Quick Guide to Kidney Transplantation

https://musicboxcle.com/2025/04/f9hv4fpd Preface Acknowledgments Contributors 1. Transplant Immunobiology ABO BLOOD GROUP ANTIGENS MAJOR HISTOCOMPATIBILITY COMPLEX, HUMAN LEUKOCYTE ANTIGEN MOLECULES HUMAN LEUKOCYTE ANTIGEN–TYPING TECHNIQUES Serotyping DNA typing Human leukocyte antigen nomenclature MINOR HISTOCOMPATIBILITY ANTIGEN NON–HUMAN LEUKOCYTE ANTIGENS ALLORECOGNITION PATHWAYS: DIRECT, INDIRECT, AND SEMIDIRECT ALLORECOGNITION HUMAN LEUKOCYTE ANTIGEN ALLOSENSITIZATION TECHNIQUES FOR DETECTION OF ANTI–HUMAN LEUKOCYTE ANTIGEN ANTIBODIES: GENERAL CONCEPTS CELL-BASED CYTOTOXICITY PANEL REACTIVE ANTIBODY ASSAY SOLID-PHASE ASSAYS USING LUMINEX TECHNOLOGY PRETRANSPLANTATION CROSSMATCH VIRTUAL CROSSMATCH IMMUNOLOGIC EVALUATION OF THE TRANSPLANT CANDIDATES REFERENCES 2. Immunosuppression THE THREE-SIGNAL MODEL OF ALLOIMMUNE RESPONSES TARGETS OF VARIOUS IMMUNOSUPPRESSIVE AGENTS BASIC PRINCIPLES OF AN IMMUNOSUPPRESSIVE PROTOCOL SIDE EFFECT PROFILES, DRUG-DRUG INTERACTIONS, NURSING AND DIETARY CONSIDERATIONS OTHER IMMUNOSUPPRESSIVE AGENTS (ALSO SUMMARIZED IN CHAPTER 3) REFERENCES 3. Allograft Rejection: Types and Treatment Strategie ALLOGRAFT REJECTION: HYPERACUTE, ACUTE, AND CHRONIC Hyperacute rejection Acute rejection Chronic rejection TREATMENT OF ACUTE REJECTION Overview Treatment of acute T cell–mediated rejection based on Banff classification Treatment of chronic active T cell–mediated rejection Treatment of acute antibody-mediated rejection Donor-specific antibody testing after plasmapheresis or plasma exchange to assess treatment response IVIG and rituximab recycling process Treatment of chronic active antibody-mediated rejection Manipulation of maintenance immunosuppression following treatment of acute T cell–mediated rejection or acute antibody-mediated rejection Suggested prophylactic antibiotics and antiviral therapy following treatment of acute rejection episodes (practice may vary among transplant centers) POSTTRANSPLANT IMMUNE MONITORING/SURVEILLANCE REFERENCES 4. Evaluation of the Potential Kidney Transplant Candidates KIDNEY TRANSPLANTATION VERSUS DIALYSIS KIDNEY TRANSPLANT EVALUATION PROCESS AND GENERAL ASSESSMENT EVALUATION BY ORGAN SYSTEM PATIENTS WITH SPECIFIC CONDITIONS SPECIFIC KIDNEY DISEASE END-STAGE KIDNEY DISEASE ASSOCIATED WITH HEMATOLOGIC MALIGNANCY HIGHLY SENSITIZED CANDIDATES EVALUATION OF PATIENTS FOR A REPEAT TRANSPLANT REFERENCES 5. Living Donor Evaluation GENERAL EVALUATION EVALUATION FOR SPECIFIC CONDITIONS HEREDITARY RENAL DISEASE INFECTIOUS DISEASE SCREENING CANCER SCREENING PREGNANCY MEDICAL CLEARANCE FOR DONOR NEPHRECTOMY SURGICAL EVALUATION DONOR SAFETY AND LONG-TERM RENAL FUNCTION REFERENCES 6. Deceased Donor Kidney Allocation, Strategies to Expand the Living Donor Pool, and Waitlist Management UNITED NETWORK FOR ORGAN SHARING LISTING CRITERIA DECEASED DONOR KIDNEY ALLOCATION SYSTEM IN THE UNITED STATES STRATEGIES TO EXPAND THE LIVING DONOR POOL Laws, ethics, and financial aspects of living kidney donation Patient education Living donor options Kidney paired donation registries and organ import/export exchange coordination of care WAITLIST MANAGEMENT Factors affecting waiting time Kidney donor options to reduce waiting time Waitlist management dynamics United Network for Organ Sharing listing status ONGOING HEALTH MAINTENANCE AND SCREENING Cancer screening Acquired cystic kidney disease and renal cell carcinoma screening Cardiovascular screening Infectious disease screening REFERENCES 7. Early and Late Posttransplant Graft Dysfunction GENERAL ASSESSMENT GRAFT DYSFUNCTION IN THE PERIOPERATIVE PERIOD (FIRST POSTOPERATIVE WEEK) GRAFT DYSFUNCTION IN THE EARLY POSTTRANSPLANT PERIOD (1 WEEK TO 3 MONTHS POSTTRANSPLANT) GRAFT DYSFUNCTION IN THE LATE POSTTRANSPLANT PERIOD (>3 MONTHS) REFERENCES 8. Glomerular Disease Recurrence After Transplantation BACKGROUND IMMUNOGLOBULIN A NEPHROPATHY Pathophysiology of immunoglobulin A nephropathy in native kidneys Recurrence of Immunoglobulin A nephropathy Treatment FOCAL SEGMENTAL GLOMERULOSCLEROSIS Pathophysiology of focal segmental glomerulosclerosis in native kidneys Recurrence of focal segmental glomerulosclerosis Clinical presentation Treatment MEMBRANOUS NEPHROPATHY Pathophysiology of membranous nephropathy in native kidneys Recurrence of membranous nephropathy Clinical manifestations Treatment MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS Pathogenesis of membranoproliferative glomerulonephritis in native kidneys Recurrence of membranoproliferative glomerulonephritis Treatment ATYPICAL HEMOLYTIC UREMIC SYNDROME Recurrence of atypical hemolytic uremic syndrome Clinical presentation Treatment LUPUS NEPHRITIS Pathophysiology of lupus nephritis in native kidneys Recurrence of lupus nephritis Treatment ANTI–GLOMERULAR BASEMENT MEMBRANE DISEASE Pathophysiology of anti–glomerular basement membrane disease in native kidneys Recurrence of anti–glomerular basement membrane disease Treatment ANTINEUTROPHIL CYTOPLASMIC AUTOANTIBODY–ASSOCIATED VASCULITIS Pathophysiology of antineutrophil cytoplasmic autoantibody–associated vasculitis Recurrence of antineutrophil cytoplasmic autoantibody–associated vasculitis Clinical presentation Treatment REFERENCES 9. Kidney Allograft Biopsy: Banff Classification and Other Transplant Histopathology REFERENCES GENERAL OVERVIEW BANFF CLASSIFICATION CATEGORIES OTHERS (NOT CLASSIFIED UNDER BANFF CATEGORIES) 10. Common Posttransplant Abnormal Laboratory Findings POSTTRANSPLANT ANEMIA LEUKOPENIA AND THROMBOCYTOPENIA POSTTRANSPLANT ERYTHROCYTOSIS COMMON ELECTROLYTE, ACID-BASE, AND CALCIUM AND PHOSPHOROUS ABNORMALITIES Hyponatremia Hyperkalemia Hypokalemia Hypocalcemia Hypercalcemia Hypomagnesemia Hypophosphatemia Acid-base disorders ABNORMAL LIVER FUNCTION TESTS REFERENCES 11. Mineral and Bone Disorders After Kidney Transplantation REFERENCES CALCIUM PHOSPHORUS PARATHYROID HORMONE VITAMIN D BONE DISEASE Spectrum of bone disease 12. Urologic Considerations in the Kidney Transplant Patient PRETRANSPLANT UROLOGIC CONSIDERATIONS THE IMMEDIATE POSTTRANSPLANT PERIOD LONG-TERM UROLOGIC CONCERNS OTHER UROLOGIC CONSIDERATIONS REFERENCES 13. Posttransplantation Infectious Complications and Vaccinations VACCINATIONS INTERNATIONAL TRAVEL VACCINATION RECOMMENDATIONS/WEBSITE RISK FACTORS FOR POSTTRANSPLANTATION INFECTIOUS COMPLICATIONS TIMETABLE OF POSTTRANSPLANTATION INFECTIOUS COMPLICATIONS RECURRENT URINARY TRACT INFECTION WORKUP AND MANAGEMENT SCREENING AND MANAGEMENT OF COMMON POSTTRANSPLANTATION VIRAL INFECTIONS Cytomegalovirus BK polyomavirus Commonly encountered viral infections Posttransplantation diarrhea and common gastrointestinal infections POTENTIAL EXPOSURE TO INFECTIOUS AGENTS: WHAT TO DO REFERENCES 14. Posttransplantation Cardiovascular Disease POSTTRANSPLANTATION HYPERTENSION POSTTRANSPLANTATION DYSLIPIDEMIA POSTTRANSPLANTATION DIABETES MELLITUS General overview Screening and management of posttransplantation diabetes mellitus POSTTRANSPLANTATION OBESITY CIGARETTE SMOKING POSTTRANSPLANTATION PROTEINURIA REFERENCES 15. Posttransplantation Malignancies GENERAL OVERVIEW SKIN CANCERS POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD) KAPOSI SARCOMA RENAL CELL CARCINOMA COLORECTAL CANCER GENERAL MANAGEMENT OF IMMUNOSUPPRESSION REFERENCES 16. Kidney Transplantation in Dual Organ Transplantation KIDNEY ALLOCATION IN DUAL ORGAN TRANSPLANTATION SIMULTANEOUS LIVER-KIDNEY TRANSPLANTATION TRANSPLANT OPTIONS FOR TYPE I DIABETICS WITH DIABETIC END-STAGE KIDNEY DISEASE SIMULTANEOUS HEART-KIDNEY TRANSPLANTATION REFERENCES 17. Nutrition Care for Adult Kidney Transplant Candidates and Recipients NUTRITION: GENERAL OVERVIEW PRETRANSPLANT Nutrition assessment pretransplant Nutrition-related evaluation/waitlist concerns Obesity Malnutrition Metabolic Bone Disease Adherence POSTTRANSPLANT Early concerns (first 6-8 weeks posttransplant period) Nutrient needs Macronutrients Micronutrients Postoperative feeding Oral Feeding Nutrition Support Nutrient-drug interactions/side effects Food safety Long-term concerns Cardiovascular disease (CVD) and hypertension Weight management Osteoporosis/posttransplant bone disease Herbal supplements Prebiotics/probiotics Alcohol Special considerations Acute Rejection Episodes Progression of Renal Disease in Kidney Transplant Pregnancy Bariatric Surgery REFERENCES 18. Management of Patients with a Failed Transplant TIMING OF DIALYSIS REINITIATION IMMUNOSUPPRESSION MANAGEMENT GRAFT INTOLERANCE SYNDROME INDICATIONS FOR ALLOGRAFT NEPHRECTOMY THE IMPACT OF GRAFT NEPHRECTOMY ON A REPEAT TRANSPLANT ALLOGRAFT NEPHRECTOMY IN PATIENTS WITH GRAFT LOSS DUE TO BK NEPHROPATHY REFERENCES 19. Modern Age Transplantation Issues ORGAN TRAFFICKING AND TRANSPLANT TOURISM MARIJUANA IN TRANSPLANTATION Overview Marijuana policy “Medical marijuana” Cannabis use disorder Marijuana harms REFERENCES 20. Frequently Asked Questions REFERENCES Index