Transplantation kidney

Liver transplantation was first performed in 1963 in the United States and United Kingdom. However, success was not achieved until 1967 when a recipient survived 1 year after the surgery. It remained an experimental procedure until the 1980s, which also coincided with the introduction of cyclosporine. In the 1970s, patient survival for 1 year was 25%, which has now improved to 85-90%. The indication for liver transplantation is an acute or chronic condition that causes an irreversible 

There are only a few reports of hyperacute rejection after liver transplantation. This may be due to the ability of the Kupffer cells to remove cytotoxic antibodies formed against the graft because of their reticuloendothelial function. Acute rejection is the more common form of rejection, which is manifested within 7-10 days after liver transplantation and exhibits symptoms of fever, malaise, pain, tachycardia and hepatomegaly. Mental disorientation in patients has also been reported during acute rejection. Liver biopsy is performed to confirm acute rejection that is generally mild in nature, and lymphocytic infiltration is observed in the portal tracts under the endothelium of the sinusoids. 

Chronic rejection after liver transplant is rare ( 3%), which is attributed to the recognition of acute rejection and the ability of the liver to regenerate itself. During chronic rejection, there is progressive failure of liver function, and humoral immune 

---

The introduction of PP2B (calcinemin) inhibitors revolutionized kidney transplantation. Cyclosporine A and tacrolimus (FK506) are the principal immunosuppressants prescribed for adult and pediatric renal transplantation. Cyclosporine A was in use clinically long before its mechanism of action was elucidated. 

Koyama, L, Bulkley, G.B., Williams, G.H. and Im, H.J. (1985). The role of oxygen free radicals in mediating the reperfusion injury of cold-preserved ischaemic kidneys. Transplantation 40, 590-595. 

It is often difficult to differentiate ARF from acute rejection in the kidney transplant recipient, as both conditions may present with similar symptoms and physical examination findings. However, fever and graft tenderness are more likely to occur with rejection while neurotoxicity is more likely to occur with cyclosporine or tacrolimus toxicity. Kidney biopsy is often needed to confirm the diagnosis of rejection.42... 

Patients who progress to ESRD require renal replacement therapy (RRT). The modalities that are used for RRT are dialysis, including HD and peritoneal dialysis (PD), and kidney transplantation. The United States Renal Data Service (USRDS) reported that the number of patients with ESRD was 452,957, with 102,567 new cases being diagnosed in 2003.2 The most common form of RRT is dialysis, accounting for 72% of all patients with ESRD. The principles and complications associated with dialysis are discussed below. Chapter 52 discusses the principles of kidney transplantation. 

Joseph Murray performed the first successful organ transplant in 1954, a kidney transplant between identical twins.1 This was a success in large part because no immunosuppression was necessary since the donor and recipient were genetically identical. Murray s success led to attempts with other organs over the next 20 years (Table 52-1). 

First successful deceased donor kidney transplant 1963... 

Most kidney transplant procedures are heterotopic, where the kidney is implanted above the pelvic bone and attached to the patient s iliac artery and vein. The ureter of the transplant kidney is attached directly to the recipient s bladder or native ureter. The native kidneys usually are not removed, and data have shown that under most circumstances, removal of the native kidneys does not influence patient survival and allograft survival. Special circumstances, however, such as renal cell carcinoma and PCKD, may necessitate native kidney removal.1,3 There were 16,477 (9914 deceased donors, 6563 living donors) kidney transplants and 903 simultaneous kidney-pancreas procedures done in 2005.3... 

The induction agents are highly immunosuppressive and, when given prior to some organ transplants (e.g., kidney transplant), allow for significant reductions in acute rejection... 

Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med 2004 351(26) 2715-2729. 

Perico N, Cattaneo D, Sayegh MH, Remuzzi G. Delayed graft function in kidney transplantation. Lancet 2004 364 1814-1827. 

Kerjaschki D, Regele HM, Moosberger I, et al. Lymphatic neoangiogenesis in human kidney transplants is associated with immunologically active lymphocytic infiltrates. J Am Soc Nephrol 2004 15 603-612. 

ORTHOCLONE OKT 3 Muronomab-CD3 Ortho Biotech Reversal of acute kidney transplant rejection, reversal of heart and liver transplant rejection... 

Zenapax Daclizumab Hoffman-La Roche Prevention of kidney transplant rejection... 

Muck, W., Mai, I., Fritsche, L., Ochmann, K., Rohde, G., Unger, S., Johne, A., Bauer, S., Budde, K., Roots, I., Neumayer, H.-H., Kuhlmann, J., Increase in cerivastatin systemic exposure after single and multiple dosing in cyclosporin-treated kidney transplant recipients, Clin. Pharmacol. Ther. 1999, 65, 251— 261. 

However, other actions to improve minority access to kidney transplantation in other ways would be acceptable. Education programs directed to... 

---