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Pancreas transplantation has rapidly moved from an experimental
procedure associated with high rates of morbidity and mortality to
a mainstream technique with excellent patient and graft survival.
Over 30,000 pancreas transplants have already been performed. The
value of pancreas transplantation however must be balanced against
the risk of the operative procedure and the innovative long-term
immunosuppressive therapy. The indications for this procedure and
the selection of the patients are critical to ensure low mortality
and any improvements in quality of life.
This concise book provides an overview of the essential aspects of transplant nephrology. Chapters cover patient evaluation, treatment options, complications and post kidney transplant approaches to various common chronic diseases. The importance of proper immunosuppressants adjustment to improve the graft half-life and overall patient quality of life are also highlighted. Up to date and practical, this book gives nephrologists and providers that treat kidney transplant patients a succinct resource on management.
Cirrhosis from hepatitis C (HCV) is now the most common indication for liver transplant (LT) in the U.S., but between 2004 and 2013, new LT listings for NASH increased by 170%. Unfortunately, fibrosis progression leading to cirrhosis, liver cancer, and liver decompensation continues to occur after transplantation. Once cirrhosis and decompensation are evident, patient survival is poor and repeat LT is considered to improve outcomes. Therefore, the never-ending thirst for new approaches in the management of patients pre- and post-transplant has led to a very promising future in transplantation, thought there is much to learn to achieve better patient outcomes. This issue of Clinics in Liver Disease addresses the core areas to achieve better patient outcomes, with articles devoted to coagulopathy before liver transplant, challenges in renal failure before LT, LT for acute alcoholic hepatitis, LT in the pregnant patient, bariatric surgery and LT,and MELD Scores in prioritization of LT, to name a few. Readers will place a high value on the current state of liver transplantation in this issue.
The use of human tissue for transplantation is becoming a billion-dollar business. This book is the first comprehensive exploration of the American tissue transplantation industry. It traces the chain of distribution of musculoskeletal tissue (e.g. bones and ligaments) and skin from the generous donation of grieving families to its transplantation into hundreds of thousands of persons each year. Commodification, commercialization, and the occasional use of tissue for "cosmetic" surgery have raised ethical questions about the acceptability of "markets" in human body parts that have been altruistically donated by families. Inevitably, questions about the informed consent and the need for responsible stewardship by the industry have been raised, often in the Press.
The book provides a comprehensive background to these ethical problems by explaining the historical development, breadth, and organization of the tissue industry, including the technical developments that have made it simultaneously clinically relevant and an attractive market for investment capital. It explores the similarities and differences in how government regulates other tissues and solid organs (such as hearts and kidneys). Contributions to the book come from an interdisciplinary group of scholars, industry representatives, government regulators, and, not least, families who have donated tissue from their dead loved ones.
The field of transplantation has grown exponentially over the last few decades, and leaders in the field may argue that we have seen only the tip of the iceberg. Perhaps in no other discipline is there a need for multidisciplinary dialogue, debate, and approaches to patient care. In preparing this book, we have attempted to introduce readers to a few of the key clinical and ethical issues confronting the field of transplantation today. In so doing, we recognize that the face of transplantation may change dramatically in the years to come. Nevertheless, the issues raised throughout this book will serve as a useful introduction to important clinical issues and as a catalyst for clinicians and researchers to expand the horizons of transplantation. Health professionals involved in evaluating and treating transplant patients must be knowledgeable of the indications for transplantation and patient outcomes and the process of evaluation and management. Chapters 1 and 2, focusing on solid organ transplantation and blood/marrow transplantation, provide this important contextual information. The next two chapters address what is often considered the most significant issue facing the field of transplantation - organ donation. While the number of patients needing transplantation has risen dramatically in recent years, the rate of organ donation has remained relatively stable. Chapter 3 highlights the many ethical issues surrounding the more general concept of organ donation, while Chapter 4 focuses specifically on the burgeoning interest in living organ donation.
International expertise in the rapidly developing field of bone marrow transplantation has been collected to provide a balanced overview of both the scientific basis and clinical practice of marrow transplantation. The early chapters dealing with biological background are followed by information relating to the practicalities of transplantation and a comprehensive review of clinical results from an extensive range of disease and graft match situations. Complications are discussed including graft-versus-host disease, infections, organ specific problems, disease recurrence and psychological reactions. The final chapters review such latest developments in the field as the role of novel antileukemic agents, haemopoietic growth factors and monoclonal antibodies. A uniquely detailed and complete reference text, this book will commend itself both to laboratory scientists and clinicians from many specialities, whether they are directly involved in carrying out marrow transplantation procedures or advising on pre and post transplant management and support.
This volume presents a comprehensive overview of the latest advances in basic and translational research in the field of reconstructive transplantation and its potential therapeutic implications. Dr. Thomas E. Starzl and Dr. Raimund Margreiter, both pioneers in the field of transplantation, have written the foreword for the book. The volume spans such topics as skin rejection, immune monitoring, stem cell-based immunomodulatory strategies, costimulatory blockade, tolerance induction, chronic rejection, ischemia reperfusion injury, nerve regeneration, cortical reintegration, and small and large animal models for reconstructive transplantation. The book is intended for biomedical researchers and basic scientists in the field of reconstructive transplantation, transplant immunology and regenerative medicine, as well as clinicians, surgeons and multidisciplinary specialists, who are practicing or interested in this novel and exciting field. Postgraduate fellows and students will also find it a valuable reference.
Atlas of Organ Transplantation, Second Edition, provides the reader with a comprehensive and pictorial step-by-step account of abdominal organ transplant procedures performed by contemporary transplant surgeons today. Emphasis is placed on newer procedures or procedures that have undergone significant modifications. It is recognized that there are many well-accepted techniques for the same procedure, with each having potential merit. While it is impossible to present all of these variations, an attempt is made to describe the common variations in surgical technique and common variation in procedure based on anatomical variations. Written by an expert in the field, Atlas of Organ Transplantation, Second Edition, includes schematic diagrams and high-quality intraoperative photographs, allowing readers to clearly visualize the course of the operative procedure. This format provides the reader with a clear visual and written description of all major transplant procedures in one reference book.
Progress in the development of surgical implant materials has been hindered by the lack of basic information on the nature of the tissues, organs and systems being repaired or replaced. Materials' properties of living systems, whose study has been conducted largely under the rubric of tissue mechanics, has tended to be more descriptive than quantitative. In the early days of the modern surgical implant era, this deficiency was not critical. However, as implants continue to improve and both longer service life and higher reliability are sought, the inability to predict the behavior of implanted manufactured materials has revealed the relative lack of knowledge of the materials properties of the supporting or host system, either in health or disease. Such a situation is unacceptable in more conventional engineering practice: the success of new designs for aeronautical and marine applications depends exquisitely upon a detailed, disciplined and quantitative knowledge of service environments, including the properties of materials which will be encountered and interacted with. Thus the knowledge of the myriad physical properties of ocean ice makes possible the design and development of icebreakers without the need for trial and error. In contrast, the development period for a new surgical implant, incorporating new materials, may well exceed a decade and even then only short term performance predictions can be made.
This guide addresses the identification and management of potential donors and the subsequent retrieval and preservation of various organs. Physiological changes that take place in the organ donor and in an organ during preservation are described, and several preservation techniques are evaluated for their ability to minimize these physiological changes. The book should be of interest to procurement coordinators, surgeons, residents and other health care professionals involved in organ retrieval.
An important review on transplantation for the general surgeon! Topics include: kidney transplant, left lobe liver transplants, advances in lung transplantation, stem cell and cellular transplants, pancreatectomy, management of organ failure, transplant immune suppression, antibody mediated rejection, cardiac assist devices, organ perfusion and preservation, weight reduction therapy, organ allocation and distribution, and more!
In 2005, surgeons in France removed part of the face from a cadaver and grafted it onto the head of a 38-year-old woman grossly disfigured by a dog attack. Three years later, in December, 2008, surgeons at the Cleveland Clinic announced they had performed the first U.S. face transplant. Although modern culture is accustomed to pushing medicine and the human body beyond all limits, the world's first partial face transplant and the seven that have followed have caused a stir that still reverberates globally.
This book begins with the story of Isabelle Dinoire, the recipient of the first face transplant, and chronicles her surgery and battles with tissue rejection. Its scope widens with a look at how surgical teams, including three U.S. transplant teams, are in a global race to perform the first full face transplant, and at how medical history has led up to this point--with prior successful transplants ranging from body parts as simple as cornea to those as neurologically complicated as the heart, a hand, and a penis.
The most novel among these surgeries--the face transplant--conjures up particular and expansive psychological issues. Authors Bluhm and Clendenin show how transplant recipients struggle with functional issues including a lifetime of anti-rejection drugs, a danger highlighted by the recent death of the second face transplant patient, in China. But just as challenging in the case of face transplant is the psychological effect on--and potential threat to--identity. Who are you, if suddenly your face--or a significant portion of it--is not what you were born with? What is it like to look in the mirror, and see a face that is not the one you have always had? Dinoire lamented, "It will never be me." That statement is an absolute simplification of the identity issues a face transplant can create, explain the authors. Bluhm and Clendenin show how, across history and media, humankind--via medicine, literature, film, and other media--has dreamed of a day when face transplants would be possible.
With so many disfigurements occurring among the military in Iraq, and experimental face transplants too expensive for implementation in the private sector, it is likely that the U.S. military will take the reins and further face transplant techniques as quickly as possible to serve injured personnel.
This book is a detailed practical guide to the use of ventricular assist devices and total artificial hearts to provide mechanical circulatory support (MCS) in patients with end-stage heart failure. It explains why MCS may be indicated, which patients require MCS, when and how to implant ventricular assist devices or a total artificial heart, and how to avoid potential complications of MCS. Management throughout the period of care is described, from preimplantation to follow-up, and both typical and atypical cases are discussed. The text features numerous helpful tips and tricks relating to surgical and nonsurgical management and is supported by a wealth of high-quality illustrations that document the preoperative evaluation and implantation techniques. Heart transplantation remains the gold standard for the treatment of patients suffering from end-stage heart failure, but the shortage of donors has led to an increase in the use of MCS. This book will assist all physicians, and especially cardiologists and anesthesiologists, who are involved in the care of these patients.
This volume of tissue banking is the second of a series extending the interdisciplinary field. All of the authors of this book have been major contributors of scientific and medical publications in their respective specialities. There are articles covering blood transfusion; bone marrow and stem cell transplantation; immunology and the role of immunology in musculoskeletal transplantation, various aspects of cryopreservation of organs, cartilage and tendons; organ perfusion preservation; the history and long term follow-up of osteochondral allografts, both frozen and fresh; neurosurgical applications; cardiovascular applications; the use of skin and newer biological membranes for wound coverage.The book is of particular importance, in that it has been written in memory of Kenneth W Sell, MD, PhD, a pioneer and promulgator of tissue banking and transplantation. Many of the physicians, surgeons and scientists who trained under his leadership have gone on to distinguish themselves in the various aspects of transplantation. Many of them have contributed to this book, exemplifying the diversity of Dr Sell's contributions to tissue banking and transplantation.
This volume is based on a very successful meeting on organ transplantation that was held in Kuwait in 1990 under the auspices of the Middle East Society for Organ Transplantation. An international group of organ transplant experts attended this conference and their contributions and deliberations have been recent1y updated to produce this definitive and authoritative summary of current clinic al practice in organ transplantation. The initial chapters appropriately focus on the immunology of organ trans- plantation with special emphasis on the initial events in the induction of alloreactivity, the mechanisms of rejection, and the potential for tolerance induction. A strong emphasis is placed on the diagnosis of rejection by cellular analysis. The section on immunosuppression deals with several new areas of clinical therapy. The section on renal transplantation is unique in several respects, the long-term results from various countries, including the Middle East, are summarized, the use of living unrelated donors and of ABO incom- patible donors - all strategies to maximize organ availability - are presented.
With the increased prevalence of kidney transplantation, transplant recipients are being treated in a variety of clinical settings - often beyond the transplant center. There is a greater need for clinicians and allied healthcare professionals to have appropriate guidance on managing these patients. Kidney Transplantation offers the latest evidence-based information on the full range of dilemmas in the medical management of kidney transplant recipients before, during and after transplantation. Beginning with the selection of patients who are candidates for transplantation, this authoritative guide covers the care of the patient on the waiting list and evaluation of donors, preoperative care, induction and immunosuppression maintenance. This wealth of new information and guidelines will serve as an important resource for the best possible care for transplant patients.
Over the past decade, there has been rapid growth in bioengineering
applications in the field of spine implants. This book explains the
technical foundation for understanding and expanding the field of
spine implants, reviews the major established technologies related
to spine implants, and provides reference material for developing
and commercializing new spine implants. The editors, who have a
track record of collaboration and editing technical books, provide
a unified approach to this topic in the most comprehensive and
useful book to date.
An ever-increasing demand for organs, with over 100,000 people on waiting lists, has driven a relentless search for new sources of organs. In 1995 the American Medical Association supported taking organs from anencephalic infants, children born without brains. In 1999 the Chinese government began removing organs from members of the politically outcast religious group Falun Gong, making a lucrative profit from sales to foreigners. Recently in Belgium physicians have euthanised a patient by removing her organs.The search for fresh organs began much earlier, in 1968, when death was redefined, so that well-preserved organs could be removed from brain-dead individuals. The early 1990s saw the introduction of donation after cardiac death, in which organs are taken from individuals whose hearts could still be resuscitated. Over the past two decades various countries have attempted markets in the sale of organs.Each of these sources of organs raises ethical concerns. Is brain death truly death, or by taking the heart of the brain-dead individual do we thereby kill him? When a person's heart stops beating is it permissible to prepare his organs for transplantation, even though we could choose to resuscitate him? Can we take organs from an infant without a brain? If a woman no longer wishes to live, can she donate her organs to others in an act of beneficent suicide? Is a market in organs acceptable?These questions and others are thoughtfully probed in this collection of essays, which features articles from theologians, philosophers, physicians, biomedicial ethicists, and an attorney.
Virtually any disease that results from malfunctioning, damaged, or
failing tissues may be potentially cured through regenerative
medicine therapies, by either regenerating the damaged tissues in
vivo, or by growing the tissues and organs in vitro and implanting
them into the patient. Principles of Regenerative Medicine
discusses the latest advances in technology and medicine for
replacing tissues and organs damaged by disease and of developing
therapies for previously untreatable conditions, such as diabetes,
heart disease, liver disease, and renal failure.
This book provides an expert view into the current technologies that are revolutionizing the field of solid organ transplantation. This unique book provides insight into progress made in areas spanning robotic surgery to tissue engineering and also gives a glimpse into what may lie ahead for this innovative specialty. Topics covered include nanotherapy, machine perfusion, artificial organ development, robotics in transplant surgery, mobile health technology, stem cell therapy, and ex vivo repair of organs. This is an ideal book for biomedical engineers, physicians and surgeons, general and transplant surgeons, medical students, medical and surgical trainees, and transplant procurement technicians.
This book deals with organ failure and the way it can be managed artificially without requiring a transplant. Written by a mixture of European and US physicians and surgeons, each of the chapters compares the artificial organ to what is currently available from the transplant point of view to highlight the current and modern available techniques for organ replacement.
The book will be a useful reading for postgraduate students and people interested in modern surgical and medical technology.
Everyone knows that transplantation can save and transform lives, but thousands die every year on waiting lists because there are not enough organs available. If more people could be persuaded to donate, more lives could be saved. But is individual reluctance to donate the root of the problem? Individual choices are made against the background of prevailing laws, conventions and institutions, and many of those present direct or indirect obstacles to organ procurement, from both the living and the dead. If any of those cannot be justified, the deaths they cause are similarly unjustified. In The Ethics of Transplants, Janet Radcliffe Richards, a leading moral philosopher and author of The Sceptical Feminist and Human Nature after Darwin, casts a sharp critical eye over these institutional barriers to organ procurement, and the logic of the arguments offered in their defence. Her incisive reasoning forces us to confront the implications of unexamined intuitions, leads to several unexpected conclusions, and in doing so demonstrates the crucial importance of clear thinking in public debate. Originally published in hardback as The Ethics of Transplants.
This book describes a practical approach to the diagnosis, management, and prevention of infectious complications in solid-organ transplant (SOT) candidates and recipients, based on both up-to-date clinical evidence and state of the art expert opinion from world-renowned experts in the field. The book is divided into three parts, the first of which explains risk assessment and the general approach to infectious diseases in the pre-, peri-, and early and late post-transplant periods. The remaining two sections address the prevention and treatment of infection with particular pathogens and the management of specific syndromes, such as pneumonia, CNS infections, UTIs, and skin infections. Infections in SOT recipients - often due to multidrug-resistant organisms - represent a major challenge. Preventive strategies need to be adapted according to the type of allograft and period after transplantation. Moreover, toxicity and drug interaction with immunosuppressive drugs must be taken into consideration when treating infectious complications. In explaining in depth how best to ensure allograft and patient survival, this book will be of value to infectious disease specialists and transplant physicians at all levels of experience.
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