内容

目次

Section 1.  History of kidney transplantation     Section 2. Recipient Selection       1. Indications and contraindications2. Evaluation and selection3. Special considerations in highly sensitized candidates4. Waitlist maintenanceSection 3. Donor Selection1. Living donora. Evaluationb. Selection2. Deceased donora. History of brain death and donation after cardiac death donors b. Evaluation and managementc. Selectioni. Heart beating deceased donors1. Standard criteria donors2. Extended criteria donorsii. Donation after cardiac deathiii. Specific donor issues and considerations1. HBsAg, HBcAb+,  HCV donors2. CDC high risk donors3. Donors on ECMOSection 4. Surgical Technique1. Organ preservation and preparation Surgeona. Historyb. Organ preservation solutionsc. Kidney graft biopsy findingsd. Static storage versus machine perfusion pumpi. Machine perfusion equipment  ii. Pump parameterse. Kidney graft back table preparationi. Short renal veinii. Multiple arteries or veinsiii. Other anatomic variants2. Recipient kidney transplantation surgical technique   a. The standard technique     b. Technical considerations in recipients with extensive atherosclerosis  i. Endarterectomyii. Renal artery onto vascular graftsc. Venous sclerosis and alternate locationsd. Urinary tract anomalies (neurogenic bladder)e. Special considerations: Robotic recipient kidney transplantation3. Live donor nephrectomya. History and important trends.b. Open donor nephrectomy. i.  Operative Techniqueii. Common complicationsc. Laparoscopic donor nephrectomyi. Operative Techniquesii. Common complicationsd. Robotic laparoscopic donor nephrectomy, SILS, and alternate extractions site laparoscopic donor nephrectomy4. Kidney Transplantation with other organs.a. Special technical concerns---Pancreas kidney transplantationb. Others: liver, heart, small bowelSection 4.  Anesthesia ManagementSection 5.  Organ Procurement Organization and New Kidney Allocation1. History and rationale for the change.  2. Recent changes and what they will mean.a. Reliance on the Kidney Donor Profile Index (KDPI) Score for allocation over the current definitions such as age<35(peds); ECD, DCD, SCD.b. Consideration for top 20% adult post-transplant survival candidates   Estimated Post Transplant survival (EPTS≤20%) for 20% or better KDPI kidneys.c. Sensitization addressed in stratified fashion with special measures for the super sensitized—regional 99%, national 100%.d. Simultaneous local and regional allocation of kidneys with KDPI >85%e. Improved access for Blood type B candidates using A2 and A2B donors.f. Elimination of Payback system.g. Waiting time includes prior time on dialysis.h. Elimination of other OPO specific variances.i. Defining Living Donors by procurement not transplant.3. Allocation policies in EU, UK, and other countriesSection 6.  Geographic Variations in Kidney Access- Final Rule Wida (UNOS) Section 7. Vulnerable Populations Section 8. Special Consideration in Living Donor Kidney Transplantation1. Necessary components of a living donor team.a. History b. Team components- surgeons, social workers, independent donor advocate.c. When living donors are taken advantage---stories from the US and elsewhere.2. Living kidney donor paired exchanges a. Historyb. Exchange systems and algorithms behind their operation.c. Benefits and potential pitfalls.i. Loss of the medical outii. Legal implicationsSection 9.  Early and Late Course after Kidney Transplantation1. Early complications after kidney transplantationd. Technicali. Vascularii. Urinaryiii. Wound problemsiv. Lymphocele formatione. Medicalv. Rejectionvi. Infectionvii. Cardio-vascular eventsviii. Disease recurrence2. Late complications after kidney transplantationSection 10.  Immunology of Kidney TransplantationSection 11. Pathology of Kidney Transplantation Section 12. Radiology of Kidney Transplantation1. Radiology in kidney transplantation2. The role of Interventional radiologySection 13. Transplant Immunosuppression 1. History of immunosuppression: an overviewa. History of immunosuppression specific to drug developmentb. Specific Drugsi. Induction therapy---principals and various agentsii. Maintenance therapy- principals and various agentsiii. Newer or more rarely used agents.2. Special consideration f. Hepatitis Cg. HIVSection 14. Tolerance: The Holy grail of TransplantationSection 15. Infection in Kidney Transplanation.Section 16.  The Contemporary Successful Kidney Transplant Program1. The Regulatory Environmenta. UNOSb. CMSc. JCHOd. Insurance2. Quality measure of a contemporary kidney transplant program3. The role of transplant coordinators4. The finance of kidney transplantation5. Kidney transplantation in the third millennium in North America: the strategy for success6. Legal issues of transplant programs in North America in the third millennium (HCV transmission at UPMC, HIV , live donor deaths, etc.)Section 17. Epidemiology of Kidney TransplantationSection 18. Ethics of Transplantation  1. History- transplant as a driver of ethics2. Principles3. Special cases Section 19. Psychosocial and financial Aspects of Transplantation   Section 20. Pediatric TransplantationSection 21, Special Topics1. Pregnancy after Kidney Transplantation2. Future Directions:a. The artificial Kidney versus the xenograft that can avoid humoral rejection.b. Prevention—Will the epidemiology of kidney failure change.