Main description:

This volume is based on a very successful meeting on organ transplantation that was held in Kuwait in 1990 under the auspices of the Middle East Society for Organ Transplantation. An international group of organ transplant experts attended this conference and their contributions and deliberations have been recent1y updated to produce this definitive and authoritative summary of current clinic al practice in organ transplantation. The initial chapters appropriately focus on the immunology of organ trans plantation with special emphasis on the initial events in the induction of alloreactivity, the mechanisms of rejection, and the potential for tolerance induction. A strong emphasis is placed on the diagnosis of rejection by cellular analysis. The section on immunosuppression deals with several new areas of clinical therapy. The section on renal transplantation is unique in several respects, the long-term results from various countries, including the Middle East, are summarized, the use of living unrelated donors and of ABO incom patible donors - all strategies to maximize organ availability - are presented.

Contents:

One: Historical Reflections.- 1. Reflections on the development of organ transplantation.- Two: Immunology of Organ Transplantation.- 2. Cellular and molecular mechanisms of allograft rejection.- 3. What does the alloreactive T cell see?.- 4. HLA matching and organ transplantation.- 5. An effective strategy for transplantation of highly sensitized patients.- 6. Rapid lymphocyte crossmatching for renal transplantation.- Three: Organ Allograft Rejection.- 7. Fifteen-year experience with fine needle aspiration biopsies at the University of Helsinki.- 8. Study of antibody specificity in highly sensitized patients using human monoclonal antibody technology.- 9. Idiotypic-Antiidiotypic antibody interaction and renal transplant survival.- Four: Immunosuppression.- 10. Transplantation and blood transfusion in 1990.- 11. Quadruple-drug immunosuppressive induction treatments for immunological high-risk patients in cadaveric renal transplantation using poly-and monoclonal antibodies.- 12. Sequential combination immunotherapy for cadaveric renal transplantation: OKT3 versus rabbit ATG induction.- 13. Multi-organ transplant experience with OKT3 and strategies for use at the University of Cincinnati Medical Center.- 14. Cyclosporine withdrawal in renal transplant recipients maintained on azathioprine, prednisone and cyclosporine.- 15. Early experience with FK 506 in liver transplantation.- 16. Deoxyspergualin. A novel immunosuppressant: experimental and clinical studies.- 17. Preliminary results with FK 506 in pancreas grafting in a nonhuman primate model.- 18. The effect of DST on graft outcome - the Turkish experience.- 19. Induction of specific unresponsiveness (tolerance) to experimental and clinical allografts using polyclonal antilymphocyte serum and donor-specific bone marrow.- 20. Comparison of cyclosporine assays using radioimmunoassay, fluorescent polarization immunoassay and high-performance liquid chromatography.- Five: Renal Transplantation.- 21. Long-term outcome in renal transplantation.- 22. Ten-year experience with 500 renal transplants.- 23. Long-term results in recipients of cadaveric renal allografts under cyclosporine therapy.- 24. Transplantation of single and double kidneys from pediatric donors.- 25. ABO-incompatible living related donor transplantation.- 26. The use of single pediatric cadaver kidneys for transplantation into adult recipients.- 27. Living unrelated donor renal transplantation.- 28. Renal transplantation in Tunisia - a three-year experience.- 29. Renal transplantation in children.- 30. Kidney donors - long-term follow up.- 31. Current techniques for permanent vascular access surgery - experience with 930 procedures.- 32. Results of 319 consecutive renal transplants from living related and living unrelated donors in Iran.- Six: Liver Transplantation.- 33. Liver transplantation: current status.- 34. An overview of liver transplantation therapy for children.- 35. Current anesthetic management in clinical liver transplantation.- 36. Risk factors in adult liver transplant recipients.- 37. The concept of reduced-size liver transplantation, including split-liver and living related liver transplantation.- 38. Immunological factors contributing to outcome in liver transplantation.- 39. Transplantation for hepatobiliary malignancies.- 40. The diagnosis and management of massive blood loss during liver transplantation.- 41. Early clinical experience with cluster resection and transplantation for right upper quadrant abdominal malignancy.- Seven: Heart/Heart-Lung Transplants.- 42. Lung transplantation: current techniques and outcomes.- 43. Heart-lung transplantation at the University of Minnesota.- 44. Specificity and sensitivity of the cytoimmunological monitoring (CIM): differentiation between cardiac rejection, viral, bacterial, or fungal infection.- Eight: Pancreas Transplantation.- 45. International Pancreas Transplantation Registry report.- 46. Techniques and experience of pancreatic transplantation with bladder drainage.- 47. Pancreas transplantation in non-uremic diabetic recipients.- 48. Early observation with pancreas transplantation using the bladder drainage procedure.- 49. Results of pancreas transplantation with irradiated spleen and segment of duodenum.- 50. Experience with pancreas transplants from living related donors.- Nine: Islet Cell Transplantation.- 51. Islet transplantation - the world Transplant Registry.- 52. Prevention of rejection of islet allografts and xenografts without continuous immunosuppression of the recipients.- 53. Effect of islet transplantation on diabetic secondary complications.- 54. Does pretreatment of islets of Langerhans with deoxyguanosine improve allograft survival without immunosuppression?.- Ten: Bone Marrow Transplantation.- 55. Current status of allogeneic bone marrow transplantation.- 56. New approach to bone marrow transplantation in thalassemia.- 57. Autologous bone marrow transplantation as treatment for bad-risk first remission acute lymphoblastic leukaemia.- 58. Conditioning regimens in bone marrow transplantation.- 59. The antileukaemic action of melphalan and total body irradiation in bone marrow transplantation.- 60. Antifungal prophylaxis with fluconazole in bone marrow transplantation.- Eleven: Xeno-Transplantation.- 61. Mass islet isolation from the pancreas of higher mammals: a potential source for islet transplantation in diabetic patients.- 62. The relationship of eicosanoids and complement components to hyperacute xenogeneic rejection and its modification by the PAF-antagonist WEB 2086BS.- 63. Antibody-induced rejection of established pig proislet xenografts in CD4+ T cell depleted diabetic mice.- Twelve: Complications in Organ Transplantation.- 64. Occurrence of malignancies in immunosuppressed organ transplant recipients.- 65. Transmission of cancer with donor organs.- 66. Long-term experience with surgical repair for transplant renal artery stenosis.- 67. Lymphoproliferative disorders after liver transplantation (OLT): a recent experience.- 68. Experience with Kaposi's sarcoma in recipients of renal transplants in Tunisia.- 69. Urological complications in 510 consecutive renal transplants.- Thirteen: Organ Procurement and Preservation.- 70. Preservation of the kidney and other organs into the nineties.- 71. Clinical experience with liver preservation.- 72. Management of the organ donor.- 73. The role of the National Kidney Foundation in cadaveric transplantation in Saudi Arabia.- Fourteen: Ethical, Legal and Religious Aspects.- 74. The position of the Transplantation Society on commercialization in organ transplantation.- 75. Ethics and transplantation: an analysis of 'rewarded gifting'.- 76. Moral, ethical and medical values sacrificed by commercialization in human organs.- 77. Commerce and trade in human organs.- 78. Some ethical concerns in organ transplantation.- 79. Islamic view on organ transplantation.- Index of subjects.