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View Full Profile. Largest kidney transplantation program in New England region. Nationally recognized pediatric liver transplant program in both patient outcomes and number of living donor transplants performed. Largest living donor kidney transplantation program in New England region. First Connecticut institution to provide kidney, liver and pancreas transplantation services. Unfortunately, many more patients are medically suitable for transplants than organs available. The waiting times are many years and growing longer. Many patients develop medical and surgical complications while waiting which may prevent them from receiving a deceased donor kidney transplant in the future.
Although the most commonly transplanted deceased donor kidneys come from previously healthy donors between the ages of 18 and 60, kidneys from other deceased donors have been successfully transplanted.
The goal of this program is to use organs from less traditional donors more effectively so that more patients can receive kidney transplants. Patients who are most likely to benefit from a kidney through this program are dialysis patients who are older and have a greater risk of problems, including death, while waiting for a transplant.
Accepting a kidney from an expanded criteria donor may shorten the waiting period for a transplant. Patients who are considered for this type of transplant also remain on the waiting list for standard kidney offers.
By accepting a kidney from a deceased donor who also had Hepatitis C, these patients could shorten the waiting time for a deceased donor kidney. The use of kidneys from donors who had Hepatitis C does not appear to have a harmful effect on the survival of the transplanted kidney or on the overall health of the patient, provided that he or she has been evaluated carefully before receiving the transplant.
A growing number of patients with end-stage renal disease are infected with the HIV virus. Through the use of effective antiviral therapy, these patients are surviving on dialysis with their HIV disease and are being considered more and more frequently for kidney transplantation. The success rate of kidney transplantation varies depending on whether the donated organ is from a living donor or a deceased donor as well as the medical circumstances of the recipient. Kidneys from living donors generally last longer.
Most kidney losses are due to rejection, but infections, circulation problems, cancer, and return of the original kidney disease can also cause kidney loss. In contrast, dialysis patients have fold greater chance of dying as compared to transplant recipients. Currently the organ supply cannot meet the demand and there is no foreseeable end to the problem.
Patients wait many years for a transplant. People are dying or becoming medically unsuitable for transplantation as these waiting times grow longer. Also, there are significant geographic differences in access to transplantation and wait times.
Transplant surgeon - Wikipedia
As each organ is a precious resource that should be utilized for maximum efficiency, the transplant community is changing the way kidneys are distributed to patients on the waiting list. Some patients may benefit, others are disadvantaged, and a delicate balance must be struck between fairness and equality.
On one hand, organs are a scarce resource and could be given to patients who would maximize the duration of the transplanted organ. In contrast organs are a societal resource that could be distributed to all potential patients based on waiting time. These two views represent utility versus equity in organ allocation. The final decision regarding the allocation policy will likely fall somewhere in between the two viewpoints. Even with creative ways to utilize more living and deceased donors, another source of kidneys is most likely necessary.
Xenotransplantation has already occurred from non-human primate donors such as chimpanzees, monkeys and baboons. However these animals are endangered species and the size and blood type differences as well as the concern of transmission of infectious diseases has led to a ban of these transplants by the Food and Drug Administration.
Currently most of the research in this field is centered on the pig as the potential xenograft donor. Pigs have desirable characteristics: multiple offspring, rapid maturity to adult age, lower risk of transmissible infectious diseases and appropriate size. The many barriers to successful xenotransplantation are under study and continued advances may lead to this type of transplantation solving the organ shortage crisis. With the short supply of organs and long waiting times, patients are now traveling outside of the United States to receive a kidney transplant.
Commercialism and poor regulation can undermine the true nature of transplantation and put patient's lives at risk. Lifelong immunosuppression is a tremendous burden on patients. Tolerance, or the ability of the body to "accept" an organ without daily anti-rejection medication has been the "Holy Grail" of transplantation. Many animal models as well as isolated reports of patients being withdrawn from these medications are encouraging. Most of the successful models incorporate intensive medication at the time of transplant with bone marrow infusions from the donor that supplied the organ.
The recipient incorporates the bone marrow cells, becomes "chimeric" and the new bone marrow cells re-educate the recipient to accept the organ. There are many issues to be refined in human transplantation but scientists and clinicians are working together to eliminate the need for lifelong immunosuppression. Continued advances in our understanding of the mechanisms involved in the acceptance of a kidney transplant has led to new and exciting medications. After testing the new medications in animal models, these drugs move into human clinical trials.
The great success of transplantation has occurred as a result of basic science research, careful testing of innovative medications and patients' willingness to participate in controlled studies of new medications. Even tolerance protocols will require short term administration of new immunosuppressive medication. The cooperation and participation of patients in clinical trials is essential to keep the field of kidney transplantation moving forward.
They provided insight, guidance, writing and production of the educational materials produced for patients and families undergoing kidney transplantation at UCSF. These educational materials provided the framework for this article. Nancy L. Ascher, M. Deborah Adey, M. Sandy Feng, M. Chris Friese, M. Ryutaro Hirose, M.
Sang Mo Kang, M.
D Andrew Posselt, M. D Eric Savransky, M. Peter G. Stock, M. Flavio Vincenti, M. John Roberts, M. Julie Yabu, M.
- Home birth : the politics of difficult choices;
- Hillman Center for Pediatric Transplantation.
- The Vulgar Tongue: Greens History of Slang.
- Transplant Surgery - Brigham and Women's Hospital.
- Defunct Federalisms (Federalism Studies).
- Transplant Team Roles.
- Ward 5B Transplantation and Liver Surgery.
Amer J Transplant ; 7[Suppl 1]: Am J Transplant ; 6: Am J Transplant ; 7[Suppl 1]: Delmonico F; Council of the Transplantation Society. A report of the Amsterdam Forum on the care of the live kidney donor: data and medical guidelines. Transplantation ; 79 [6 Suppl]: S Living donor kidney transplantation: a review of the current practices for the live donor.
J Am Soc Nephrol ; Nephrol Dial Transplant ; Lancet ; Transplantation ; Kidney Transplant Chronic kidney disease is a major health concern in this country afflicting more than eight million Americans. Normal Kidney Function The kidneys are organs whose function is essential to maintain life.
Filtration of the blood to remove waste products from normal body functions, passing the waste from the body as urine, and returning water and chemicals back to the body as necessary. Regulation of the blood pressure by releasing several hormones. Stimulation of production of red blood cells by releasing the hormone erythropoietin. Kidney Disease When the kidneys stop working, renal failure occurs. Common Causes of End-Stage Renal Disease Diabetes mellitus High blood pressure Glomerulonephritis Polycystic Kidney Disease Severe anatomical problems of the urinary tract Treatments for End-stage Renal Disease The treatments for end-stage renal disease are hemodialysis, a mechanical process of cleaning the blood of waste products; peritoneal dialysis, in which waste products are removed by passing chemical solutions through the abdominal cavity; and kidney transplantation.
Kidney Transplantation Kidneys for transplantation come from two different sources: a living donor or a deceased donor. The Living Donor Sometimes family members, including brothers, sisters, parents, children 18 years or older , uncles, aunts, cousins, or a spouse or close friend may wish to donate a kidney. Deceased Donor A deceased donor kidney comes from a person who has suffered brain death.
Transplant Evaluation Process Regardless of the type of kidney transplant-living donor or deceased donor-special blood tests are needed to find out what type of blood and tissue is present. Blood Type Testing The first test establishes the blood type. Tissue Typing The second test, which is a blood test for human leukocyte antigens HLA , is called tissue typing.
Crossmatch Throughout life, the body makes substances called antibodies that act to destroy foreign materials. Serology Testing is also done for viruses, such as HIV human immunodeficiency virus , hepatitis, and CMV cytomegalovirus to select the proper preventive medications after transplant. Phases of Transplant Pre-transplant Period This period refers to the time that a patient is on the deceased donor waiting list or prior to the completion of the evaluation of a potential living donor.
These may include, but are not limited to: General Health Maintenance: general metabolic laboratory tests, coagulation studies, complete blood count, colonoscopy, pap smear and mammogram women and prostate men Cardiovascular Evaluation: electrocardiogram, stress test, echocardiogram, cardiac catheterization Pulmonary Evaluation: chest x-ray, spirometry Potential Reasons of Excluding Transplant Recipient Uncorrectable cardiovascular disease History of metastatic cancer or ongoing chemotherapy Active systemic infections Uncontrollable psychiatric illness Current substance abuse Current neurological impairment with significant cognitive impairment and no surrogate decision maker Transplant Surgery The transplant surgery is performed under general anesthesia.
The following complications do not occur often but can include: Bleeding, infection, or wound healing problems. Difficulty with blood circulation to the kidney or problem with flow of urine from the kidney. These complications may require another operation to correct them. Anti-Rejection Medications Anti-rejection medications, also known as immunosuppressive agents, help to prevent and treat rejection.
It was found that extremely thin pieces of skin could be cut free and would obtain enough nourishment from the serum in the graft bed to stay alive while new blood vessels were being formed.
Department of General, Visceral and Transplantation Surgery
This free grafting of skin, together with the flap techniques already mentioned, constituted the main therapeutic devices of the plastic surgeon in the correction of various types of defects. Skilled manipulations of such grafts produced surprising improvements in the appearance of those born with malformed faces and in the disfigurements resulting from severe burns.
Cornea , which structurally is a modified form of transparent skin, can also be free grafted, and corneal grafts have restored sight to countless blind eyes. Blood transfusion can be regarded as a form of tissue graft. The blood-forming tissues— bone marrow cells—can also be transplanted. If these cells are injected into the bloodstream, they home to the marrow cavities and can become established as a vital lifesaving graft in patients suffering from defective marrow.
The chief distinguishing feature of organ and limb grafts is that the tissues of the organ or limb can survive only if blood vessels are rapidly joined anastomosed to blood vessels of the recipient. This provides the graft with a blood supply before it dies from lack of oxygen and nourishment and from the accumulation of poisonous waste products. As can be seen from the examples cited, living-tissue grafts may be performed for a variety of reasons.
Skin grafts can save life in severe burns , can improve function by correcting deformity, or can improve appearances in a cosmetic sense, with valuable psychological benefits. Organ grafts can supply a missing function and save life in cases of fatal disease of vital organs, such as the kidney.
A tissue removed from one part of the body and transplanted to another site in the same individual is called an autograft. Autografts cannot be rejected. Similarly, grafts between identical twins or highly inbred animals— isografts—are accepted by the recipients indefinitely.