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. As for readers, this license allows users to download, copy and build upon published chapters 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. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. 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. .. 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 Transplantation Network instituted a formalized definition of marginal kidneys in 2002 with the advent of the Expanded Criteria Donor (ECD) (Metzger... composition of the intracellular fluid, and was used for perfusion/rinsing of the organ in cold temperature “in situ”, and also for its further hypothermic storage, achieving kidney preservation for up to 30 hours In 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... 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... Definition 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,... (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... hours) Ability to control flow and pressure, therefore ability to monitor intrarenal resistance during perfusion Decreased renal vasospasm Ability to provide metabolic support during perfusion Potential for pharmacological manipulation during perfusion Disadvantages: 1 2 3 Increased cost Endothelial injury Possibility of mechanical failure 4 Renal Transplantation – Updates and Advances 2.2 Normothermic... 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... 25% Terms- expanded criteria donor or marginal donor simply means accepting suboptimal quality grafts, either from a living donor or a cadaver donor with some acceptable medical risks Scientific Registry of Transplant 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... 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 . RENAL TRANSPLANTATION – UPDATES AND ADVANCES Edited by Layron Long Renal Transplantation – Updates and Advances Edited by Layron Long. 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. hours. In the 1980’s Belzer, Renal Transplantation – Updates and Advances 2 Southard and many other investigators started to lay the foundations for understanding the metabolic changes