Kidney Transplantation 6th Edition: Principles and PracticePDF
|Author||Peter Morris MD PhD FRS FRCS and Stuart J. Knechtle MD FACS|
|File size||13.5 MB|
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It is now 7 years since the fifth edition of this book was published, and it is fair to say that since the first edition, published in 1979, each edition has reflected the rapid and continuing advances in renal transplantation. All chapters have been rewritten and updated, many by new contributors. As always, subjects of relevance come and go. In this edition, a separate chapter on transplantation in the highly sensitized recipient and across the ABO blood barrier appears, whereas a chapter on fine needle aspiration cytology of the transplanted kidney as well as a chapter on renal xenotransplantation, which appeared for the first time in the fifth edition, have been discarded. Xenotransplantation remains a major area of research endeavour; however, there is no clinical application in sight at this time, which perhaps seemed more likely at the time of the fifth edition. Overall, the format is much the same as before, with many new contributors and also, above all, a new editor—Stuart Knechtle has joined Peter Morris for the first time in the production of this edition. We continue to see evidence of the advances in immunosuppression, but there is also a recognition of the increasing morbidity associated with using immunosuppression long term. Furthermore, the long-term results of renal transplantation are not as good as the short- and medium-term results might have led one to anticipate. Thus, there is now a major emphasis on chronic allograft nephropathy, which may be due to a host of injurious events, and the possibility of its prevention or treatment.
Considerable attention has been given to calcineurin-sparing and steroid-sparing protocols using the more powerful new immunosuppressive agents in an attempt to achieve this goal, and several approaches are contained within the various chapters on immunosuppressive agents. This edition, like the fifth edition, illustrates the continuing progress in all aspects of renal transplantation, but disappointingly there is little to describe in the way of induction of tolerance in clinical practice, which is to some extent due to the lack of appropriate biomarkers of tolerance or immunosuppression. We suspect that the next edition will have a whole chapter on biomarkers of immunosuppression, but at the moment their role is more speculative than actual. Patient and graft survival figures continue to improve in the short and medium term, graft survival now being around 90% or even better at 1 year. This is quite remarkable in view of the increasing number of high-risk patients undergoing transplantation, as well as the greater use of marginal donors.Without doubt, this is a tribute not only to the work of the scientists and clinicians who have made this possible but also to the thousands of patients who have participated in this evolution of what has been described as one of the medical miracles of the 20th century.