Atlas of Organ Transplantation

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Atlas of Organ Transplantation

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Abhinav Humar, Arthur J. Matas and William D. Payne

Atlas of Organ Transplantation

With 438 Figures

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Abhinav Humar, MD, Arthur J. Matas, MD, William D. Payne, MD,

FRCS FACS FACS

Department of Surgery Department of Surgery Department of Surgery

Division of Division of Division of

Transplantation Transplantation Transplantation

University of Minnesota University of Minnesota University of Minnesota

Minneapolis, MN Minneapolis, MN Minneapolis, MN

USA USA USA

Cover photograph by author.

British Library Cataloguing in Publication Data Atlas of organ transplantation

1. Transplantation of organs, tissues, etc. – Atlases

I. Humar, Abhinav II. Matas, Arthur J. III. Payne, William D.

617.9′54

ISBN-13: 9781846283147 ISBN-10: 1846283140

Library of Congress Control Number: 2005938494

ISBN-10: 1-84628-314-0 e-ISBN 1-84628-316-7 Printed on acid-free paper ISBN-13: 978-1-84628-314-7

The software disk accompanying this book and all material contained on it is supplied without any warranty of any kind. The publisher accepts no liability for personal injury incurred through use or misuse of the disk.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or trans- mitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency.

Enquiries concerning reproduction outside those terms should be sent to the publishers.

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Preface

The ﬁeld of organ transplantation has undergone remarkable changes in the last decade.

The growing numbers of agents available for immunosuppression have played a significant role in the advancement of this field. However, just as important has been the development of surgical innovations in the field. This includes not only the development of new surgical procedures, but also modifications of the existing ones. This has involved all areas of organ transplantation including deceased-donor procurement techniques, living-donor transplantation, and transplantation of the individual organs including kidney, liver, pancreas, and intestine. Examples include procurement from non–heart- beating donors; living-donor transplants involving the liver, pancreas, or intestine;

laparoscopic donor nephrectomy; split-liver transplants; and multivisceral transplants.

All of these represent new, innovative procedures that are being performed on a regular basis only in the last few years. Given these recent dramatic changes in the surgical face of transplantation, we felt it was time for a surgical atlas of transplantation that high- lighted these recent developments.

The aim of this book is to provide the reader with a comprehensive, pictorial step-by- step account of abdominal organ transplant procedures performed by contemporary transplant surgeons. Emphasis has been placed on newer procedures or procedures that have undergone signiﬁcant modiﬁcations. It is recognized that there are many well- accepted techniques for the same procedure, with each having potential merit. While it is impossible to present all of these variations, an attempt has been made to describe the common variations in surgical technique.

Innovations in imaging have allowed us to organize this atlas in a format that provides the reader with the most clear and realistic view of the operative procedures.

Schematic diagrams are included to complement high-quality intraoperative photo- graphs, allowing readers to clearly visualize the course of the operative procedure. A unique feature of this atlas is a digital video ﬁle of the major operative procedures, which provides the reader with the closest possible experience to being present in the operat- ing suite. It is hoped that this format will provide the reader with a clear visual and written description of all major abdominal transplant procedures performed by the modern transplant surgeon.

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The editors gratefully acknowledge the contributing authors for their hard work in the preparation of individual chapters or sections of chapters. The help of Dr. Khalid Khwaja was greatly appreciated in the design of the illustrations used in this atlas. The videos that accompany this atlas would not have been made possible without the expertise and hard work of Dr. Bradley Linden, Eric Carolan, and Jake Gotler.

Acknowledgments

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Preface . . . v

Acknowledgments . . . vii

Operative Videos . . . xiii

Contributors . . . xv

1 Multiorgan Procurement from the Deceased Donor . . . . 1

Standard Multiorgan Procurement . . . 1

Mark L. Sturdevant and Abhinav Humar Introduction . . . 1

Surgical Technique . . . 2

Non–Heart-Beating Donor Organ Procurement . . . 23

David J. Reich Background . . . 23

a) Deﬁnitions . . . 23

b) History . . . 24

c) Impact of Non–Heart-Beating Donors . . . 24

Results Following Transplantation of Non–Heart-Beating Donor Organs . . . 25

a) Kidneys . . . 25

b) Livers . . . 25

c) Author’s Experience . . . 26

Preoperative Maneuvers and Operative Strategy for Non–Heart-Beating Donor Organ Procurement . . . 26

a) Uncontrolled Non–Heart-Beating Donors . . . 26

b) Controlled Non–Heart-Beating Donors . . . 27

c) Surgical Technique . . . 27

d) Premortem Cannulation Technique . . . 30

Ethical Issues and Professionalism . . . 31

2 Dialysis Access Procedures . . . . 35

Khalid O. Khwaja Hemodialysis . . . 35

Introduction . . . 35

Surgical Procedures . . . 36

a) Radiocephalic Fistula . . . 36

b) Brachiocephalic Fistula . . . 38

c) Basilic Vein Transposition . . . 44

d) Forearm Loop Arteriovenous Graft . . . 46

e) Upper Arm Arteriovenous Graft . . . 49

f) Lower Extremity Access Procedure . . . 51

Deceased Donor

1. Multiorgan Procurement

Kidney

2. Brachiocephalic Arteriovenous Fistula

3. Hand-Assisted Laparoscopic Donor Nephrectomy 4. Benching Kidney from Deceased Donor

5. Adult Kidney Transplant (Two Arteries) 6. Pediatric Kidney Transplant

Pancreas Transplant

7. Benching Pancreas from Deceased Donor

8. Pancreas Transplant Alone: Systemic/Bladder Drainage

9. Simultaneous Pancreas Kidney (SPK) – Portal/Enteric Drainage Contribution by: Osoma Gaber, Hosein Shokouh-Amiri

10. Laparoscopic Distal Pancreatectomy for Living-Donor Pancreas Transplant Contribution by: Miguel Tan, Raja Kandaswamy, Rainer W.G. Gruessner

Liver Transplant

11. Benching Liver from Deceased Donor

12. Deceased Donor Liver Transplant – Adult Recipient

13. In-Situ Split of the Deceased Donor Liver for Adult/Pediatric Recipients Contribution by: Hasan Yersiz, John Renz, Ronald Busutil

14. In-Situ Split of the Deceased Donor Liver for Two Adult Recipients

15. Adult to Adult Living-Donor Liver Transplant Using the Right Lobe – Donor Procedure

16. Adult to Adult Living-Donor Liver Transplant Using the Right Lobe – Recipient Procedure

Intestinal Transplant

17. Living-Donor Intestinal Transplant

Operative Videos

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Contributors

A. Osama Gaber, MD, FACS Methodist Transplant Institute University of Tennessee Memphis, TN, USA Thomas M. Fishbein, MD Transplant Institute

Georgetown University Hospital Washington, DC, USA

Rainer W.G. Gruessner, MD, PhD Department of Surgery

Division of Transplantation University of Minnesota Minneapolis, MN, USA Abhinav Humar, MD, FRCS Department of Surgery Division of Transplantation University of Minnesota Minneapolis, MN, USA Raja Kandaswamy, MBBS Department of Surgery Division of Transplantation University of Minnesota Minneapolis, MN, USA Khalid O. Khwaja, MD Transplant Center

Beth Israel Deaconess Medical Center Boston, MA, USA

Arthur J. Matas, MD, FACS Department of Surgery Division of Transplantation University of Minnesota Minneapolis, MN, USA Cal S. Matsumoto, MD

Georgetown University Hospital Washington, DC, USA

William D. Payne, MD, FACS Department of Surgery Division of Transplantation University of Minnesota Minneapolis, MN, USA

David J. Reich, MD, FACS Liver Transplant Program Department of Surgery Albert Einstein Medical Center Philadelphia, PA, USA

John F. Renz, MD, PhD Center for Liver Disease New York Presbyterian Hospital New York, NY, USA

Hosein Shokouh-Amiri, MD, FACS Live Donor and Pediatric Liver

Transplantation

Methodist Transplant Institute University of Tennessee Memphis, TN, USA

Mark L. Sturdevant, MD Department of Surgery Division of Transplantation University of Minnesota Minneapolis, MN, USA

David E.R. Sutherland, MD, PhD Department of Surgery

Division of Transplantation University of Minnesota Minneapolis, MN, USA

Miquel Tan, MD

Division of Transplantation Department of Surgery Johns Hopkins Hospital Baltimore, MD, USA

Hasan Yersiz, MD

Department of Hepatobiliary and Liver Transplant Surgery

Dumont-UCLA Transplant Center David Geffen School of Medicine at

UCLA

University of California, Los Angeles Los Angeles, CA, USA

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Atlas of Organ Transplantation

Atlas of Organ Transplantation

Abhinav Humar, Arthur J. Matas and William D. Payne

Atlas of Organ Transplantation

Preface

Acknowledgments

Contents

Deceased Donor

Kidney

Pancreas Transplant

Liver Transplant

Intestinal Transplant

Operative Videos

Contributors