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Books on the topic 'Transplants; Immunosuppression; Grafts'

Author: Grafiati

Published: 4 June 2021

Last updated: 4 February 2022

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1

Oremus, Mark. Utility of monitoring mycophenolic acid in solid organ transplant patients. Rockville, MD: Agency for Healthcare Research and Quality, 2008.

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2

Nessralla, Laurie-Ann. Incidence of rejection, morbidity, mortality and graft function in renal transplant recipients following cyclosporine to azathioprine switch. [New Haven: s.n.], 1990.

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3

Retter, Andrew. Management of the bone marrow transplant recipient in ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0375.

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Bone marrow transplants are an exciting and rapidly evolving area of haematology providing life-saving therapy to many patients and the number performed annually is increasing. Transplants are generally not considered as first line therapy due to their inherent toxicity and high rate of complications. The patients tend to have more heavily pre-treated disease with it attendant toxicities and a decreased physiological reserve. Admission rates vary between series from 15 to 30%. It is increasingly important that intensivists are aware of the basic principles of bone marrow transplantation and its’ possible morbidities. There are two types of transplant autologous transplants, where the patient’s own stem cells are returned to them and transplants from a donor. Only allogeneic transplants are associated with graft-versus-host disease. Allograft recipients also require immunosuppression to prevent transplant rejection. It is essential that this immunosuppression is continued when patients are admitted to intensive care. Transplant patients are always severely immunocompromised and prone to prolonged periods of neutropenia. They routinely receive antiviral, antifungal, and antibacterial prophylaxis, which must be continued on their admission. They remain vulnerable to unusual infections presenting in an atypical fashion. It is essential to have both a very low clinical threshold of suspicion for infection and detailed local protocols established to guide empirical antimicrobial therapy. Although traditionally poor, the prognosis is slowly improving.

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4

Barrett, Jessica, and Martin Carby. Transplant. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0021.

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Since the first successful lung transplant in 1981, tens of thousands of operations have been performed across the world. Yet despite significant technical advances, mortality is the highest of any solid organ transplant. Most patients will have a major complication within the first 5 years of the operation. These are best managed in transplant centres. However, a working knowledge of the presentation and initial management is essential for a respiratory physician. Although the rate of complications remains high, more than 80% of patients with surviving transplants report no limitation of activity at 1, 3, and 5 years. Developments in surgical technique have reduced immediate complications, and immunosuppressive regimens continue to improve. However, the incidence of obliterative bronchiolitis remains high and is responsible for the majority of graft failures.

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5

Gruenewald, Simon, and Philip Vladica. Renal transplant imaging. Edited by Jeremy R. Chapman. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0282.

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The purpose of imaging of the transplant kidney is to assess integrity, anatomy, and function. Relatively or actually non-invasive technologies can be used to monitor for potential early post-transplant complications such as acute tubular necrosis, acute rejection, haematoma, pyelonephritis, abscess, urinoma, ureteral obstruction, vascular complications, and rarely graft torsion. The technologies also assist in the diagnosis and management of late complications such as those arising from immunosuppression, chronic rejection, lymphocoele, cyst, renal artery stenosis, urinary obstruction, and tumours. This chapter demonstrates the capacity of the various imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging, to assist in the clinical management of the renal transplant recipient.

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6

Melville, Williams G., Burdick James F. 1941-, and Solez Kim 1946-, eds. Kidney transplant rejection: Diagnosis and treatment. New York: M. Dekker, 1986.

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7

1968-, Oremus Mark, Zeidler Johannes, and United States. Agency for Healthcare Research and Quality., eds. Utility of monitoring mycophenolic acid in solid organ transplant patients. Rockville, MD: Agency for Healthcare Research and Quality, 2008.

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8

1968-, Oremus Mark, Zeidler Johannes, and United States. Agency for Healthcare Research and Quality., eds. Utility of monitoring mycophenolic acid in solid organ transplant patients. Rockville, MD: Agency for Healthcare Research and Quality, 2008.

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9

Utility of monitoring mycophenolic acid in solid organ transplant patients. Rockville, MD: Agency for Healthcare Research and Quality, 2008.

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10

Knight, Simon R., and Rutger J. Ploeg. Immediate post-transplant care and surgical complications. Edited by Jeremy R. Chapman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0280_update_001.

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Care of the post-transplant kidney patient is complex and requires multidisciplinary team working. Careful attention is paid to haemodynamics, fluid balance, microbiology, drug prescription, and patient instruction. Delays in, or reduction of, graft function should be investigated and treated immediately to ensure long-term graft survival. Because complications do occur, they must be recognized early and dealt with promptly. The nature of the transplant operation and the need for immunosuppression mean that the complications differ from those of ordinary general surgical patients, and so require specialist medical, microbiological, or radiological input with a narrower time window for correction. This chapter covers the immediate postoperative care of the renal transplant recipient both as an inpatient and the early period as an outpatient, highlighting the potential complications and their management.

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11

Ramsay, Michael A. E. Anaesthesia for transplant surgery. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0067.

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The provision of anaesthesia for organ transplantation requires a team of specialist anaesthetists who are available 24 hours a day. The cold and warm ischaemia times may have very deleterious effects on the graft. The team must have a basic understanding of the immune system and the strategies of immunosuppression therapy. The preoperative assessment of the patient requires an understanding of the cause and effects of the compromised organ that is to be replaced. The procedure in many instances will result in a reperfusion syndrome when the graft is revascularized and also an ischaemia–reperfusion injury. The understanding of these entities is essential as is the preparation and protocols to treat or ameliorate the effects of these syndromes if they occur. The preparation for many organ transplants includes invasive monitoring of haemodynamics, cardiac function, pulmonary function, and acid–base balance. Access for massive transfusion therapy and coagulation assessment is essential for many transplant procedures. The maintenance of body temperature and fluid balance may be challenging. The protection and monitoring of the function of major organs such as the brain, heart, lungs, and kidneys is essential but the homeostasis of endocrine function and electrolytes is also important. The provision of excellent anaesthesia is a key component of a successful transplant programme. A small team of highly trained professionals with extensive training and experience in transplant anaesthesia provide the best results.

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12

1948-, Racusen Lorraine C., Solez Kim 1946-, and Burdick James F. 1941-, eds. Kidney transplant rejection: Diagnosis and treatment. 3rd ed. New York: M. Dekker, 1998.

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13

Williams, G. Melville. Kidney Transplant Rejection: Diagnosis and Treatment (Kidney Disease Series, Vol 7). Marcel Dekker Inc, 1986.

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14

Rush, David N., and Peter W. Nickerson. Rejection. Edited by Jeremy R. Chapman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0283_update_001.

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Rejection of the transplanted kidney is an important cause of graft loss despite modern cross-matching techniques and immunosuppressive agents. The incidence of acute rejection episodes in the first post-transplant year is down to less than 15% in low-risk recipients, but as many as one-third of allograft losses over 10 years result from alloimmunity. Rejection may occur at any time following transplantation, from minutes—hyperacute, to days—acute, or in the longer term—chronic. Rejection can be predominantly through either T-cell-mediated or antibody-mediated mechanisms. It may present clinically as either abrupt or insidious dysfunction of the graft, or it may be subclinical and thus silent, detected only by protocol biopsy or other technology. The prevention and treatment of T-cell-mediated rejection is usually successful with current immunosuppressive agents. Antibody-mediated rejection, on the other hand, is not easily treated and is the principal cause of late renal allograft loss. This chapter presents the concepts and details of this central issue in clinical transplantation.

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15

1941-, Burdick James F., ed. Kidney transplant rejection: Diagnosis and treatment. 2nd ed. New York: Dekker, 1992.

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16

Solez, Kim, James F. Burdick, and Lorraine C. Racusen. Kidney Transplant Rejection: Diagnosis and Treatment (Kidney Disease, Vol. 9). 2nd ed. Marcel Dekker Inc, 1991.

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17

Kulkarni, Kunal, James Harrison, Mohamed Baguneid, and Bernard Prendergast, eds. Transplantation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198729426.003.0030.

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Organ transplantation is now a well-established therapy for patients with end-stage organ failure. Over the last 20 years, the results of transplantation have improved incrementally for many reasons, including better recipient selection, improved anaesthetic and surgical techniques, the introduction of more effective antiviral agents, and better post-transplant immunosuppressive management. The problem of early graft loss from acute rejection is now uncommon, and the main challenges today are chronic allograft rejection and the side effects of non-specific suppression of the immune response. Randomized clinical trials continue to inform and further improve clinical practice. Because transplantation today is largely successful, the traditional endpoints of 1-year patient and graft survival are no longer sufficient, and more sophisticated endpoints are needed that reflect graft function and quality of life after transplantation. This chapter brings together studies which recognize this need for clinical trials which improve practice and focus on more broadly defined endpoints.

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18

Rees, Lesley. Growth and development. Edited by Norbert Lameire and Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0291.

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Enabling achievement of full height potential in a child with chronic kidney disease (CKD) is one of the major and most challenging goals for the paediatric nephrologist. Short stature is associated with psychological maladjustment and with increased morbidity and mortality. The causes of poor growth are multifactorial and include poor nutrition, and metabolic, haematological, and endocrine disturbances. The most vulnerable times are the periods of most rapid growth, that is, infancy and puberty. Growth during infancy is principally dependent on nutrition so many infants need supplemental enteral feeding. Growth delay correlates with severity of CKD, with those on dialysis faring the worst such that by CKD stage 5, approximately 25% of patients are below the normal range for height. Height achieved post transplant is dependent on graft function and is better in younger children and those who have the best height attainment pre transplant. The use of steroid-free immunosuppressive regimens is encouraging. The prognosis for final height is improving.

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19

Morris, Peter J., and Jeremy R. Chapman. The evolution of kidney transplantation. Edited by Jeremy R. Chapman. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0275.

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The history of kidney transplantation starts in 1902 with Ullman transplanting kidneys between dogs, and Carrel’s development of vascular anastomotic techniques. The developments in the 1950s in Boston, Paris, and the laboratories of Medawar and others demonstrated both proof of the principle and some of the barriers to clinical kidney transplantation. The 1960s laid the groundwork for organ preservation, immunosuppression, and histocompatibility leading to the creation of transplant units in many countries. In the 1970s, there was steady progress in understanding the immunology of allograft rejection and its suppression. The advent of azathioprine used with steroids in the early 1960s resulted in 1-year graft survival rates of around 60% and patient survival of 90% in good units. However, with the introduction of ciclosporin in the early 1980s, renal transplantation became an even more reliable renal replacement option as there was a dramatic reduction in the incidence of irreversible acute rejection. The 1990s saw the introduction of both better immunosuppression and better infection prophylaxis, which further improved patient outcomes. The first decade of the twenty-first century has been characterized by the promise of new technologies in many areas, only some of which have delivered clinical benefit. Molecular human leucocyte antigen (HLA) typing and detection of antibodies to HLA antigens, standardized immunosuppression and anti-infective prophylaxis, surveillance biopsy, and developing systems for increasing donation rates are delivering major benefits. Gene biomarkers, stem cell therapy, and tolerance protocols have yet to make an impact. This chapter describes the historical development of transplantation and how it has yielded the results delivered in clinical practice today.

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