Handbook of Kidney Transplantation 5th Edition PDF
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The modern era of transplantation can be said to have begun with two momentous events in the early 1950s. In 1953, Peter Medawar and his colleagues at University College, London described actively acquired immunologic tolerance in rats, thus heralding the science of transplant immunology and an ongoing search for a similar, reproducible phenomenon in humans. The modern era of clinical transplantation began on December 23, 1954, when Joseph Murray and his colleagues at Harvard performed the first kidney transplantation between identical twin brothers. Both these pioneers were rewarded with the Nobel Prize for their contributions.
In many ways, the promise of these discoveries has been fulfilled in the half century that has followed. The mere fact that organ transplantation is the subject of a handbook such as this reflects the extent to which it has become normative medical practice. Hundreds of thousands of lives have been saved, and quality years have replaced years of suffering.
Our understanding of the complex immunobiology of the immune response has advanced and has brought widespread benefits well beyond the field of organ transplantation. A broad armamentarium of immunosuppressive medications is now available, and innovative surgical techniques serve to expand the donor pool and minimize morbidity. National and international organ-sharing organizations are an accepted part of the medical landscape of the developed world.
Modern organ transplantation can be visualized as a complex edifice that rests on a triangular base. In one corner is the basic research that is the life-blood of improvement and innovation. Nowhere in medicine is the term translational medicine more relevant or does research reach the bedside with greater speed. In another corner is clinical transplant medicine, a new medical subspecialty that requires compulsive, detail-oriented clinical care and both organ-specific and broad expertise. In the third corner are the ethical and cultural underpinnings of the whole transplantation endeavor, an endeavor that is utterly dependent on a well-developed sense of shared humanity and community and on absolute trust among medical staff, patients, and families that is the bedrock of societal acceptance of organ donation, from both the living and the dead.
The edifice is strong, but its strength cannot be taken for granted. The immune system still has many secrets it has yet to reveal. As this text describes, the ultimate goal of donor-specific tolerance, either complete or near complete, appears ‘‘near, but yet so far.’’ Clinical xenotransplantation, a procedure that promised to provide the ultimate answer to the organ donor shortage, remains remote. The availability of new immunosuppressive agents has permitted the introduction of innovative immunosuppressive regimens designed to minimize toxicity. Yet the success of clinical transplantation—with low mortality, high graft survival, and a low incidence of rejection episodes—has, paradoxically, made it more difficult to prove the benefit of new approaches. Because the demand for organs greatly outstretches supply, patients with advanced kidney disease who do not have a living donor may be faced with an interminable, and often morbid, wait for an organ from a deceased donor. The need for living donors has, on the one hand, provided a stimulus to develop ingenious new techniques and approaches to facilitate donation, and on the other hand, spawned an illegal, exploitive, global market in purchased organs. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (see Appendix) serves to codify the protection of the health and welfare of living donors while promoting the effective and healthy practice of deceased donation all over the globe.
The 4-year intervals between the publication of each of the editions of the Handbook of Kidney Transplantation are a reflection of the rate of change in the world of organ transplantation. This fifth edition has been thoroughly updated and revised to reflect the most current knowledge and practice in the field. Like its predecessors, its mission is to make the clinical practice of kidney transplantation fully accessible to all those who are entrusted with the care of our long-suffering patients.
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