Understanding the Complexities of Kidney Transplantation

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- Kidney transplantation is a complex field that incorporates several different specialties to manage the transplant patient. This book was created because of the importance of kidney transplantation. This volume focuses on the complexities of the transplant patient. In particular, there is a focus on the comorbidities and special considerations for a transplant patient and how they affect kidney transplant outcomes. Contributors to this book are from all over the world and are experts in their individual fields. They were all individually approached to add a chapter to this book and with their efforts this book was formed. Understanding the Complexities of Kidney Transplantation gives the reader an excellent foundation to build upon to truly understand kidney transplantation.
- The history of kidney transplantation is thought to have originated at the early beginning of the previous century with several attempts of Xenografting, and experimental works on vascular sutures (Küss & Bourget, 1992)1. But it really started more than 60 years ago with first attempts of deceased donor transplantation (DCD) and the first successful kidney transplantation of homozygote twins in Boston (Toledo-Pereyra et al, 2008)2. Belgian surgeons contributed to that field of medicine by performing in the early sixties the first ever organ procurement on a brain dead heart beating donor (DBD) (June 1963) (Squifflet, 2003)3. Later on, in the eighties, they published a first series of living unrelated donor (LURD) transplantations, as well as ABO-Incompatible living donor (ABO-Inc LD) transplantations. With the advent of Cyclosporine A, and later other calcineurin inhibitors such as Tacrolimus, with the advent of more potent immunosuppressive drugs (IS), the gap between the number of renal transplant candidates and the number of transplanted recipients was and is continuously increasing in Belgium and most countries. It opened the search for other sources of organs such as donors after cardiac death (DCD) defined with the Maastricht conference and the extended criteria donors (ECD) compared to standard criteria donors (SCD). In Belgium another source of DCD was identified after the promulgation in 2002 of a law on euthanasia. The Belgian example and all its historical measures could help others to fight against organ shortage and its consequences, organ trafficking, commercialization and tourism.
- Already in old civilizations, the Egyptians, the Greeks, the Romans, were dreaming and expecting morphological changes in the structure and behavior of the human body. Old mythologies with their sculptures and art offer many examples such as gods, heroes, sirens, tritons, centaurs which are “prefiguration” of the xenotransplantation era (Küss & Bourget, 1992)1. The real transplantation story started with Saints COSMAS and DAMIAN during the fourth century: the extraordinary influence of these physicians extended far beyond the Middle Ages and even into modern times (Squifflet, 2003)4. After learning the medical art, these legendary early Christian brothers were said to have earned so much grace through the Holy Spirit that they were able to banish all diseases from man and beast. Therefore, in the fourth century, they transplanted a Moor’s leg to their Sacristan (Fig. 1). In Rome, the healing brothers were venerated, but they were also martyred under Diocletian (Fig. 2) and subsequently canonized. Today, they are acknowledged as the patron Saints of Surgery.

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Understanding the Complexities of Kidney Transplantation

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