UNDERSTANDINGTHE COMPLEXITIESOFKIDNEY TRANSPLANTATION  EditedbyJorgeOrtizandJasonAndré             Understanding the Complexities of Kidney Transplantation Edited by Jorge Ortiz and Jason André Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. 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. 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 articles. 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 Davor Vidic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Sebastian Kaulitzki, 2010. Used under license from Shutterstock.com First published August, 2011 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 Understanding the Complexities of Kidney Transplantation, Edited by Jorge Ortiz and Jason André p. cm. ISBN 978-953-307-819-9 free online editions of InTech Books and Journals can be found at www.intechopen.com  VI Contents Chapter 9 Donor Quality Scoring Systems and Early Renal Function Measurements in Kidney Transplantation 215 Quirino Lai, Francesco Nudo, Vincenzo Morabito, Giovanni Battista Levi Sandri, Fabio Melandro, Lucia Parlati, Nicola Guglielmo, Marco Di Laudo, Manuela Garofalo, Luca Poli, Renzo Pretagostini and Pasquale B Berloco Chapter 10 Donor Characteristics in 1,000 Consecutive Simultaneous Pancreas-Kidney Transplants 237 Hans W. Sollinger, Jon S. Odorico, Glen E. Leverson, Barbara J. Voss and Anthony M. D’Alessandro Chapter 11 Perioperative and Long-Term Safety of Living Kidney Donors 243 Masahiko Okamoto Chapter 12 Perioperative Hydration Policy 259 Mahmoud M. Othman Chapter 13 Anaesthesia for Kidney Transplantation 271 Yasser Haggag and Imran Ahmad Chapter 14 Augmentation Cystoplasty: in Pretransplant Recepients 279 Ashraf Abou-Elela Part 2 Special Considerations 331 Chapter 15 ABO-incompatible Kidney Transplantation 333 Mina Hur, Hee-Won Moon and Seog-Woon Kwon Chapter 16 Combined Liver and Kidney Transplantation 349 Cláudia Fagundes and Mónica Guevara Chapter 17 Transplantation for the Complex Patient with Hepatitis C and End Stage Renal Disease: A Review 359 Jorge Ortiz, Jason Andre, Kamran Khanmoradi and Victor Araya Chapter 18 Combined Kidney-Islet Transplantation 371 Giuseppe Cavallari, Flavia Neri and Bruno Nardo Chapter 19 Kidney-Pancreas Transplantation 387 Farzad Kakaei and Saman Nikeghbalian Chapter 20 Clinical Pharmacokinetics of Triple Immunosuppression Scheme in Kidney Transplant (Tacrolimus, Mycophenolate Mofetil and Corticosteroids) 407 Robles Piedras Ana Luisa and Monroy Funes Manuel Alejandro Contents VII Chapter 21 Desensitization and Induction Immunosuppressive Therapy in Highly HLA-Sensitized Patients Receiving Cadaveric Renal Allograft) 439 Juana Margarita Rufino Hernández, José Manuel González-Posada Delgado and Domingo Hernández Marrero Part 3 Surgical Approaches and Complications 459 Chapter 22 The Transplantation Operation and Its Surgical Complications 461 Junjie Zhao, Zhenli Gao and Ke Wang Chapter 23 Novel Renal Transplant-Related Surgical Approaches in the 21st Century 487 Shih-Chieh Jeff Chueh and Bashir R. Sankari Chapter 24 Minimally Invasive Renal Transplantation 509 Ole Øyen Chapter 25 Surgical Complications of Renal Transplantation 527 Marcelo Ferreira Cassini, Murilo Ferreira de Andrade and Silvio Tucci Junior Chapter 26 Vascular Complications in Kidney Transplantation 547 Alexandros Giakoustidis, Nikolaos Antoniadis and Dimitrios Giakoustidis  Preface  Kidney failure is a major financial burden throughout the world. Renal failure and dialysisinparticularareassociatedwithanincreasedmortalityriskandhighmedical costs.AccordingtoanarticlepublishedinUSATodayin2009,dialysiscosttheUS$8.6 billionin2007andin2006 20.1%of dialysispatientsdied.Theonlyalternativethatis availabletodialysisatthistimeiskidneytransplantation, awaytogivepatientswith renalfailureanewbeginning. Kidneytransplantationisacomplexfieldthatincorporatesseveraldifferentspecialties tomanagethetransplantpatient.Becausepatientswithkidneyfailurefrequentlyhave  othersignificantcomorbidities,theworkupforapotentialtransplant recipient canbe quiteinvolved.Apotentialtransplantrecipientoftenhassignificantexposuretoblood borne infections like hepatitis, HIV, and many other potential pathogens. Patients often have severe hypertension or poorly controlled diabetes that has lead to their renalfailure andyetothersstillhaveahistoryofheartproblems. This book was created because of the importance of kidney transplantation. This particular volume focusesonthe complexities of the transplant patient.In particular, thereisafocusonthecomorbiditiesandspecialconsiderationsforatransplantpatient andhowthey affectkidneytransplantoutcomes. Inthisbookyouwillalsofindabriefhistoryonthefieldofkidneytransplantationas well as theethical considerations in thefieldof transplantation. Next,the reader will  find a section dedicated to special potential transplant recipients who require specializedconsiderations when contemplating transplantation. There is a discussion ontheactualtransplantprocedure andpotential fornewerandinnovativemethodsto completingakidneytransplantation. Contributors to this book are from all over the world and are experts in their individualfields. Theywereallindividuallyapproached toaddachaptertothisbook  and with their efforts this book was formed. Understanding the Complexities of Kidney Transplantation gives the reader an excellent foundation to build upon to truly understandkidneytransplantation. Dr.JorgeOrtizandDr.JasonAndré AlbertEinsteinMedicalCenter Philadelphia,PA [...]... 25 24 25 23 20 36 11 5 2 0 19 95 19 96 19 97 19 98 19 99 2000 20 01 2002 2003 2004 2005 2006 7 2 2007 2008 23 20 6 8 12 2009 Number of liver transplants Fig 14 b 40 DCD liver 35 DBD liver 30 25 18 20 15 10 5 0 31 33 19 6 19 95 22 21 25 20 29 21 22 11 5 2 19 97 19 99 20 01 2003 2005 2007 13 2009 Fig 14 c Fig 14 Proportion of DCD/DBD donors (a), kidney (b) and liver (c) transplantations between 19 95 and 2009 at the... rate (Fig 13 ) 350 300 250 4 200 19 95 42 60 45 NHBD 263 245 253 223 216 218 222 223 243 216 226 20 01 238 227 19 6 214 19 3 38 8 2000 230 19 94 15 0 10 0 28 5 HBD 50 2 010 2008 2009 2007 2006 2005 2003 2004 2002 19 99 19 97 19 98 19 96 0 Fig 13 Effective donor number in Belgium between 19 94-2 010 In 2009: 44% University Hospitals – 56% collaborative Hospitals At the University of Liege (Le Dinh et al., 2 011 )28, the... eccentric biangulation technique proposed by Cobett in the Sixties (Fig 4) (Squifflet et al 19 93)5 Year 19 02 19 02 19 06 19 09 19 12 19 28 19 36 19 51 Author Ullmann Carrel Jaboulay Unger Carrel Voronoff Voronoy Küss 19 52 19 54 19 62 Hamburger Hume Murray Merril Hamburger 19 62 Küss 19 62 to 19 64 Remtsma Starzl Hume Starzl 19 63 19 66 19 67 Kelly Lillehei Barnard Dicovery or application Dog kidney into the neck Developed... Kidney Transplantation: Past, Present and Future (with Special References to the Belgian History) 25 60 DCD Number of procurements 50 DBD 40 33 30 43 29 20 27 33 27 10 30 25 21 19 26 22 30 25 10 1 2002 0 19 95 19 96 19 97 19 98 19 99 2000 20 01 3 2003 2 2004 2005 7 8 2006 2007 11 2008 17 2009 Fig 14 a 60 DCD kidney Number of kidney transplants 55 DBD kidney 50 45 40 35 45 37 30 49 25 35 20 15 32 27 23 10 29... June 3, 19 63 February 2, 19 87 February 23, 19 86 Number Total 3.355 23 8 Pancreas (Total) Pancreas + kidney (SPK) Pancreas alone (PTA) Pancreas + liver Pancreas after liver Pancreas after failed Kd (SPK) (Islets after kidney) November 10 , 19 82 November 10 , 19 82 February 5, 19 83 September 22, 19 88 April 4, 19 98 May 11 , 19 99 (October 13 , 2002) 89 83 (in 82 recipients) 3 1 1 1 (2) Live donor 5 01 (Squifflet... (Squifflet J.P., 2007 )17 Table 4 Total number of Organ (Kidney and Pancreas) Transplantations at Saint Pierre Hospital in Louvain (June 3, 19 63 to October 30, 19 77) and Saint-Luc Hospital in Brussels (November 1, 19 77 to September 30, 2005) by G.P.J Alexandre (June 19 63 to October 19 91) and J.P Squifflet (January 19 78 to September 30, 2005) 18 Understanding the Complexities of Kidney Transplantation Year... Rapamycin (or Sirolimus-Sir) had been discovered in the 19 70s as an antifungal, but the potential of its IS properties for commercial development was not recognized until the late 19 80s Large-scale trials have demonstrated its potential and have led to its recent approval for use in kidney transplantation (Table 3) Year 19 50 19 59 19 68 19 78 19 81 1989 19 91 1998 Immunosuppressive milestones Glucocorticoid therapy... first lung transplantation was performed by Fritz Derom (19 68), the first adult liver transplantation by P.J Kestens (19 69) and soon later (19 70) in children by J.B Otte, the first heart transplantation by G Primo (19 73) and the first pancreas transplantation by J.P Squifflet (19 82) Finally, the Belgian Transplantation community had to wait until June 19 86 to get a law on Organ Donation and Transplantation. .. and pancreas transplantation Program at Saint Pierre Hospital in Louvain (June 3, 19 63 to October 30, 19 77) and Saint-Luc Hospital in Brussels (November 1, 19 77 to September 30, 2005) by G.P.J Alexandre (June 19 63 to October 19 91) and J.P Squifflet (January 19 78 to September 30, 2005) 5.2 From the brain death concept to the Belgian law on organ donation and transplantation In November 19 57, Pope Pius... Bourget, 19 92 )1 Fig 6 Surgical techniques for kidneys implantation a The groin technique (Voronoy) b The French technique The History of Kidney Transplantation: Past, Present and Future (with Special References to the Belgian History) 11 (Küss & Bourget, 19 92) 1 Fig 7 The French technique used for transplanting Mr Marius Renard at Necker Hospital (19 52) 12 Understanding the Complexities of Kidney Transplantation . (Squifflet et al. 19 93) 5 . Year Author Dicovery or application 19 02 19 02 19 06 19 09 19 12 19 28 19 36 19 51 19 52 19 54 19 62 19 62 19 62 19 63 19 66 19 67 Ullmann Carrel. (Küss & Bourget, 19 92) 1 . Understanding the Complexities of Kidney Transplantation 8 a. b. c. a: two stitches are place on both sides at 1 hour and 11 hour, at 5 hour and. Bourget, 19 92) 1 . Fig. 5. First renal homotransplantation by Voronoy in 19 33. Implantation in the groin of the recipient. Later on, David Hume in Boston (19 47) and Lawler in Chicago (19 50),