Living Donor Organ Transplantation

458 Pages·17.599 MB·458\458

Living Donor
TranspLanTaTion
Living Donor
TranspLanTaTion
Edited by
Henkie p. Tan
Thomas E. Starzl Transplantation Institute
Pittsburgh, Pennsylvania, USA
amadeo Marcos
Thomas E. Starzl Transplantation Institute
Pittsburgh, Pennsylvania, USA
ron shapiro
Thomas E. Starzl Transplantation Institute
Pittsburgh, Pennsylvania, USA
CRC Press
Taylor & Francis Group
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Version Date: 20130325
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To our families for their love and support.
To our live donors for their altruistic acts.
To our recipients for their courage and faith in us.
To Dr. Starzl for providing challenges, inspiration, and a vision.
Preface
Living Donor Transplantation discusses all aspects of living donor solid organ and cellular
t ransplantation in current clinical practice, including kidney, liver, pancreas, lung, small bowel,
islet, and hematopoietic stem cell transplantation. Each organ/cell-specific chapter includes
sections on the medical evaluation, technical aspects of the operation, and donor and recipient
outcomes. Special topics also include the history of living donor organ transplantation, the
psychosocial aspects of donation and the transplant process, anesthetic management, preven-
tion and control of infections, pregnancy in transplant recipients, the financial impact of
living donation, transplantation tolerance, transplantation for malignancy, the ethics of paid
living donation (pro and con), and living donor transplantation in pediatric recipients.
This book describes in detail the state of the art and practice of live donor organ trans-
plantation. Although many of the chapters are from the Thomas E. Starzl Transplantation
Institute at the University of Pittsburgh, it represents a broad-based attempt to present, as
clearly as possible, a comprehensive guide to the practice of live donor organ transplantation
and includes important contributions from many other transplant centers in the United States.
Chapters 1 to 3 are introductory overviews. Chapter 1 is a discussion of the history of
living donor organ transplantation by Dr. Thomas E. Starzl, the “father” of modern transplan-
tation and winner of both the Medawar Prize and the National Medal of Science. Chapter 2
examines the psychosocial aspects of living organ donation and the transplant process, empha-
sizing the well-being of donors both before and after transplantation. Chapter 3 describes the
general medical evaluation of the living donor.
Chapters 4 to 13 are specific to living donor kidney transplantation. Chapter 4 focuses on
issues related to the medical evaluation of live kidney donors. Chapter 5 is about the different
technical aspects of live donor nephrectomy. This extensive chapter covers open, minimal inci-
sional open, laparoscopic, hand-assisted laparoscopic, and robotically hand-assisted laparoscopic
donor nephrectomy techniques. Chapters 6 and 7 consider the perioperative and long-term
risks to the live kidney donors. These chapters also present a live donor nephrectomy complica-
tion classification scheme. Chapter 8 is a discussion of the long-term outcomes for live kidney
donors by Dr. Arthur Matas of the University of Minnesota, examining the long-term conse-
quences of living with a single kidney (survival, renal function, cardiovascular disease,
p roteinuria, risk factors of end-stage renal disease, and quality of life) and the limitations of the
current data. Chapter 9 covers donor and recipient outcomes after laparoscopic live donor
nephrectomy. Chapter 10, by Drs. Lloyd Ratner and R. John Crew of Columbia Presbyterian
Hospital in New York, reviews immunologically incompatible living donor kidney transplants in
the highly sensitized, positive crossmatch, and ABO-incompatible recipients. In Chapter 11,
Drs. Dorry Segev, Robert Montgomery, and colleague at Johns Hopkins in Baltimore, Maryland,
focus on expanding live donor renal transplantation through paired and nondirected donation.
Chapter 12 discusses a limited experience with living donor kidney transplantation in HIV-
positive recipients. Chapter 13 examines pediatric living donor renal transplantation.
Chapters 14 to 20 are specific to living donor liver transplantation. Chapter 14 analyzes
issues related to the evaluation of the live liver donor and recipient. Chapter 15 investigates the
technical aspects of live donor hepatectomy. Chapter 16 explores live liver donor outcomes.
Chapter 17 is a discussion of recipient outcomes after living donor liver transplantation by
Drs. James Pomposelli, Elizabeth Pomfret, and Roger Jenkins of the Lahey Clinic. Chapter 18
describes recipient outcomes from the Pittsburgh experience with alemtuzumab preconditioning
and tacrolimus monotherapy. Chapter 19 focuses on pediatric living-donor liver transplantation.
Chapter 20 examines living donor liver transplantation for hepatocellular carcinoma.
vi Preface
A discussion of live donor pancreas transplantation by Drs. Miguel Tan, Raja Kandaswamy,
Rainer Gruessner, and David Sutherland of the University of Minnesota is undertaken in
Chapter 21. This chapter spotlights the preoperative donor evaluation, operative technique
(including hand-assisted laparoscopic donor distal pancreatectomy), the recipient operation,
and donor and recipient outcomes.
Chapter 22 is an examination of living-donor islet cell transplantation by Drs. Emamaullee
and J. Shapiro of the University of Alberta, Edmonton, Canada. This chapter describes the
evaluation of the live donor and recipient, technical aspects of the islet transplantation proce-
dure, and donor and recipient outcomes.
Chapter 23 is a discussion of living lobar lung transplantation by Drs. Mark Barr and
Vaughn Starnes of the University of Southern California. It covers evaluation, technical aspects,
and donor and recipient outcomes.
In Chapters 24 to 26, Dr. Luca Cicalese and colleague of the University of Massachusetts
discuss live-donor small intestinal transplantation. Chapter 24 reviews specific issues related
to the donor and recipient evaluation. Chapter 25 analyzes the surgical technique, and
Chapter 26 examines donor and recipient outcomes.
A discussion of hematopoietic stem cell transplantation by Dr. Andrew Yeager and
c olleagues from the Arizona Cancer Center takes place in Chapters 27 to 29. Chapter 27 investi-
gates the collection, processing, and infusion of adult hematopoietic stem cells (bone marrow
and peripheral blood stem cells). Chapter 28 is an examination of the applications and outcomes
of autologous and allogeneic hematopoietic stem cell transplantation, and Chapter 29 is a
discussion of umbilical cord blood cell transplantation.
Chapters 30 to 36 are special topics related to living donor organ transplantation.
Chapter 30 examines anesthetic management for living donor organ transplantation. Chapter 31
focuses on the management of infections in living donor transplant recipients. Chapter 32 is
a discussion of pregnancy after living donor organ transplantation by Drs. Vincent Armenti
and colleagues of the National Transplantation Pregnancy Registry. Chapter 33 covers the
financial impact of living donor organ transplantation. Chapter 34 describes transplantation
tolerance. In this chapter, the mechanisms of immunological tolerance and the barriers to its
induction are depicted. Chapters 35 and 36 consider the ethics of paid living donation. The
case for a regulated system of kidney sales is made by Dr. Arthur Matas, and the case against
organ sales is taken up by Dr. Arthur Caplan of the University of Pennsylvania.
Chapters 37 and 38 are sample live kidney- and liver-donor consent forms created by the
editors at the Starzl Transplantation Institute.
We hope that this book proves to be a useful guide for individuals interested in living
donor transplantation.
Henkie P. Tan
Amadeo Marcos
Ron Shapiro
Acknowledgments
This multiauthored book represents the work of many individuals. We would like to thank all
the authors (and their families) who contributed their time and energy to produce the specific
chapters of this book.
As we all know, the care of transplant donors and recipients is possible only with the help
and commitment of a large number of physician consultants, transplant coordinators, nurses,
social workers, and other staff personnel. Specifically, we would like to thank Annie M. Smith,
RN, CCTC, and Eileen Stanford, RN, BSN, our two very proud live kidney donors. We also
thank Gerri James, RN, CCTC; Cindy Anderson, RN, CCRN, CCTC; Diane Connors RN, MPH;
Linda Boig, RN, CCTC; Theresa Caponi, RN, CCTC; Deborah Good, RN, BSN, CCTC; Jareen
Flohr, RN, BSN, CCTC; Shirley Grube, MSW, ACSW, BCD, LCSW, MPH; and many others who
are part of the transplant teams at the Thomas E. Starzl Transplant Institute at the University of
Pittsburgh.
We would like to thank Dana Bigelow, development editor at Informa Healthcare, for her
patience and guidance as well as Alan Kaplan, project editor at Informa Healthcare, and Paula
Garber, editorial supervisor at the Egerton Group. Thanks also to Chris DiBiase for the cover
illustrations.
We would also like to thank Judy Canelos, M.A., Communications Specialist II, and
Miranda G. Rosen, Web Editor/Medical Writer, for their help in proofreading and editing the
manuscripts. Without their valued help and participation, this book could not have been com-
pleted. We also want to thank Diana Smith, Administrative Assistant, for her help in preparing
the manuscripts.
Finally, we would like to thank our families, especially our wives (Robin, Cristina, and
Mary), for their love and support; our live donors, for their altruistic acts; our recipients, for
their courage and faith in us; and Dr. Thomas E. Starzl, for providing challenges, inspiration,
and a vision.
Contents
Preface …. v
Acknowledgments …. vii
Contributors …. xiii
Part I: Overview
1. Live-Donor Organ Transplantation: Then and Now 1
Thomas E. Starzl and Amadeo Marcos
2. Psychosocial Aspects of Living Organ Donation 7
Mary Amanda Dew, Galen E. Switzer, Andrea F. DiMartini,
Larissa Myaskovsky, and Megan Crowley-Matoka
3. General Medical Evaluation of the Living Donor 27
Jerry McCauley, Thomas Shaw-Stiffel, and Henkie P. Tan
Part II: Living-Donor Kidney Transplantation
4. Evaluation: Specific Issues for Living-Donor Kidney Transplantation 33
Mark Unruh, Christine Wu, Henkie P. Tan, and Jerry McCauley
5. Technical Aspects of Live-Donor Nephrectomy 49
Amit Basu, Ron Shapiro, John L. Falcone, and Henkie P. Tan
6. Perioperative Donor Risk 69
Henkie P. Tan, Zebulon Z. Spector, and Ron Shapiro
7. Long-Term Risks of Living Donation 77
Connie L. Davis
8. Long-Term Outcomes for the Donor 87
Arthur J. Matas and Hassan Ibrahim
9. Donor and Recipient Outcomes After Laparoscopic Live-Donor Nephrectomy 101
Henkie P. Tan, David J. Kaczorowski, Amit Basu, Joseph Donaldson, and Ron Shapiro
10. Immunologically Incompatible Renal Transplants: Highly Sensitized Recipients,
Positive Crossmatches, and ABO Blood Group Incompatibility 113
Lloyd E. Ratner and R. John Crew
11. Expanding Live-Donor Renal Transplantation Through Paired and
Nondirected Donation 125
Dorry L. Segev, Sommer E. Gentry, Henkie P. Tan, and Robert A. Montgomery
12. Living-Donor Renal Transplantation in HIV Positive Recipients 137
Henkie P. Tan, David J. Kaczorowski, Amadeo Marcos, and Ron Shapiro
x Contents
13. Pediatric Living-Donor Kidney Transplantation 149
Vivek Sharma, Ron Shapiro, Demetrius Ellis, and Henkie P. Tan
Part III: Living-Donor Liver Transplantation
14. Evaluation: Specific Issues 159
Vladimir Bogin, Henkie P. Tan, Amadeo Marcos, and Thomas Shaw-Stiffel
15. Technical Aspects of Live-Donor Hepatectomy 169
Vivek Sharma, Henkie P. Tan, J. Wallis Marsh, and Amadeo Marcos
16. Donor Outcomes 185
Henkie P. Tan, Abigail E. Martin, Arman Kilac, Roberto Lopez, and Amadeo Marcos
17. Recipient Outcomes After Living-Donor Liver Transplantation 197
James J. Pomposelli, Elizabeth A. Pomfret, and Roger L. Jenkins
18. Adult Recipient Outcomes: The Pittsburgh Experience with Alemtuzumab
Preconditioning and Tacrolimus Monotherapy—Two-Year Outcomes 207
Henkie P. Tan, Kusum Tom, Ngoc L. Thai, Paulo Fontes, Michael DeVera,
Joseph Donaldson, Igor Dvorchik, and Amadeo Marcos
19. Pediatric Living-Donor Liver Transplantation 217
Kyle Soltys, Geoffrey Bond, Rakesh Sindhi, Henkie P. Tan, Amadeo Marcos,
and George V. Mazariegos
20. Living-Donor Liver Transplantation for Hepatocellular Carcinoma 227
J. Wallis Marsh, Matthew P. Holtzman, and Igor Dvorchik
Part IV: Living-Donor Pancreas Transplantation
21. Living-Donor Pancreas Transplantation 235
Miguel Tan, Raja Kandaswamy, David E. R. Sutherland, and
Rainer W. G. Gruessner
Part V: Living-Donor Islet-Cell Transplantation
22. Islet-Cell Transplant: Evaluation, Technical Aspects, and Donor and
Recipient Outcomes 245
Juliet A. Emamaullee and A. M. James Shapiro
Part VI: Living-Donor Lung Transplantation
23. Living Lobar-Lung Transplantation 259
Mark L. Barr and Vaughn A. Starnes
Part VII: Living-Donor Intestinal Transplantation
24. Intestinal Transplantation from Living Donors: Specific Issues and
Donor/Recipient Evaluation 269
Luca Cicalese
25. Living-Donor Intestinal Transplantation: Surgical Technique 281
Luca Cicalese
26. Living-Donor Intestinal Transplantation: Clinical Outcomes 297
Luca Cicalese and Shimul A. Shah
Contents xi
Part VIII: Hematopoietic Stem-Cell Transplantation
27. Collection, Processing, and Infusion of Adult Hematopoietic Stem Cells
(Bone Marrow and Peripheral Blood Stem Cells) 309
Leslie A. Andritsos, Candace Paprocki, and Andrew M. Yeager
28. Applications and Outcomes of Autologous and Allogeneic Hematopoietic
Stem-Cell Transplantation 319
Gregory Gerstner, Jennifer Christian, and Andrew M. Yeager
29. Umbilical-Cord Blood-Cell Transplantation 329
Michael L. Graham, Martin Andreansky, and Andrew M. Yeager
Part IX: Special Topics in Living-Donor Transplantation
30. Anesthesia for Living-Donor Transplantation 341
Raymond M. Planinsic
31. Management of Infections in Living-Donor Transplant Recipients 363
Fernanda P. Silveira and David L. Paterson
32. Pregnancy After Living-Donor Transplantation 379
Vincent T. Armenti, Michael J. Moritz, and John M. Davison
33. Financial Impact of Living-Donor Organ Transplantation 395
Liise K. Kayler, Abigail E. Martin, and Henkie P. Tan
34. Transplantation Tolerance 405
Fadi G. Lakkis
35. Ethics of Paid Living-Unrelated Donation: The Case for a Regulated System
of Kidney Sales 417
Arthur J. Matas
36. Do No Harm: The Case Against Organ Sales from Living Persons 431
Arthur L. Caplan
Part X: Sample Consent Forms to Living Kidney and Liver Donation
37. Consent to Living Kidney Donation 435
Henkie P. Tan, Amadeo Marcos, and Ron Shapiro

38. Consent to Living Partial-Liver Donation 441
Henkie P. Tan, Ron Shapiro, and Amadeo Marcos
Index …. 449