L’enciclopedia Treccani riporta alla voce chimera: “un’idea senza fondamento, un sogno vano, una fantasticheria strana, un’utopia”.
Il trapianto è stato a lungo chimera dell’uomo, almeno fino al 23 dicembre del 1954 quando Richard Herrick diventò, grazie alla generosità del gemello omozigote, il primo paziente sopravvissuto alla sindrome uremica.
La chimera non è solo un sogno, un’altra accezione del termine fa riferimento ad una poderosa creatura mitologica costituita dai tessuti di tre animali di specie diversa (leone, capra e serpente), considerata l’incarnazione delle forze distruttrici.
Con la stessa forza della chimera, trapiantologi e scienziati, hanno affrontato le avversità della biologia (e della generale perplessità) fino a codificare il trapianto come pratica clinica sicura che ha cambiato e cambia tutt’ora la vita di molte persone.
Dal 1954 ad oggi si sono succedute numerose chimere, oggi è ragionevole pensare che
superare le barriere dell’incompatibilità immunologica non sia più una chimera.
A partire da questa evidenza mi preme condurre due riflessioni conclusive.
Anche se il nostro studio, così come molti altri analoghi nel panorama internazionale, conferma la validità della strategia desensibilizzante per risolvere il problema dell’incompatibilità della coppia donatore-ricevente, appare opportuno agire in modo da promuovere l’adozione di protocolli di trapianto con modalità cross-over in tutti i Centri che si occupano di trapianti per ottimizzare le possibilità di match delle coppie.
131
Purtroppo, tutt’ora i pazienti inseriti nel programma nazionale cross-over nei singoli centri sono pochi per lo sviluppo a pieno regime del programma. Speriamo che in futuro l’inerzia dei singoli centri italiani venga meno in favore dei bisogni dei pazienti.
Oltre a ridurre sensibilmente i costi del trapianto tra pazienti incompatibili, sarebbe possibile candidare al trapianto da donatore vivente anche quei pazienti che non potrebbero tollerare la terapia desensibilizzante.
L’algoritmo che proponiamo prevede di riservare la terapia desensibilizzante ai soli pazienti
difficult-to-match, dando priorità alla ricerca di una coppia compatibile tra il pool degli
iscritti al programma che potrebbe essere ampliato anche alle coppie immunologicamente compatibili disponibili.
D’altro canto, il trapianto in modalità cross-over permette di aggirare piuttosto che di
superare le barriere dell’incompatibilità immunologica.
L’effettivo superamento dei limiti che il sistema immunitario pone all’attività trapiantologica, sono ben lungi dall’essere superati; solo lo sviluppo di terapie così performanti da indurre la tolleranza immunologica ai tessuti allogenici, potrà trasformare questa chimera in realtà.
I protocolli di terapia desensibilizzante, che oggi hanno permesso di superare la barriera dell’incompatibilità immunologica, potrebbero rappresentare, domani, un gradino, tra tanti, della scala che porterà a scavalcare il muro immunologico che si oppone allo xenotrapianto.
132
Bibliografia
1. Jameson JL, Kasper DL, Fauci AS, et al. Harrison’s Principles of Internal Medicine. McGraw- Hill; 2015.
2. De Nicola L, Donfrancesco C, Minutolo R, et al. [Epidemiology of chronic kidney disease in Italy: current state and contribution of the CARHES study]. G Ital Nefrol. 28(4):401-407. 3. Schena FP, Selvaggi FP. Malattie Dei Reni e Delle Vie Urinarie. McGraw-Hill; 2003. 4. Garibotto G, Biancone L, Pontremoli R. Manuale Di Nefrologia. Minerva medica; 2017. 5. Venuta F, Rossi M. Trapianti Di Organi e Tessuti. Seu; 2010.
6. Vistoli F, Perrone V, Amorese G, Boggi U, Orlando G. Kidney Transplant Recipient Surgery. In: Kidney Transplantation, Bioengineering and Regeneration. Elsevier; 2017:111-125. doi:10.1016/B978-0-12-801734-0.00009-6
7. Danovitch GM. Handbook of Kidney Transplantation. Lippincott Williams & Wilkins; 2010. 8. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of Mortality in All Patients on Dialysis,
Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric
Transplant. N Engl J Med. 1999;341(23):1725-1730. doi:10.1056/NEJM199912023412303 9. Schnuelle P, Lorenz D, Trede M, Van Der Woude FJ. Impact of renal cadaveric
transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol.
1998;9(11):2135-2141.
10. Winkelmayer WC, Weinstein MC, Mittleman MA, Glynn RJ, Pliskin JS. Health Economic Evaluations: The Special Case of End-Stage Renal Disease Treatment. Med Decis Mak. 2002. doi:10.1177/027298902236927
11. Traitanon O, Gallon L. Indications for Renal Transplantation: Evaluation of Transplant Candidates. In: Kidney Transplantation, Bioengineering, and Regeneration: Kidney
Transplantation in the Regenerative Medicine Era. ; 2017. doi:10.1016/B978-0-12-801734-
0.00014-X
12. Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant. 2005;19(4):433-455. doi:10.1111/j.1399-0012.2005.00378.x
13. Mourad G, Djamali A, Turc-Baron C, Cristol JP. Lipoprotein glomerulopathy: a new cause of nephrotic syndrome after renal transplantation. Nephrol Dial Transplant. 1998;13(5):1292- 1294.
14. Jacquet A, Pallet N, Kessler M, et al. Outcomes of renal transplantation in patients with autosomal dominant polycystic kidney disease: a nationwide longitudinal study. Transpl
Int. 2011. doi:10.1111/j.1432-2277.2011.01237.x
15. Audard V, Kamar N, Sahali D, et al. Rituximab therapy prevents focal and segmental glomerulosclerosis recurrence after a second renal transplantation. Transpl Int. 2012;25(5):e62-e66. doi:10.1111/j.1432-2277.2012.01462.x
133
plasmapheresis and rituximab in a second living-related kidney transplant pediatric recipient with a very high risk for focal segmental glomerulosclerosis recurrence. Pediatr
Transplant. 2012;16(7):E286-E290. doi:10.1111/j.1399-3046.2011.01610.x
17. Keith DS. Therapeutic apheresis rescue mission: recurrent focal segmental
glomerulosclerosis in renal allografts. Semin Dial. 2012;25(2):190-192. doi:10.1111/j.1525- 139X.2011.01031.x
18. Stephanian E, Matas AJ, Mauer SM, et al. Recurrence of disease in patients retransplanted for focal segmental glomerulosclerosis. Transplantation. 1992. doi:10.1097/00007890- 199204000-00009
19. Sprangers B, Kuypers DR. Recurrence of glomerulonephritis after renal transplantation.
Transplant Rev. 2013. doi:10.1016/j.trre.2013.07.004
20. Josephson MA, Spargo B, Hollandsworth D, Thistlethwaite JR. The Recurrence of Recurrent Membranous Glomerulopathy in a Renal Transplant Recipient: Case Report and Literature Review. Am J Kidney Dis. 1994. doi:10.1016/S0272-6386(12)80685-8
21. McDonald SP, Russ GR. Recurrence of IgA nephropathy among renal allograft recipients from living donors is greater among those with zero HLA mismatches. Transplantation. 2006. doi:10.1097/01.tp.0000230131.66971.45
22. Ullman E. TISSUE AND ORGAN TRANSPLANTATION. Ann Surg. 1914;60(2):195-219. 23. A C. The surgery of blood vessels etc. Johns Hopkins Hosp Bull. 1907.
24. Carrel A, Guthrie CC. Successful transplantation of both kidneys from a dog into a bitch with removal of both normal kidneys from the latter. Science (80- ). 1906.
doi:10.1126/science.23.584.394
25. Carrel A. Results of the transplantation of blood vessels, organs and limbs. J Am Med
Assoc. 1908. doi:10.1001/jama.1908.25410200010001b
26. Aida L. Alexis Carrel (1873–1944): Visionary vascular surgeon and pioneer in organ transplantation. J Med Biogr. 2014. doi:10.1177/0967772013516899
27. Merchant J, Tan SY. Alexis Carrel (1873-1944): Pioneer of vascular surgery and organ transplantation. Singapore Med J. 2013. doi:10.11622/smedj.2013217
28. Deschamps JY, Roux FA, Saï P, Gouin E. History of xenotransplantation.
Xenotransplantation. 2005. doi:10.1111/j.1399-3089.2004.00199.x
29. Morris PJ, Knechtle S. Kidney Transplantation-Principles and Practice: Seventh Edition.; 2013.
30. Hamilton DN, Reid WA. Yu. Yu. Voronoy and the first human kidney allograft. Surg Gynecol
Obstet. 1984. doi:10.1080/01425690701737481
31. Medawar PB. The behaviour and fate of skin autografts and skin homografts in rabbits: A report to the War Wounds Committee of the Medical Research Council. J Anat. 1944;78(Pt 5):176-199.
32. BILLINGHAM RE, KROHN PL, MEDAWAR PB. Effect of cortisone on survival of skin homografts in rabbits. Br Med J. 1951;1(4716):1157-1163.
33. Billingham RE, Brent L, Medawar PB. “Actively acquired tolerance” of foreign cells. 1953. J
134
34. KUSS R, TEINTURIER J, MILLIEZ P. [Some attempts at kidney transplantation in man]. Mem
Acad Chir (Paris). 1951;77(22-24):755-764.
35. MICHON L, HAMBURGER J, OECONOMOS N, et al. [An attempted kidney transplantation in man: medical and biological aspects]. Presse Med. 1953;61(70):1419-1423.
36. MERRILL JP, MURRAY JE, HARRISON JH, GUILD WR. Successful homotransplantation of the human kidney between identical twins. J Am Med Assoc. 1956;160(4):277-282.
37. Starzl TE. History of clinical transplantation. World J Surg. 2000. doi:10.1007/978-0-387- 68113-9_80
38. Morris PJ, Knechtle SJ. Kidney Transplantation : Principles and Practice. Saunders/Elsevier; 2008.
39. Patel R, Terasaki PI. Significance of the Positive Crossmatch Test in Kidney Transplantation.
N Engl J Med. 1969. doi:10.1056/NEJM196904032801401
40. Ting A, Morris PJ. MATCHING FOR B-CELL ANTIGENS OF THE HLA-DR SERIES IN CADAVER RENAL TRANSPLANTATION. Lancet. 1978. doi:10.1016/S0140-6736(78)91025-5
41. Ting A, Morris PJ. The role of HLA matching in renal transplantation. Tissue Antigens. 1985. doi:10.1111/j.1399-0039.1985.tb00445.x
42. Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR. Laparoscopic live donor nephrectomy. Transplantation. 1995.
43. Dionigi. Chirurgia - Basi teoriche e chirurgia generale. In: Elseiver. ; 2011. doi:10.1017/CBO9781107415324.004
44. Pietrabissa A, Boggi U, Vistoli F, Moretto C, Ghilli M, Mosca F. Laparoscopic living donor nephrectomy in Italy: a national profile. Transplant Proc. 2004;36(3):460-463.
doi:10.1016/j.transproceed.2004.02.070
45. Pietrabissa A, Boggi U, Moretto C, Ghilli M, Mosca F. Laparoscopic and hand-assisted laparoscopic live donor nephrectomy. Semin Laparosc Surg. 2001;8(2):161-167. 46. Barsotti M, Boggi U, Tregnaghi C, et al. [Living donor kidney transplant: the crossover
modality]. G Ital Nefrol. 26(4):488-498.
47. Boggi U, Vistoli F, Signori S, et al. Robotic renal transplantation: First European case.
Transpl Int. 2011. doi:10.1111/j.1432-2277.2010.01191.x
48. Matesanz R, Domínguez-Gil B, Coll E, De La Rosa G, Marazuela R. Spanish experience as a leading country: What kind of measures were taken? Transpl Int. 2011.
doi:10.1111/j.1432-2277.2010.01204.x
49. Matesanz R, Domínguez-Gil B, Coll E, Mahíllo B, Marazuela R. How Spain Reached 40 Deceased Organ Donors per Million Population. Am J Transplant. 2017.
doi:10.1111/ajt.14104
50. De La Rosa G, Domínguez-Gil B, Matesanz R, et al. Continuously evaluating performance in deceased donation: The Spanish Quality Assurance Program. Am J Transplant. 2012. doi:10.1111/j.1600-6143.2012.04138.x
51. Murray JE. Surgery of the Soul : Reflections on a Curious Career. Science History Pubns; 2004.
135
Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant. N Engl J Med. 1999. doi:10.1056/NEJM199912023412303
53. Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342(9):605-612. doi:10.1056/NEJM200003023420901
54. Cosio FG, Alamir A, Yim S, et al. Patient survival after renal transplantation: I. The impact of dialysis pre-transplant. Kidney Int. 1998. doi:10.1046/j.1523-1755.1998.00787.x
55. Mathew TH, McDonald SP, Russ GR. Donor and recipient risk factors and choice of immunosuppression determine long-term outcome in renal transplantation. Transplant
Proc. 2001. doi:10.1016/S0041-1345(01)02465-4
56. Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT. Preemptive kidney transplantation: The advantage and the advantaged. J Am Soc Nephrol. 2002. doi:10.1097/01.ASN.0000013295.11876.C9
57. Papalois VE, Moss A, Gillingham KJ, Sutherland DER, Matas AJ, Humar A. Pre-emptive transplants for patients with renal failure: an argument against waiting until dialysis.
Transplantation. 2000. doi:10.1097/00007890-200008270-00016
58. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis. Transplantation. 2002. doi:10.1097/00007890-200211270-00005
59. Fonseca I, Teixeira L, Malheiro J, et al. The effect of delayed graft function on graft and patient survival in kidney transplantation: an approach using competing events analysis.
Transpl Int. 2015;28(6):738-750. doi:10.1111/tri.12543
60. Pietrabissa A, Pugliese L, Abelli M, Ticozzelli E, Rampino T. The Living Donor. In: Kidney
Transplantation, Bioengineering and Regeneration. Elsevier; 2017:41-50.
doi:10.1016/B978-0-12-801734-0.00004-7
61. Futagawa Y, Waki K, Gjertson DW, Terasaki PI. Living-unrelated donors yield higher graft survival rates than parental donors. In: Transplantation. ; 2005.
doi:10.1097/01.TP.0000160763.60597.D0
62. Rees MA, Fumo DE. Strategies to Increase the Donor Pool. In: Kidney Transplantation,
Bioengineering, and Regeneration: Kidney Transplantation in the Regenerative Medicine Era. ; 2017. doi:10.1016/B978-0-12-801734-0.00006-0
63. Boulware LE, Hill-Briggs F, Kraus ES, et al. Effectiveness of educational and social worker interventions to activate patients’ discussion and pursuit of preemptive living donor kidney transplantation: a randomized controlled trial. Am J Kidney Dis. 2013;61(3):476-486. doi:10.1053/j.ajkd.2012.08.039
64. LaPointe Rudow D, Hays R, Baliga P, et al. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J
Transplant. 2015;15(4):914-922. doi:10.1111/ajt.13173
65. Maple NH, Hadjianastassiou V, Jones R, Mamode N. Understanding risk in living donor nephrectomy. J Med Ethics. 2010;36(3):142-147. doi:10.1136/jme.2009.031740
66. Delmonico FL. A report of the Amsterdam forum on the care of the live kidney donor: Data and medical guidelines. In: Transplantation. ; 2005.
136
67. Ahmadi AR, Lafranca JA, Claessens LA, et al. Shifting paradigms in eligibility criteria for live kidney donation: A systematic review. Kidney Int. 2015. doi:10.1038/ki.2014.118
68. Ibrahim HN, Foley R, Tan L, et al. Long-Term Consequences of Kidney Donation. N Engl J
Med. 2009;360(5):459-469. doi:10.1056/NEJMoa0804883
69. Muzaale AD, Massie AB, Wang M-C, et al. Risk of End-Stage Renal Disease Following Live Kidney Donation. JAMA. 2014;311(6):579. doi:10.1001/jama.2013.285141
70. Johnson EM, Remucal MJ, Gillingham KJ, Dahms RA, Najarian JS, Matas AJ. Complications and risks of living donor nephrectomy. Transplantation. 1997. doi:10.1097/00007890- 199710270-00007
71. Ellison MD, McBride MA, Taranto SE, Delmonico FL, Kauffman HM. Living kidney donors in need of kidney transplants: A report from the organ procurement and transplantation network. Transplantation. 2002. doi:10.1097/00007890-200211150-00025
72. Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tydén G, Groth CG. Kidney donors live longer.
Transplantation. 1997;64(7):976-978.
73. Reese PP, Bloom RD, Feldman HI, et al. Mortality and cardiovascular disease among older live kidney donors. Am J Transplant. 2014. doi:10.1111/ajt.12822
74. Tong A, Chapman JR, Wong G, Craig JC. Living kidney donor assessment: Challenges, uncertainties and controversies among transplant nephrologists and surgeons. Am J
Transplant. 2013. doi:10.1111/ajt.12411
75. Adams PL, Cohen DJ, Danovitch GM, et al. The nondirected live-kidney donor: Ethical considerations and practice guidelines. A national conference report. Transplantation. 2002. doi:10.1097/00007890-200208270-00030
76. Dew MA, Jacobs CL, Jowsey SG, Hanto R, Miller C, Delmonico FL. Guidelines for the psychosocial evaluation of living unrelated kidney donors in the United States. In:
American Journal of Transplantation. ; 2007. doi:10.1111/j.1600-6143.2007.01751.x
77. Rodrigue JR, Schutzer ME, Paek M, Morrissey P. Altruistic kidney donation to a stranger: Psychosocial and functional outcomes at two US transplant centers. Transplantation. 2011. doi:10.1097/TP.0b013e31820dd2bd
78. Henderson AJZ, Landolt MA, McDonald MF, et al. The living anonymous kidney donor: Lunatic or saint? Am J Transplant. 2003. doi:10.1034/j.1600-6143.2003.00019.x
79. Massey EK, Kranenburg LW, Zuidema WC, et al. Encouraging psychological outcomes after altruistic donation to a stranger. Am J Transplant. 2010. doi:10.1111/j.1600-
6143.2010.03115.x
80. Banga N, Nicol D. Techniques in laparoscopic donor nephrectomy. BJU Int. 2012. doi:10.1111/j.1464-410X.2012.11058.x
81. Rajab A, Pelletier RP. The safety of hand-assisted laparoscopic living donor nephrectomy: The Ohio State University experience with 1500 cases. Clin Transplant. 2015.
doi:10.1111/ctr.12501
82. Tokodai K, Takayama T, Amada N, Haga I, Nakamura A, Kashiwadate T.
Retroperitoneoscopic living donor nephrectomy: Short learning curve and our original hybrid technique. Urology. 2013. doi:10.1016/j.urology.2013.08.003
137
Hundred Patients. Urology. 2009. doi:10.1016/j.urology.2009.02.083
84. Tzvetanov I, Bejarano-Pineda L, Giulianotti PC, et al. State of the art of robotic surgery in organ transplantation. World J Surg. 2013. doi:10.1007/s00268-013-2244-x
85. Andersen MH, Mathisen L, Oyen O, et al. Postoperative Pain and Convalescence in Living Kidney Donors-Laparoscopic Versus Open Donor Nephrectomy: A Randomized Study. Am J
Transplant. 2006;6(6):1438-1443. doi:10.1111/j.1600-6143.2006.01301.x
86. Øyen O, Andersen M, Mathisen L, et al. Laparoscopic versus open living-donor
nephrectomy: experiences from a prospective, randomized, single-center study focusing on donor safety. Transplantation. 2005;79(9):1236-1240.
87. Kok NFM, Lind MY, Hansson BME, et al. Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial. BMJ.
2006;333(7561):221. doi:10.1136/bmj.38886.618947.7C
88. Klop KWJ, Dols LFC, Kok NFM, Weimar W, IJzermans JNM. Attitudes Among Surgeons Towards Live-Donor Nephrectomy. Transplant J. 2012;94(3):263-268.
doi:10.1097/TP.0b013e3182577501
89. Mjøen G, Øyen O, Holdaas H, Midtvedt K, Line P-D. Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry.
Transplantation. 2009;88(11):1273-1279. doi:10.1097/TP.0b013e3181bb44fd
90. Leventhal JR, Kocak B, Salvalaggio PRO, et al. Laparoscopic donor nephrectomy 1997 to 2003: lessons learned with 500 cases at a single institution. Surgery. 2004.
doi:10.1016/j.surg.2004.06.025
91. Furian L, Rigotti P. [Living donor kidney transplant: the surgical procedure]. G Ital Nefrol. 26(4):516-522.
92. Ruiz R, Novick AC, Braun WE, Montague DK, Stewart BH. Transperitoneal live donor nephrectomy. J Urol. 1980;123(6):819-821.
93. Redman JF. An anterior extraperitoneal incision for donor nephrectomy that spares the rectus abdominis muscle and anterior abdominal wall nerves. J Urol. 2000;164(6):1898- 1900.
94. Clayman R V, Kavoussi LR, McDougall EM, et al. Laparoscopic nephrectomy: a review of 16 cases. Surg Laparosc Endosc. 1992;2(1):29-34.
95. Kerbl K, Clayman R V, McDougall EM, Kavoussi LR. Laparoscopic nephrectomy. BMJ. 1993;307(6917):1488-1489.
96. Ratner LE, Hiller J, Sroka M, et al. Laparoscopic live donor nephrectomy removes
disincentives to live donation. In: Transplantation Proceedings. ; 1997. doi:10.1016/S0041- 1345(97)00955-X
97. Tanabe K, Miyamoto N, Ishida H, et al. Retroperitoneoscopic Live Donor Nephrectomy (RPLDN): Establishment and Initial Experience of RPLDN at a Single Center. Am J
Transplant. 2005;5(4):739-745. doi:10.1111/j.1600-6143.2004.00702.x
98. Wadström J. Hand-assisted retroperitoneoscopic live donor nephrectomy: experience from the first 75 consecutive cases. Transplantation. 2005;80(8):1060-1066.
99. Saad S, Paul A, Treckmann J, Nagelschmidt M, Heiss M, Arns W. Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital. Surg Endosc
138
Other Interv Tech. 2008. doi:10.1007/s00464-007-9459-6
100. Kok NFM, Dols LFC, Hunink MGM, et al. Complex vascular anatomy in live kidney donation: Imaging and consequences for clinical outcome. Transplantation. 2008.
doi:10.1097/TP.0b013e318172802d
101. Shirodkar SP, Gorin MA, Sageshima J, et al. Technical modification for laparoscopic donor nephrectomy to minimize testicular pain: A complication with significant morbidity. Am J
Transplant. 2011. doi:10.1111/j.1600-6143.2011.03495.x
102. Janki S, Verver D, Klop KWJ, et al. Vascular management during live donor nephrectomy: An online survey among transplant surgeons. Am J Transplant. 2015.
doi:10.1111/ajt.13142
103. Zacherl J, Bock S, Feussner H, Erhardt W, Siewert JR, Stangl M. Periarterial application of papaverine during laparoscopic donor nephrectomy improves early graft function after kidney transplantation in pigs. Surg Endosc. 2004. doi:10.1007/s00464-003-8912-4 104. Friedersdorff F, Wolff I, Deger S, et al. No need for systemic heparinization during
laparoscopic donor nephrectomy with short warm ischemia time. World J Urol. 2011. doi:10.1007/s00345-011-0704-1
105. Gunabushanam V, Matas A, Humar A. Kidney Transplantation. In: Atlas of Organ
Transplantation. London: Springer London; 2015:109-154. doi:10.1007/978-1-4471-4775-
6_5
106. Wolf Jr. JS, Tchetgen MB, Merion RM. Hand-assisted laparoscopic live donor nephrectomy. Urology. 1998.
107. Ratner LE, Montgomery RA, Maley WR, et al. Laparoscopic live donor nephrectomy: the recipient. Transplantation. 2000;69(11):2319-2323.
108. Odland MD, Ney AL, Jacobs DM, et al. Initial experience with laparoscopic live donor nephrectomy. Surgery. 1999;126(4):603-6; discussion 606-7.
109. Jacobs SC, Cho E, Foster C, Liao P, Bartlett ST. Laparoscopic donor nephrectomy: the University of Maryland 6-year experience. J Urol. 2004;171(1):47-51.
doi:10.1097/01.ju.0000100221.20410.4a
110. Chandak P, Kessaris N, Challacombe B, Olsburgh J, Calder F, Mamode N. How safe is hand- assisted laparoscopic donor nephrectomy?--results of 200 live donor nephrectomies by two different techniques. Nephrol Dial Transplant. 2009;24(1):293-297.
doi:10.1093/ndt/gfn463
111. Giacomoni A, Di Sandro S, Lauterio A, et al. Evolution of robotic nephrectomy for living donation: From hand-assisted to totally robotic technique. Int J Med Robot Comput Assist
Surg. 2014. doi:10.1002/rcs.1576
112. Patel S, Cassuto J, Orloff M, et al. Minimizing morbidity of organ donation: analysis of factors for perioperative complications after living-donor nephrectomy in the United States. Transplantation. 2008;85(4):561-565. doi:10.1097/TP.0b013e3181643ce8
113. Shokeir AA. Open Versus Laparoscopic Live Donor Nephrectomy: A Focus on the Safety of Donors and the Need for a Donor Registry. J Urol. 2007. doi:10.1016/j.juro.2007.07.008 114. Ruiz-Deya G, Cheng S, Palmer E, Thomas R, Slakey D. Open donor, laparoscopic donor and
hand assisted laparoscopic donor nephrectomy: a comparison of outcomes. J Urol. 2001. doi:10.1016/S0022-5347(05)65751-5
139
115. Troppmann C, Perez R V., McBride M. Similar long-term outcomes for laparoscopic versus open live-donor nephrectomy kidney grafts: An OPTN database analysis of 5532 adult recipients. Transplantation. 2008. doi:10.1097/TP.0b013e318166ad77
116. Andersen MH, Mathisen L, Oyen O, et al. Postoperative Pain and Convalescence in Living Kidney Donors-Laparoscopic Versus Open Donor Nephrectomy: A Randomized Study. Am J
Transplant. 2006. doi:10.1111/j.1600-6143.2006.01301.x
117. Nanidis TG, Antcliffe D, Kokkinos C, et al. Laparoscopic versus open live donor nephrectomy in renal transplantation: A meta-analysis. Ann Surg. 2008. doi:10.1097/SLA.0b013e318153fd13
118. Morrissey PE, Monaco AP. Living Kidney Donation: Evolution and Technical Aspects of Donor Nephrectomy. Surg Clin North Am. 2006. doi:10.1016/j.suc.2006.06.008 119. Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival
following live kidney donation. JAMA. 2010. doi:10.1001/jama.2010.237 120. Tilney NL. Transplant : From Myth to Reality. Yale University Press; 2003.
121. Lentine KL, Schnitzler MA, Xiao H, et al. Racial variation in medical outcomes among living kidney donors. N Engl J Med. 2010. doi:10.1056/NEJMoa1000950
122. Nogueira JM, Weir MR, Jacobs S, et al. A study of renal outcomes in obese living kidney donors. Transplantation. 2010. doi:10.1097/TP.0b013e3181f6a058
123. Garg a X, Muirhead N, Knoll G, et al. Proteinuria and reduced kidney function in living kidney donors: A systematic review, meta-analysis, and meta-regression. Kidney Int. 2006. doi:10.1038/sj.ki.5001819
124. Morgan BR, Ibrahim HN. Long-term outcomes of kidney donors. Curr Opin Nephrol
Hypertens. 2011. doi:10.1097/MNH.0b013e32834bd72b
125. Nanni G, Tondolo V, Citterio F, et al. Comparison of oblique versus hockey-stick surgical incision for kidney transplantation. Transplant Proc. 2005.
doi:10.1016/j.transproceed.2005.06.055
126. Mital D, Foster PF, Jensik SC, et al. Renal transplantation without sutures using the vascular clipping system for renal artery and vein anastomosis--a new technique. Transplantation. 1996;62(8):1171-1173.
127. Jones JW. A new anastomotic technique in renal transplants reduces warm ischemia time.
Clin Transplant. 1998;12(1):70-72.
128. Ye G, Mo H-G, Wang Z-H, Yi S-H, Wang X-W, Zhang Y-F. Arterial anastomosis without sutures using ring pin stapler for clinical renal transplantation: comparison with suture anastomosis. J Urol. 2006;175(2):636-40; discussion 640. doi:10.1016/S0022-
5347(05)00143-6
129. Wong VKH, Baker R, Patel J, Menon K, Ahmad N. Renal transplantation to the ovarian vein: a case report. Am J Transplant. 2008;8(5):1064-1066. doi:10.1111/j.1600-
6143.2008.02185.x
130. Linn R, Ginesin Y, Bolkier M, Levin DR. Lich-Gregoir anti-reflux operation: a surgical experience and 5-20 years of follow-up in 149 ureters. Eur Urol. 1989;16(3):200-203. 131. Kahan BD, Ponticelli C (Claudio). Principles and Practice of Renal Transplantation. Martin
140
132. Duckett T, Bretan PN, Cochran ST, Rajfer J, Rosenthal JT. Noninvasive radiological diagnosis