Kidney & Pancreas Transplantation Ernesto Pompeo Molmenti
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1Kidney and Pancreas Transplantation2
3Kidney and Pancreas Transplantation
Ernesto Pompeo Molmenti MD PhD MBA Vice Chairman, Department of Surgery Director, Transplant Program North Shore-LIJ Health System Long Island, New York, USA Professor, Departments of Surgery and Medicine Hofstra North Shore–LIJ School of Medicine Long Island, New York, USA Forewords Michael J Dowling Lawrence G Smith Ron Shapiro
4
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Kidney and Pancreas Transplantation
First Edition: 2015
9789351523390
Printed at:
5
To my bright and beautiful wife Christine Louise.
6 We become victims of what we underestimate, ignore, and disregard.
Molmenti
7 Contributors 19 Collaborators
Radiology Chapters
  • Eran Ben-Levi MD
  • Karen S Black MD
  • Alexander J Blood BA
  • Grazyna Bober RDMS
  • Dennis Burgos RDMS
  • Brian J Burke MD
  • Drew M Caplin MD
  • Jesse Chusid MD MBA
  • Regina S Druz MD FACC
  • Adam L Evans MD
  • Bilha Chesner Fish MD
  • Barak Friedman MD
  • Eric J Gandras MD
  • Veronica Claudia Gigena MD
  • Evelina Grayver MD FACC
  • Craig R Greben MD FSIR
  • Gregory M Grimaldi MD
  • Brett Helfner MD
  • John J Hines MD
  • Asaph CJ Levy BS
  • Pamela Lombardi MD
  • Saiedeh Maghool RDMS
  • Jessica Moon RDMS
  • James B Naidich MD
  • Jason J Naidich MD
  • Diana Navi RDMS
  • Radha Persaud RDMS
  • Amalia Pose BS RDMS
  • Daniel Putterman MD
  • David R Rosman MD
  • Kathrin Sakni RDMS
  • Lindsay Schwartz RDMS
  • Priya K Shah MD
  • Rakesh D Shah MD
  • Eric J Siskind MD
  • Branson Sparks
  • Karen Torres BS RDMS
  • Gene G Tronco MD
  • Biana Trost MD
  • Robert Villani MD
  • Rona F Woldenberg MD
  • Pey-Jen Yu MD
20 Input and Strategic Design
  • Adam Aponte MD MSc FAAP
  • Matthew A Bank MD
  • Eileen Bishop MD
  • Sabina Figari Bizzotto
  • Sylvester M Black MD PhD
  • Fouad N Boctor MD PhD
  • John Chang MD
  • John D Chelico MD MA FACP
  • Charles Choy MD
  • Christian Coppa
  • James M Crawford MD PhD
  • Salvatore Cumella MD
  • Suzanne El-Sayegh MD FACP
  • Lara Fishbane
  • Patrick J Gannon PhD
  • Maria D Georgiades MD
  • Gary Giangola MD FACS
  • Lawrence R Glassman MD
  • Azzour D Hazzan MD
  • Jerrold Hirsch PhD
  • Susana Hong MD
  • E Ilamathi MD FACP FNKF
  • Mitchel C Jacobs MD FACP
  • Sam H James MD
  • Jasmeet Kaur MD
  • Nancy Kheck PhD
  • Y H Kieso-Chelico MSCR
  • Mark Kissin MD
  • Michael W Kleeman DO FACS
  • Jeffrey A Kraut BA MBA
  • K V Krishnasastry MD
  • Dana Lustbader MD FCCM
  • Jerzy Macura MD
  • Anna Mathew MD
  • Joseph Mattana MD
  • James C Maurer MD
  • Alexia Molmenti
  • Hebe Molmenti MD PhD
  • Luis A Molmenti MD PhD
  • Octavio Molmenti
  • Luis F Morales MD
  • Cameron Moser
  • Samuel Packer MD
  • Frank and Linda Perlman
  • Rajasekhar Perumalla MD
  • John Platz MD
  • Lauren E Procaccino
  • James Sardo MD
  • Todd L Slesinger MD FACEP
  • Laurence N Spier MD
  • Joel Stern NH PhD
  • James Sullivan MD
  • Hugo Villar MD
  • Robert S Waldbaum MD
  • Rimda Wanchoo MD
21 Manuscript Evaluation
  • A Abdurakhmanov BA
  • Haris S Ahmed MD
  • Khalid K Al-Talib MD FACP
  • Eden Amdemichael MD
  • Maxine Ames
  • S Sandeep Anantha MD
  • Evan R Ashley AOS NREMT-P
  • Krassimir Atanassov MD
  • Coney Bae MD
  • Meade P Barlow MD
  • Cerdi Beltrė BA
  • Dron Bhandari MBBS
  • Omar D Bholat MD FACS
  • Vinoth Birabaharan BS
  • Daina A Blitz
  • Alexander J Blood BA
  • Mark S Blum MD
  • Dana E Bregman BA
  • Joaquin A Cagliani MD
  • Shayna Carp
  • Alexandra M Cerutti MD
  • Ashley Chandler
  • Jennifer S Chang MD
  • Sebastian Choi
  • Pablo Ciaravino MD
  • Chris Cipolla
  • Romain Cosandre MD
  • Catherine M De Stio BS
  • Gary Deutsch MD
  • Jordan A Dienstag BS
  • Charles M Ekstein MD
  • Annalise R Ellis MHA
  • Melissa D Fana MD
  • Diego Lucas Fernández MD
  • Hannah C Gannon
  • Julian Gannon
  • Victoria M Gilbert BS
  • Katherine M Giovinazzo
  • Andrew J Godwin MD
  • Ayush Goel
  • Alex D Gold
  • Jamie Golden MD
  • Michael J Golia MD
  • Ilana Golovaty MS RD
  • Edwin Goncharuk
  • Ekjot S Grewal BA
  • Benjamin Guzik BA
  • Lindsay Hahn
  • Jeffrey Hallock
  • Majid Hamidi BS
  • Justin P Henneman MS
  • Mallory J Highstein BA
  • Jacob Hirsch
  • Hannah B Hoffman BA
  • Lauren Hoffman
  • Jared M Hutson MD
  • Mitchell Jacobs MD
  • Sapna Jairath MD MHA
  • Nicholas Jandovitz PharmD
  • Vivek Jayaschandran MBBS
  • Trevor R Jones
  • Rohan Jotwani
  • Aditya Kadiyala MD MPH
  • Ameneh D Kalani MD
  • Sanjay D Kalra
  • Bilge D Kalyon MD
  • Irena Karanetz MD
  • Matthew Katz
  • Naixin Kang MD
  • Mamata Khanal MD
  • Armen Kasabian MD
  • Shachar Kenan MD
  • Brian Koch
  • P Praveen Kolumam MBBS
  • Amie J Kraus MD
  • Adam M Kressel MD
  • Marc D Krokowski MPA
  • Minh Le Nguyen MD
  • David Leon BS
  • Rachelle Y Leong MD
  • Sam Leung MD
  • Asaph CJ Levy
  • Leandro A Lumermann MD
  • Frances L Mabrey BA
22
  • Sulynn Machado BA
  • Reshmi Madankumar BS
  • Jonathan R Mallen BS
  • B T Manekshana MD MSc
  • Osvaldo Marcenaro BS RT(R)
  • Laura W Marinelli MD
  • Christine Mathew
  • Lauren E Mathew
  • Jessica E McSharp BS
  • Barbara Mellace
  • Marcelo Mendez Jr MD
  • Jenna S Meriggi
  • Robert T Metzler BS
  • Marni A Mishler MD
  • Munazza Mohammad MD
  • Víctor A Moon MD
  • Nikhil Mulchandani MD
  • Clancy Mullan BS
  • M Y Mutawakkil BSc
  • Lakshmi Nambiar MD
  • Kusuma Nio MD
  • Jolanta Barbara Norelli BA
  • Homaira Omar ANP MBA
  • Alisha R Oropallo MD
  • Adam I Ovadia BA
  • Thomas Panetta MD
  • Madhavan Parvathy MBBS
  • Lauren Michele Paster MD
  • Jennifer N Peacock MD MPH
  • Shabana Perveen MD
  • Soniya N Pinto MBBS
  • Darci Pitchon MD
  • Lauren M Plumley MD MPH
  • Sahil Rawal
  • Deepa Ramadurai BA
  • Abhita T Reddy BA
  • Sameer Rehman MBBS
  • John P Ricci MD
  • Melissa K Robinson MD
  • Jesus Rosado
  • Joshua E Ross MD
  • Benjamin Russo
  • Emil Sameyah MD
  • Syed M Sayeed MD
  • Christopher Scavelli
  • Christina Scelfo BS
  • Tony Shao MD
  • Ilya Shnaydman MD
  • Adam W Shen MD
  • Lauren Shikowitz-Behr MD
  • Louis R Spiegel MD
  • Sharon S Stanley MD
  • Shawn Swift MPA
  • Neil Tanna MD MBA
  • Santo P Terranova DO
  • N P J Theckumparampil MD
  • Patrick Touhy BA
  • Mary Bridget Tracey
  • Maureen Tracey
  • Richard O Tyrell MD
  • Mario Vega MD
  • Ricardo Vega MD
  • H Franco Veglia MD
  • John Wagner MD
  • Heath A Walden MD
  • Steven Weintraub MD
  • Georgia T Xenophontos
  • Harry Zemon MD FACS
23 Foreword
In 2007, the North Shore-LIJ Health System opened a kidney transplant center at North Shore University Hospital in Manhasset, the first transplant program serving residents of New York State’s Nassau and Queens counties. Transplant surgery was available in Manhattan and on eastern Long Island, but it put an undue burden on patients and family members from Nassau and Queens, who had to travel for surgeries and pre- and postoperative care.
Our goal with the program was twofold: ensure broader access to state-of-the-art, patient-centered kidney transplant surgery and provide the very best surgical and postoperative care available anywhere.
To lay the groundwork for the new program, we assembled the region's foremost kidney transplantation team led by renowned surgeon and organ transplantation expert Ernesto P Molmenti, MD PhD MBA. The results speak for themselves.
In less than a decade, under Molmenti’s direction, the interdisciplinary transplantation team has developed a reputation for delivering the highest quality of kidney transplant care in both inpatient and outpatient settings. It has been an important evolution in organ transplant care for the entire tri-state region.
Molmenti is a distinguished surgeon, internationally recognized author and educator, who mentors surgical and nephrology residents and medical students as a Professor of Surgery and Medicine at the Hofstra North Shore-LIJ School of Medicine in New York.
He shares his clinical expertise in the comprehensive textbook Kidney and Pancreas Transplantation. I trust you will find it to be an invaluable resource and reference.
Michael J Dowling
President and Chief Executive Officer
North Shore-LIJ Health System
24New York, USA
25 Foreword
Molmenti and his coauthors have produced Kidney and Pancreas Transplantation, which deals with the medical, surgical, and short- and long-term care of these patients. The chapters cover an extraordinary breadth of subjects ranging from patient selection, medical care, and surgical techniques to health policy and quality of care. It is noteworthy that the field of transplantation, which used to be the business only of select tertiary care facilities, now is a medical intervention that has returned so many patients to their community caregivers that it is an essential area of learning for virtually all physicians. Kidney and Pancreas Transplantation utilizes some novel ways to transmit the essential “need to know” information in a readily accessible format. The book is filled with outstanding tables, bullet points, illustrations, photos, histopathology, and radiology. The text is concise and the key elements of each section are easily focused on by the reader.
Thus, I would compliment the authors not only on producing the textbook in a cutting-edge area of medical practice but also in exploring an innovative and highly effective way to transmit that information. Anyone interested in understanding the basis of these highly complex areas of medical and surgical practice will find this book extraordinarily useful.
Lawrence G Smith MD MACP
Dean, Hofstra North Shore-LIJ School of Medicine
Physician-in-Chief, North Shore-LIJ Health System
26Long Island, New York, USA
27 Foreword
Molmenti and his colleagues have written a detailed and comprehensive textbook on Kidney and Pancreas Transplantation. Classic textbooks have historically gone over the details of recipient selection, donor selection, technical aspects, medical management issues, discussions of immunosuppression, outcomes, and complications after transplantation, and this book describes these topics in meticulous detail, using a format that combines both outline and text as needed, with a number of detailed photographs and figures. However, as the field of transplantation has matured, it has acquired bureaucratic structures related to outcomes assessment and quality improvement, and a modern textbook needs to include a discussion of all of these associated topics. One of the virtues of this book is its inclusion of all of these areas so as to provide a truly comprehensive overview of all aspects of Kidney and Pancreas Transplantation. This book is written for all professionals actively engaged in the field, including fellows, attendings, nurses, and administrators, and provides a broadly based reference for anyone with a serious interest in Kidney and Pancreas Transplantation.
Molmenti was one of my fellows during his training in transplantation, and one of the most satisfying aspects of teaching is the success of one’s students. I am proud of Molmenti’s accomplishments and delighted that he has put together such a well constructed textbook.
Ron Shapiro MD
Professor of Surgery
Robert J Corry Chair in Transplantation Surgery
Associate Clinical Director
Thomas E Starzl Transplantation Institute
University of Pittsburgh,
28Pittsburgh, Pennsylvania, USA
29 Preface
This new text is intended to be the most comprehensive, up-to-date book published on the topic of Kidney and Pancreas Transplantation. It examines the entire gamut of considerations for transplantation, including candidate evaluation, surgical techniques, and complications. We present practical and focused information in a concise, easy-to-read format for busy practitioners.
We have written the text for a multidisciplinary audience and feature contributions from imaging specialists, surgeons, pathologists, anesthesiologists, and dermatologists. Unique topics include epigenetics, imaging, complications, pathology, dermatologic manifestations, obesity and metabolic syndromes, and cutting-edge material on robotic surgical techniques. We also offer extensive coverage of living and deceased donor kidney considerations. This text will be a definitive resource for all members of the transplant team and is intended to encourage a spirit of teamwork among all.
Conveniently divided into 22 sections including 72 chapters, the text is richly illustrated with full-color figures and photos that clearly illustrate step-by-step surgical procedures and key concepts.
We are delighted that you have taken the time to consider our book and hope that you find it very useful.
30 Molmenti
Acknowledgments
31 We are grateful for the ongoing support of:
Mr and Mrs John and Janet Raggio/Janet and John Raggio Nephrology Institute
Mr John Raggio and Donna R Kesselman MD
Mr and Mrs John and Lindsay Raggio
Ms Lauren Raggio and Mr Kyle Hall
Mr and Mrs Michael and Donna Mazzei/NuBest Salon and Spa
Mr and Mrs Jamie and Violet Mazzei/NuBest Salon and Spa
Mr and Mrs Leland and Lise Hirsch
We would like to acknowledge for their professional development and support:
Alice Fornari EdD RD
Director of Faculty Development
North Shore-LIJ Health System
Associate Dean of Educational Skills Development
Hofstra North Shore-LIJ School of Medicine
Associate Professor of Science Education, Population Health and Family Medicine
Victor Fornari MD
Director, Division of Child and Adolescent Psychiatry
North Shore University Hospital and Long Island Jewish Medical Center
(including Zucker Hillside Hospital and Cohen Children’s Medical Center)
Professor of Psychiatry & Pediatrics
Hofstra North Shore-LIJ School of Medicine
We would also like to acknowledge for their interest and enthusiasm:
Mr and Mrs Rocco F Andriola Esq
Mr and Mrs Chris and Angela Paradysz
We would like to thank and acknowledge the following for their continuous support:
Alessandro Bellucci MD
Steven Fishbane MD
Richard Schwarz MD
We would like to thank the following collaborators for their invaluable contribution ensuring the accuracy of this work:
Hannah Millward Fisher MLS
Robert E Fisher MLS
We would like to thank the following for the tireless effort preparing this work:
Claudia Cassidy
32 Transplant Team:
Barry Kristen NP; Bongiorno Louise MS RD CSR CDE; Brown Hoshane; Cappello Joan LMSW; Cascone Barbara BS; Cassidy Claudia AAS; De Barros Irene P; DeFlorio Patricia NP; Flecha Antonetta PharmD; Goldstein Marlene LCSW; Green Kathleen RN; Hernandez Freddy BA; John Tess MSN; Kiernan Lisa RN; Mayvaldov Evgenia NP; Martocci Maude RN; Minogue Elizabeth LCSW; Moore Tracy LCSW; Morgan Ruth M DC; Reyes Julissa; Reynoso Celenia BS; Russo Linda RN; Sendach Jon MPA FACHE; Siegel-Joffe Rachel B LCSW; Somerville Susan RN; Williams Amanda R; Wilson Petrian; Wrynn Barbara RN; Zoll Kristin LMSW