Living Donor Kidney Transplantation

210 Pages·2005·1.67 MB·English

by  Jonas Wadstrom, Robert Gaston

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Living Donor Kidney Transplantation
Current Practices, Emerging Trends and
Evolving Challenges
Edited by
Robert S Gaston, MD
Jonas Wadström, MD
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Living Donor Kidney Transplantation
Current Practices, Emerging Trends and
Evolving Challenges
Edited by
Robert S Gaston, MD
Division of Nephrology
University of Alabama at Birmingham
Birmingham, Alabama, USA
Jonas Wadström, MD
Division of Transplantation Surgery
University Hospital
Uppsala, Sweden
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© 2005 Taylor & Francis, an imprint of the Taylor & Francis Group
Cover based on a design created by Suzanne Lundqvist Tengzelius
First published in the United Kingdom in 2005
by Taylor & Francis, an imprint of the Taylor & Francis Group,
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Tel.: [phone]
Fax.: [phone]
E-mail:
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Contents
Preface vii
Francis L Delmonico
Introduction and acknowledgements viii
Jonas Wadström, Robert S Gaston
List of contributors x
1. A brief history of living donor kidney transplantation 1
Robert S Gaston, Arnold G Diethelm
2. Advantages of living donor kidney transplantation in the current era 9
Herwig-Ulf Meier-Kriesche, Bruce Kaplan
3. Immunological advantages of living donor kidney transplantation 21
Stuart W Robertson, Jesse A Flaxenburg, David M Briscoe
4. Selection and evaluation of potential living kidney donors 33
Lorna P Marson, Jennifer A Lumsdaine, John LR Forsythe, Anders Hartmann
5. Living kidney donors with isolated medical abnormalities: the SOL-DHR
experience 55
Gilbert T Thiel, Christa Nolte, Dimitri Tsinalis
6. Living donor nephrectomy 75
Jonas Wadström
7. Long-term risks after living kidney donation 99
Ingela Fehrman-Ekholm, Gilbert T Thiel
8. The psychosocial impact of donor nephrectomy 113
Ingela Fehrman-Ekholm
9. Overcoming ABO incompatibility 119
Kazunari Tanabe, Gunnar Tydén
10. Overcoming MHC incompatibility 131
Robert A Montgomery, Christopher E Simpkins, Daniel S Warren
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vi LIVING DONOR KIDNEY TRANSPLANTATION
11. Paired-exchange in living donor kidney transplantation 143
Kiil Park, Jong Hoon Lee
12. Nondirected living donors 151
Arthur J Matas, Cheryl L Jacobs, Catherine A Garvey, Deborah D Roman
13. Legal and ethical dilemmas in living donor kidney transplantation 157
David PT Price
14. Financial and insurance considerations for living donors 165
Jürg Steiger, Thomas R McCune
15. Is it desirable to legitimize paid living donor kidney transplantation programmes?
Part 1: Evidence in favour 171
Janet Radcliffe Richards
Part 2: Evidence against 181
William D Plant
Index 191
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Preface
Living donor kidney (LDK) transplantation cedure is increasingly accepted even as our
has become the definitive approach to the understanding of donor risk is becoming
treatment of end-stage renal failure, providing better defined.
a better quality of life and the best opportunity This compendium brings a timely reflec-
for survival when compared with dialysis or tion of the modern day practice of LDK trans-
transplantation from a deceased donor. The plantation, assembled by an outstanding
number of live kidney donors is increasing group of experts. The authors convey the
rapidly worldwide and, since 2001, has sur- nuances of the current situation, the respons-
passed the number of deceased donors in the ibility of the medical community to the live
USA. Several factors have influenced this kidney donor as a patient and the potential
change. The advent of laparoscopic nephrec- for complacency regarding donor risk. Their
tomy has reduced the morbidity of the perspective is consistent with principles high-
nephrectomy procedure, making more donors lighted at a recent international forum on the
receptive to an interruption of the healthy care of the live kidney donor (Amsterdam,
course of their lives. Just as importantly, 2004) that emphasized ethical principles of
seminal outcome data reported by Terasaki voluntarism, informed consent and medical
and Cecka enabled an expansion of LDK follow-up. These principles must dictate
transplantation irrespective of the human medical practice in LDK transplantation for
leukocyte antigen (HLA) match or the the foreseeable future.
donor–recipient relationship. Now, even blood Perhaps future generations of physicians
type disparity or a positive crossmatch between will understand the profound dilemma that
the donor and the recipient is no longer the permeates our current experience. There is
insurmountable biological obstacle to success- an insufficient supply of organs and a
ful transplantation that it was just a decade demanding remedy that rationalizes potential
ago. Any person who is well and willing to harm to a well individual. Human live donor
donate may now be a live kidney donor. transplantation cannot be the ultimate solu-
This year marks the fiftieth anniversary of tion to the ever-increasing need for organs.
the first successful kidney transplantation Nevertheless, there is a visionary sensibility to
between identical twins. In a relatively brief be underscored. Until primum non nocere can
period, LDK transplantation has progressed be restored to the pedestal of medical care by
from an experimental modality to standard the use of an alternative source of organs
treatment. Francis Moore recognized early on (not derived from humans), this book com-
that LDK transplantation would challenge the prehensively records the best practices cur-
medical dictum to ‘first do no harm’, but also rently available.
predicted that it would persevere: ‘the living Francis L Delmonico, MD
human donor provides by far the best tissue’. Harvard Medical School
Indeed, the advantages of LDK transplanta- Massachusetts General Hospital
tion are now readily apparent and the pro- Boston, Massachusetts, USA
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Introduction and acknowledgements
Successful solid organ transplantation origin- donor transplantation will find the entire
ated with the living kidney donor. It has volume eminently approachable.
always been the desire of many involved to This work originated in a series of inter-
move beyond utilizing healthy persons as a national symposia devoted to the topic of
source for transplantable organs. Neverthe- living donor kidney transplantation. Proceed-
less, a half-century later, we find ourselves, in ings of these meetings, convened in Lisbon,
many ways, more dependent on living donors Miami, Berlin and Venice between 2001 and
than ever. This circumstance incorporates the 2003, remain accessible (at the time of publi-
impact of numerous changes in the field, not cation) at www.livekidney.com. The content
least of which is the dramatic improvement in reflects the input of an intuitive steering com-
outcomes for kidney transplant recipients mittee (John Forsythe, Arthur Matas, Kiil
and the resulting unprecedented demand for Park, Kazunari Tanabe and Gilbert Thiel) as
the procedure. In many countries, living well as the collective insights of a renowned
donors now provide the majority of trans- group of contributors from Asia, Europe and
plantable kidneys. Despite substantial efforts the Americas. We are indebted to them for
to address medical and ethical questions that their labours without which neither the sym-
have accompanied utilization of live donors posia nor the textbook could have succeeded.
since inception in 1954, new challenges con- Likewise, this effort would not have been
tinue to arise, often in almost rapid-fire possible without the ongoing support of two
sequence: laparoscopic donor nephrectomy, entities: Fujisawa* and Thomson ACUMED.
ABO- and MHC-incompatible transplanta- The idea for a project to address issues associ-
tion, unrelated donors, non-directed dona- ated with living donor kidney transplantation
tion and, somewhat ominously, paid donors. originated with Fujisawa Healthcare, Incorpo-
All these developments have maintained rated. Fujisawa’s generous funding for the
issues surrounding the living donor at the project, with no restrictions on content or
forefront of kidney transplantation. contributors, is extraordinary and gratefully
Living Donor Kidney Transplantation: Current appreciated. The consummate professionals
Practices, Emerging Trends and Evolving Chal- at Thomson ACUMED (especially Sharon
lenges is an attempt to summarize, for the first Smalley, Rachel Ramsay, Andrea King and Jo
time, the changing face of this field in a single, Jackson) provided outstanding organizational
readily accessible volume. Its focus is clinical, and editorial support. Our gratitude to these
and we anticipate its greatest utility to be two special groups of people cannot be over-
among all categories of healthcare profession- stated.
als involved in, or intending to begin, a living Given the time commitment inherent in
donor kidney programme. While each chapter an effort like this, we are indebted to col-
stands alone as an informative examination of leagues in Uppsala and Birmingham for
a specific issue, we hope those seeking a com- their assistance with clinical duties. We are
prehensive, state-of-the-art overview of living also blessed with supportive, understanding
*On 1 April 2005, Fujisawa ceased to exist following a merger with Yamanouchi to create Astellas Pharma
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INTRODUCTION AND ACKNOWLEDGEMENTS ix
families, and express our gratitude to them the lives of others: living donors. Perhaps one
(especially our wives, Eva and Susie) for their day, such sacrifices will no longer be neces-
ongoing support. sary. For now, however, we can only offer our
Finally, we dedicate this book to those who humble thanks.
have made transplantation a successful
option for so many, namely, those brave souls Jonas Wadström, MD
whose faith in our judgement and skills has Robert S Gaston, MD
enabled them to contribute so significantly to