pediatric Kidney Transplant in Uropaties 213 Cristian Sager, Juan Carlos López, Víctor Durán, Carol Burek, Juan Pablo Corbetta and Santiago Weller Preface Due to the advances in renal transplantation, the treatment of end stage renal disease has been revolutionized. The modern progression of transplant surgery, molecular genetics, and pharmacogenetics has led to a reduction in surgical complications, prolonged survival, and improvements in the coset effectiveness of renal transplants. This text offers a medley of international papers that address the most recent advances in the field. “Renal Transplantation - Updates and Advances“ provides a comprehensive , concise, evidence based codification of the current state of surgical techniques, immunology, pharmacology, and molecular science regarding the treatment and management of renal transplantation for end stage renal disease. This book is a treasure – trop of data, providing access to vital information, providing a great reference to state of the art perspectives on the subject at hand. Dr. Layron Long Samaritan Urology Good Samaritan Regional Medical Center Corvallis, OR USA [...]... (Suppl 6): S5 3–6 6 24 Renal Transplantation – Updates and Advances Duraj F, Tydén G, Blom B (1995) Living‐donor nephrectomy: how safe is it? Transplant Proc1995; 27:80 3–8 04 Ekberg H, Tedesco-Silva H, Demirbas A, et al.(2007) Symphony comparing standard immunosuppression to low dose cyclosporine, tacrolimus or sirolimus in combination with MMF, daclizumab and corticosteroids in renal transplantation. .. the transplantation of ECD and DCD kidneys would result in higher costs More frequent need for hemodialysis, more hospital readmissions due to poor or late onset graft function and more opportunistic infections in recipients of ECD and DCD kidneys results in higher cost for their initial medical care 22 Renal Transplantation – Updates and Advances 5.2 Marginal cadaveric donor The Organ Procurement and. .. Recipients (SRTR)/Organ Procurement and Transplantation Network (OPTN) data showed 41% discard rate for ECD kidneys Common reasons for 18 Renal Transplantation – Updates and Advances discard of these donor kidneys were older donors, glomerulosclerosis on biopsy and poor renal perfusion (Sunga et al, 2008) Current utilization is 15% of all transplanted kidneys 2 Marginal versus expanded criteria donor Some authors... and Point System Richmond, VA: United Network for Organ Sharing; 2002: 1–2 6 Voiculescu A, Schlieper G, Hetzel GR et al (2002) Kidney transplantation in the elderly: agematching as compared to HLA-matching: a single center experience Transplantation 2002; 73: 135 6–1 359 26 Renal Transplantation – Updates and Advances Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LYC, Held PJ, Port FK(1999):... perfusion during the preservation period 6 Renal Transplantation – Updates and Advances As previously mentioned, in cold ischemia, besides hypothermia, perfusion fluids are also needed Therefore, the renal allograft is subjected to ischemia in anaerobic hypothermia, which is accompanied by the events described below 3.2.1 Cellular edema induced by ischemia and hypothermia Under normal conditions, the... agents, hydroxyl-ethyl-starch (colloid), phosphate (buffer), adenosine (precursor of ATP synthesis), 12 Renal Transplantation – Updates and Advances and glutathione and allopurinol (to counteract oxygen radicals) It does not contain glucose and it is an “intracellular” solution (rich in potassium and low in sodium), similar to the EC solution The disadvantages of UW are the following: 1 2 3 4 5 High... Outcome of kidney transplantation from highrisk donors is determined by both structure and function Transplantation 1999; 67:1162-1167 Kauffman MH, Bennett LE, McBride MA, Ellison MD (1997) The expanded donor Transplant Rev 1997; 11: 16 5–1 90 Keizer KM, de Fijter JW, Haase-Kromwijk BJ, Weimar W (2005) Non-heart-beating donor kidneys in the Netherlands: allocation and outcome of transplantation Transplantation... the 1980’s Belzer, 2 Renal Transplantation – Updates and Advances Southard and many other investigators started to lay the foundations for understanding the metabolic changes that occur in the extracted organs after explantation In this chapter the techniques for kidney allograft preservation will be briefly reviewed, and the pathophysiological changes that occur during preservation and reperfusion of... preservation by simple cooling: a) it reduces the Preservation of Renal Allografts for Transplantation 13 vascular resistance induced by ischemia and facilitates the elimination of erythrocyte remnants from the microcirculation, which allows better reperfusion after implantation, and b) it allows testing of the viability or quality of the organ before implantation, by monitoring the flow and pressure, or by. .. (such as albumin and other colloids) quickly diffuse to the interstitial space and cause edema when perfused The preservation solution needs to contain substances that will create enough osmotic colloidal pressure to allow the free exchange of essential substances with the preserving solution, without expanding the interstitial space (Fig 5) 8 Renal Transplantation – Updates and Advances Fig 5 Osmotic . RENAL TRANSPLANTATION – UPDATES AND ADVANCES Edited by Layron Long Renal Transplantation – Updates and Advances Edited by Layron. can be obtained from orders@intechweb.org Renal Transplantation – Updates and Advances, Edited by Layron Long p. cm. ISBN 978-953-51-0173-4