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Kidney Transplant Surgery

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  • Thanks ringer21 for the post. we should be aware of kidney diseases, their causes, symptoms, treatment and prevention. About 66% of kidney failures are said to be due to diabetes and hypertension, and in India about 25 to 40% of the population is said to be at risk to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Fortis Urology one of the best medical centre for Kidney Transplant Surgery in India.
    http://www.fortisurology.com
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  • 1. News: Mom gets dual-transplant from her children Submit Search this site: The Kidney Transplant Program at USC University Hospital is dedicated to providing comprehensive perioperative care to patients with chronic renal disease, including end-stage renal disease. Our team consists of physician and surgeon specialists and nurse coordinators whose purpose is the efficient pre-transplant evaluation and management and a smooth transition into the transplant phase. Following kidney transplantion, care will be coordinated by the USC nurse transplant coordinator and depends on consistent communication between the transplant physicians, the patient, and the referring doctor. Within the scope of our program exist the necessary services to provide comprehensive evaluation and management of patients before and after the transplant event. The kidney transplant procedure is performed at the USC University Hospital. The USC University Hospital, opened in 1991, is a modern 284-bed hospital on the USC Health Sciences Campus near downtown Los Angeles. The Kidney Transplant Program is one component of the full-service Multi-Organ Transplantation Program at the University of Southern California School of Medicine. One legacy program also performs transplants of heart, lung, liver, and bone marrow. We are affiliated with the Southern California Organ Procurement Center (SCOPC), an agency that has been ranked in the top five of 69 organ procurement agencies throughout the nation for quality and efficiency of organ retrieval. Additionally, all of our transplant programs are members of the United Network of Organ Sharing (UNOS), which is the central agency in the United States whic is
  • 2. responsible for equitable allocation of organs. These affiliations provide our patients with the best opportunities to receive new organs. Since the first kidney transplant was performed at USC University Hospital in October 1991, more than 250 have been done, with an average 92% patient survival rate and 87% graft survival rate at three years post-transplant -- statistics well above the UNOS national averages. Full Scope of Services Expanded surgical techniques, improved anti-rejection protocols, and high-quality patient care characterize the USC program and are critical factors in our current success in kidney transplantation. Candidates for kidney transplantation are individuals with chronic kidney failure related to: q diabetes q hypertension q glomerulonephritis (chronic kidney inflammation with failure). q polycystic kidneys q other kidney diseases Patients have convenient access to a range of comprehensive services, including: q A Full-Service Dialysis Center - Located on the USC medical campus next to the University Hospital, the dialysis center is a new facility that offers dialysis in a comfortable environment. q Access Management - Physicians, nurse specialists, and ancillary personnel have the capability of establishing reliable dialysis access including fistulas, grafts, and peritoneal catheters. In addition, we have the surgical and interventional radiologic skills to troubleshoot and manage difficult access problems, including clotted access, graft revision, and catheter infections. q Cadaveric Transplantation - Cadaver organs are acquired based on criteria set forth by UNOS. Working with SCOPC, the USC team is able to implant allocated organs within 24 hours. q Living Donor Transplantation - Live donor transplantation has become increasingly common, due in large part to the success of the procedure and the shortage of cadaveric organs. Living donation allows the immediate transplantation of kidneys into recipients so operations can be scheduled electively once a suitable living donor has been identified. This avoids the long waiting times encountered with cadaveric donation. The USC University Hospital program has earned an outstanding reputation for its living donor program and now offers a new minimally invasive approach to living donor nephrectomy (see laparoscopic kidney removal below). q Followup Care - Our physicians are practiced in the use of the latest immunosuppressive drugs, including a new class of specific antibodies to some of the cellular receptors responsible for rejection. These FDA-approved drugs have reduced the frequency of rejection episodes by about 40 percent. Laparoscopic Kidney Removal One of the newest and most advanced procedures offered by the USC Kidney Transplant Program is laparoscopic kidney removal from living donors. In this minimally invasive approach, four or more small incisions are made in the abdominal wall. Video equipment and instruments are inserted through these punctures to visualize, dissect, clip, and staple. Once the kidney is freed from its
  • 3. attachments, it is extracted from the abdomen through a 3-inch supra-pubic incision, and cooled. It is then prepared for immediate implantation into the recipient, following the donor surgery. This minimally invasive procedure results in less pain, a reduction in hospitalization from five days to one or two days and a return to normal activity in about a week for the donor. Family Involvement Kidney transplantation is a family affair, especially if the recipient is receiving a kidney donation from a living relative. For this reason, family members are intricately involved in the care process, including decision making and follow-up lifestyle changes. The USC transplant coordinators help kidney patients and their families communicate and learn about what is happening. They are available 24 hours a day to answer emergency questions. They also serve as liaisons among patients, referring physicians, and the USC kidney transplant team. Through their commitment and dedication, patients and family members experience a true continuity of care from admission into the program through post-transplant follow-up. A Dedication to Education The Kidney Transplant Program at USC University Hospital is dedicated to both patient and physician education. We provide continuing medical education for outside physicians and dialysis center staff by providing conferences on topics related to pre-transplant and post-transplant management issues, maintain a web site for patient and physician access (kidneytransplant.org), host a monthly transplant support group for abdominal organ transplant candidates and recipients (to be announced), and a yearly physician symposium to discuss cutting-edge issues in kidney transplantation. Patient Education The complexity of kidney transplantation requires intensive education for patients, living donors (if applicable), and family members. The program has produced brochures in English and Spanish regarding all aspects of the transplant process. In addition, recipients and donors receive extensive one-on-one instruction and education by members of the multidisciplinary transplant team. A patient support group for transplant patients is also held on a regular basis, helping recipients find strength and encouragement through the experiences of others. Physician Education Members of the Kidney Transplant Program are regularly invited to local and national meetings to discuss the latest advances in the field of end-stage renal disease and kidney transplantation. They also speak to local groups of physicians and hold Grand Rounds across the Southland. In addition, our physicians are available for telephone consultations and invite colleagues to call with questions about complex cases. For More Information There are several ways to obtain more information about this program or to make a referral: q Visit our contact information page, or phone Kidney Transplant Program Administrator Brad Selby at (323) 442-5908. q Call 1-800-USC-CARE and ask for information about the Kidney Transplant Program. q Visit our Patient's Guide to Kidney Transplant Surgery Web Site.
  • 4. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu Copyright © USC Kidney Transplant Program. This Web site was developed in 1999 as a service provided by the USC Kidney Transplant Program. This Web site provides selected information available about kidney transplantation which may become out of date over time. It is important that consumers see a healthcare professional for detailed information about medical conditions and treatment. This information is not intended to be a substitute for the advice of a healthcare professional, or a recommendation for any particular treatment plan. The USC Kidney Transplant Program has made and will continue to make efforts to include accurate and up-to-date information on this Web site.
  • 5. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Quality Care in a University Setting Transplant At USC University Hospital and the USC/Norris Comprehensive Kidney-Pancreas Transplant Cancer Center and Hospital, we are committed to offering patients a Pancreas Transplant choice in their care. We understand that many patients choose not to Information for Patients accept blood products, and we respectfully accommodate this choice. Transplant Patient Guide Our Transfusion-Free Medicine and Surgery Program is designed to About the USC meet the individual needs of patients who do not wish to receive blood University Hospital transfusions. In our academically based program at the University of Financial Considerations Southern California School of Medicine, physicians and surgeons from Kidney Glossary many disciplines perform innovative techniques that minimize blood loss, thereby avoiding the need for blood products including red blood Features cells, platelets and plasma. What's New Kidney Research Transfusion-Free Medicine & Surgery requires special and Development expertise--expertise that is found at the Keck School of Medicine of USC. Calendar of Events Kidney Newsletter All of the physicians and surgeons who participate in the Downloads Transfusion-Free Medicine & Surgery Program are USC faculty members, offering advanced tertiary/quaternary care. Patients benefit General Information directly from the academic affiliation, receiving access to the latest Faculty and Staff medical advances. Contact Information Web Links Advanced Skills and Technology Site Map Alternatives to blood transfusions have been made possible through Search this site advances in medical and surgical techniques and technology. Blood loss can be minimized through: q Using lasers rather than scalpels. Submit q Stimulating bone marrow to produce red blood cells in advance of a procedure. q Enhancing circulation of the patient's own blood during surgery through volume expanders or intravenous fluids. q Tracking oxygen levels during surgery with skin monitors. q Using cellsavers during surgery to collect, recirculate and readminister the patient's own blood.Speeding blood clotting during surgery with an argon beam coagulator. q Utilizing intraoperative hypotension anesthesia to lower blood pressure during surgery, minimizing bleeding. Participating Medical and Surgical Specialties
  • 6. The medical staff at both USC University Hospital and the Norris Comprehensive Cancer Center and Hospital are faculty of the USC School of Medicine. Many of them are recognized as international leaders in their fields who provide tertiary/quaternary medical and surgical services for patients from around the world. With Dignity and Respect In just three short years, Nicolas Jabbour, M.D. and Randy Henderson have taken the USC Transfusion-Free Medicine and Surgery Program from an intriguing idea to one of the most well-recognized centers in the country. Through his experience with patients who do not want to take blood products, Jabbour says he has not only obtained a deeper understanding of the religious beliefs of some patients but has also come to ardently believe in the importance of minimizing blood loss for all patients, at all times. "When I meet a Jehovah's Witness patient, or any individual who does not want blood products," says Jabbour, "I see my job as not to convince them to receive blood but rather to find a way to treat them with dignity and a profound respect for their beliefs. Our program tries to provide the best possible care within our limitations--and to turn those limitations into surgical and therapeutic challenges instead." USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 7. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Transplant Kidney-Pancreas Transplant Pancreas Transplant What is Laparoscopic Surgery? View a Laparoscopic Information for Patients Left Donor Nephrectomy Transplant Patient Guide Laparoscopic surgery is RealVideo movie, approx. 10 minutes About the USC performed by inflating the abdomen with gas, usually University Hospital carbon dioxide, which creates a Financial Considerations space between the wall of the Kidney Glossary abdomen and the organs inside. Features Using short incisions in the skin, What's New narrow tubes are inserted Kidney Research through the abdominal wall so and Development that instruments can be slid Calendar of Events Can't view the video? through them to perform the maneuvers necessary for the Click here to download Kidney Newsletter a free RealPlayer Downloads operation. All this is viewed directly on a video monitor which General Information receives its picture from a video Faculty and Staff camera attached to the laparoscope. Contact Information Using these techniques, operation on the gallbladder, stomach, intestines, Web Links kidney, and other organs is possible. Site Map Search this site Laparoscopic Kidney Removal Using narrow instruments inserted through tiny punctures no more than a Submit ½ inch long it is now possible for the surgeon to free up the kidney and tie off the blood vessels. A short incision about 2 ½ inches long is made to remove the kidney. The site on the abdominal wall depends on the kidney to be donated because the donor is positioned on the operating table with the chosen kidney uppermost (see diagram below). The place is selected for cosmetic considerations and reduced disturbance to the muscles underneath in order to minimize pain.
  • 8. The Operation
  • 9. Four or five tiny incisions are made in the abdominal wall for the video equipment and instruments to dissect, insert metal clips, staples or tie knots, and remove the kidney from its attachments. A blood thinning drug (heparin) is given to prevent blood clotting in the kidney after it is removed. The kidney is scooped up in a bag and extracted from the abdomen through a short incision (5 in above diagram) and chilled on ice. It is then prepared for immediate implantation into the recipient who will already be anesthetized in an adjoining operating room. Drugs are given to make the kidney excrete large volumes of urine just before removal so a catheter is left in the bladder to measure the urine output and keep you comfortable. It is usually removed within a few days. Benefits to the Donor The advantages of laparoscopic surgery come from minimizing the trauma of access to internal organs. By avoiding a long incision through the muscles, many post-operative problems are eliminated and pain is markedly reduced. This enables the donor to breathe and cough better. Use of strong pain medications is drastically reduced so the drowsiness, fatigue and unsteadiness they cause is minimized. Risks for the Donor All operations carry some risk. Those which are the most important for you to know about are mentioned here. Most of the complicated laparoscopic procedures which we perform require full general anesthesia to allow enough relaxation of the muscles of the abdominal wall so that the operative space to work in is large enough. Modern anesthesia is very safe and the anesthesiologists at USC are all highly skilled, board certified physicians. Naturally they will need to be fully informed of any medical disorders that you may have or problems with anesthesia in the past. It is especially important that if you have any heart problems, your regular physician can send copies of old EKGs and information about any other tests that you may have had. Any operation can be complicated by bleeding and infection. If an operation has been performed through a large incision, a hernia (or muscle defect) can develop in the wound days, months or years later. Thrombosis and pulmonary embolus (clots to the lungs) are an ever present risk. It has been our experience that these complications are much less frequent after laparoscopic than conventional surgery. Even in traditional surgery, each operation has a specific complication that every surgeon strives to avoid. These potential pitfalls are still present when the operation is performed laparoscopically and will be outlined to you, depending on the type of procedure you require. Occasionally, difficulties are encountered during surgery that cannot be safely managed laparoscopically. This may be suspected before the operation and confirmed with the laparoscope. If so, conversion to a conventional open procedure is for your safety. Alternatives Most live donors come to us for laparoscopic surgery, although we have an extensive background in traditional surgery. Much of the discussion of
  • 10. alternative forms of treatment will have taken place before coming to see us. If we feel that your best interests will not be served by laparoscopic surgery we will tell you so and suggest an appropriate alternative. Complications It is rare for there to be problems due to the surgery. Bleeding during or after surgery is the chief complication and is minimized by careful technique. Low blood pressure and faintness may be signs of bleeding and should be evaluated by the surgical team. Because the operation is performed alongside other organs it is theoretically possible that an injury could occur to one of them. Persistent pain, fever, nausea or vomiting should be notified to the surgeon. Admission and Discharge Admission takes place two hours before the planned procedure. The donor operation takes 3-4 hours and the recipient operation lasts about 2 hours. In addition, the time necessary for anesthesia before and after operation may be 30-60 minutes. We will call your waiting relatives as soon as the surgery is finished to report on your progress. You will be allowed to drink a few hours after you wake up and will start light foods the next day. The area of the kidney often slows normal bowel function so return to a normal diet must be cautious. You may be able to go home the next day, or the day after depending on how comfortable you are. Related links: q Conventional Kidney Transplant USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 11. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Regular donor nephrectomy requires a long incision with removal of a Transplant rib, to allow the surgeon access to the kidney, blood vessels and Kidney-Pancreas Transplant ureter. Hospitalization of about 5 days is necessary. Nonetheless, this operation has been performed thousands of times, providing a safe, Pancreas Transplant reliable way of removing the donated kidney. Information for Patients Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit The new kidney is placed low in the right or left groin area. Diseased kidneys are not removed unless necessary. Complications Wound infection is the most common complication other than the procedure, and can usually be treated as an outpatient. Because the operation is performed alongside other organs it is theoretically possible that an injury could occur to one of them. Persistent pain, fever, nausea or vomiting should be reported to the surgeon. Admission and Discharge
  • 12. Admission takes place two hours before the operation. The operation takes about 3-4 hours. In addition, the time necessary for anesthesia before and after the surgery may be 30-60 minutes. We will call your waiting relatives as soon as the surgery is finished to report on your progress. You will be allowed to drink a few hours after you wake up and will start light foods the next day. The area of the kidney often slows normal bowel function so return to a normal diet must be cautious. You may be able to go home after 2-3 days, depending on how comfortable you are. Related links: q Live-Donor Laparoscopic Kidney Transplant USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 13. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Some clinical studies have shown that diabetic patients undergoing Transplant kidney transplantation alone have a lower graft survival when compared with diabetic patients undergoing kidney and pancreas Kidney-Pancreas Transplant transplant procedures together. It is customary in most centers to Pancreas Transplant transplant both kidney and pancreas together from the same donor. Information for Patients Monitoring is then done for the rejection episodes of both organs via Transplant Patient Guide the kidney graft. Most patients enjoying a normal life away from dialysis and threat of hypoglycemic or hyperglycemic episodes. About the USC University Hospital The operative procedure takes approximately five to seven hours for Financial Considerations both organs together, and most patients are hospitalized for two to Kidney Glossary three weeks. Pancreas-only transplantation is also considered in very selected cases where renal failure is not present but diabetes Features management is difficult, or where the patient is under threat of other What's New severe complications, such as blindness. Selectivity is based on a Kidney Research graft survival rate of at least 15 to 20 percent below that of and Development kidney/pancreas, though recent advances in this field have led to improved outcomes with pancreas-only transplants. Calendar of Events Kidney Newsletter The kidney/pancreas transplantation team includes transplant Downloads surgeons, endocrinologists and nephrologists as well as ancillary personnel. General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 14. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Rarely are pancreases transplanted independently of a simultaneous kidney transplant. Two instances that allow this procedure to be Laparoscopic Transplant considered are: Conventional Kidney Transplant q A Kidney-Pancreas Transplant Pancreas Transplant Information for Patients Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events person Kidney Newsletter has Downloads already received General Information a Faculty and Staff kidney Contact Information transplant Web Links from a Site Map living Search this site donor, but is still Submit in need of a pancreas transplant. q A prior pancreas transplant has failed. A successful pancreas transplant can benefit a diabetic person in at
  • 15. least three ways: q Some types of diabetes-caused damage to the body may be controlled or partially healed. q Insulin injections are no longer needed and the person can enjoy a regular diet. q A person typically enjoys greater activity and independence. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 16. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Transplant q A Patient's Guide to Kidney Transplant Kidney-Pancreas Transplant Surgery Home Page Pancreas Transplant Information for Patients Transplant Patient Guide q A Guide to Medications - A comprehensive guide to About the USC preventative and protective drugs. University Hospital Financial Considerations q Kidney Transplant Team - Those who help make Kidney Glossary every transplant a success. Features What's New q The Organ Donation Process - Factors in Kidney Research donating and receiving a kidney. and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 17. About The Kidney q How the Kidneys Work q Symptoms of Kidney Disease Before Surgery q Why a Transplant is Necessary q Pretransplant Evaluation q The Transplant Team q Preparing and Waiting for a Transplant During Surgery q Getting the Go-Ahead q At the Hospital q Preparing the Patient for Surgery q Kidney Transplant Surgery Procedure After Surgery q Waking Up in the Intensive Care Unit q Medical Management in the Acute Care Unit q Clinic and Follow-Up Visits This Web site was developed in q Lab Tests 1999 as a service provided by the q Additional Tests and Procedures USC Kidney Transplant Program. q Monitoring at Home This Web site provides selected q Resuming Normal Activities information available about kidney q Avoiding Infection transplantation which may become out of date over time. It is q Communicating with the Healthcare Team important that consumers see a healthcare professional for detailed Medications & Complications information about medical q Medication Guidelines conditions and treatment. This q Information About Specific Medications information is not intended to be a substitute for the advice of a q Postoperative Complications healthcare professional, or a
  • 18. The Donation Process recommendation for any particular treatment plan. The USC Kidney q Factors in the Donation Process Transplant Program has made and q The Donor/Blood Type Compatibility will continue to make efforts to q The Waiting List and Other Concerns include accurate and up-to-date q Organ Procurement Organization (OPO) information on this Web site. q United Network of Organ Sharing (UNOS) If you have any questions, please contact us: Other Kidney Sources q Transplant and Medical Sources q Useful Web Links Glossary of Kidney Terms Site Map USC Kidney Transplant Program Translate this site using Alta Vista Phone: (323) 442-5908 Fax: (323) 442-5721 usckidney@surgery.hsc.usc.edu
  • 19. HOW THE KIDNEYS WORK How the The kidneys are two Kidneys Work bean-shaped organs located toward the back of the body on either side of the spine near Symptoms of the waistline. They are about Kidney Disease the size of a fist and are protected by other organs and two of the lower ribs. Normal functioning kidneys serve the Glossary body in several very important ways. They: Site Map q Clean your blood and remove waste products Home q Balance water and salt to control fluid in the body q Control blood pressure q Help make red blood cells and strong bones q Control the amount of potassium, calcium, magnesium and phosphorus in the blood <Back Next> Symptoms of Kidney Disease If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 20. SYMPTOMS OF KIDNEY DISEASE How the Kidneys Work Symptoms may include: Symptoms of q Fluid Kidney Disease retention q Shortness of breath Glossary q Change in mental status Site Map q Abnormal urine or Home blood test results q Headache q High blood pressure q Fatigue <Back Next> Why a Transplant is Necessary If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 21. WHY A TRANSPLANT IS NECESSARY Why a Transplant A number of diseases can directly damage the kidney. Damage to the is Necessary kidney can seriously affect the removal of water and waste products, production of red blood cells, regulation of blood pressure and balance of electrolytes such as potassium, calcium and phosphorus. Pretransplant Evaluation If the damage is severe enough, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life. Transplant Team Preparing for a Transplant <Back Next> Pretransplant Evaluation Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 22. PRETRANSPLANT EVALUATION Why a Transplant Pretransplant tests, as well as giving a clear picture of the patient's is Necessary overall health status, help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option. This increases the likelihood of success. Pretransplant Evaluation The following procedures help in evaluating a patient's health status: q Physical exam - Gives the doctor an overall picture of the Transplant Team patient's conditions. q Chest x-ray - Determines the health of the patient's lungs and Preparing for lower respiratory tract. a Transplant q Complete medical and surgical history - Determines what additional tests may need to be done. q Electrocardiogram (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that Glossary was previously unsuspected. q Ultrasound with Doppler examination - Determines the Site Map quality of the iliac vessels. q Blood tests - The patient's blood count, blood and tissue type, Home blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed. q Blood typing - Every person is a blood type A, B, AB or O. The donor's blood type does not have to be the same as the recipient's blood type, but it must be "compatible" (see crossmatch testing). q Pulmonary function test - The patient will be asked to breathe into a tube attached to a measuring device, which will reveal how well his lungs are working and determine his blood's capacity to carry oxygen. q Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free. q Lower GI series - Ensures that the patient is free of intestinal abnormalities. q Renal function studies - Urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function. q Tissue typing - This test is done on white blood cells. White blood cells have special "markers" that distinguish "tissue type", which are used to find a matching kidney. q Panel Reactive Antibody (PRA) - A way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. It is easier to acquire a kidney if a recipient's immune system is calm or measures 0%. An immune system may be active from blood transfusion,
  • 23. pregnancy, a previous transplant or a current infection. q Viral testing - Determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome. q Mammogram - X-ray of a woman's breast that can detect signs of breast cancer. q Pap smear - Cells collected from a woman's cervix that are microscopically analyzed for signs of cancer. q Echocardiogram - Reveals any abnormalities in the heart. q Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant. q Other tests - Any special tests or doctor visits that might be needed for the transplant workup. Histocompatibility Laboratory Tests Tissue Typing - This test is done on white blood cells. The white blood cells have special "markers" that tell your "tissue type". You inherit tissue type from your mother and father. This test is used to match a kidney and/or pancreas to you. Panel Reactive Antibody (PRA) - This test shows how active your immune system is. It is easier for you to get a kidney if your immune system is calm or measures 0%. Blood will be drawn at your dialysis center and sent to our laboratory. Your immune system may be active from blood transfusions, pregnancy, a previous transplant or a current infection. Crossmatch Testing - This test is done when a donor kidney is available. Your blood is mixed with the donor's blood. If there is no reaction (negative crossmatch) it means you are "compatible" with the donor. If there is a reaction (positive crossmatch), the kidney will not work for you because it is "incompatible". Other Tests - The transplant doctors will ask for any special tests they think you will need. For example, people with diabetes will need more tests for their heart. Your transplant coordinator or dialysis doctor can help you make arrangements for these tests. Clinical Laboratory Tests Blood Typing - There are four different blood types. They are A, B, AB and O. Every person has one of these blood types. The donor's blood type does not have to be the same. However, it must be "compatible" with your blood type for you to receive the kidney and/or pancreas.
  • 24. Viral Testing - It is important for us to know if you have been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS). We will test you for these at your clinic appointment. <Back Next> The Transplant Team If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 25. ABSORPTION the degree and speed at which a drug enters the bloodstream from the small intestine Glossary <Back Site Map ACUTE TUBULAR NECROSIS (ATN) Home reversible kidney damage resulting in delayed kidney function. Among other factors, it may be caused by quality of donor organ, time of organ storage before transplantation, or medications to prevent rejection. <Back ALKALINE PHOSPHATASE an enzyme produced by liver (and other) cells; elevated blood levels of this substance may indicate abnormal function of the liver or other organs <Back ALLOGRAFT (allogenetic graft or homograft) a graft between two individuals who are of the same species (eg. human) but have genetic differences <Back ANEMIC low red blood cell count <Back ANESTHETIC medication that reduces pain by dulling sensation <Back ANTACID a drug that aids in protecting the digestive system and relieves heartburn and digestive discomfort <Back ANTIBODY a protein produced by the body to eliminate foreign substances, such as bacteria <Back ANTIGEN a foreign molecule or substance, such as a transplant, that triggers an immune response.
  • 26. This response may be the production of antibodies, which, in turn, try to inactivate or destroy the antigen (transplanted organ) <Back ARTERIOGRAM (angiogram) an x-ray of the arteries taken with the aid of a dye <Back ATHEROSCLEROSIS a buildup of fats in the lining of the arteries that may interfere with the flow of blood <Back B Cell a specialized white blood cell responsible for the body's immunity. B cells play a central role in antibody production <Back BACTERIA small organisms (germs) that can cause disease <Back BIOAVAILABILITY a measure of how much of an administered drug is absorbed into the bloodstream, actually reaching the intended site of action in the body. For example, medicine is absorbed from the GI tract, travels through the bloodstream, and reaches the organ tissues, where it works to fight infection, prevent rejection, etc. <Back BIOPSY the removal and examination of tissue for diagnosis <Back BLADDER the part of the urinary tract that receives urine from the kidneys and stores it until urination <Back BLOOD UREA NITROGEN a byproduct of protein breakdown in the body <Back BRAIN DEATH when the brain has permanently stopped working, as determined by a neurological
  • 27. surgeon, artificial support systems may maintain functions such as heartbeat and respiration for a few days <Back BUN BUN stands for blood urea nitrogen, a waste product normally excreted by the kidney. Your BUN value represents how well the kidneys function <Back CADAVERIC DONOR an individual who has recently died of causes that do not affect the function of an organ to be transplanted. Either the person or the person's family has generously offered organs and/or tissues for transplantation <Back CELLCEPT® an immunosuppressive drug used with other immunosuppressants to prevent the rejection of the transplanted organ. Also known by its chemical name, myophenolate mofetil <Back CHOLESTEROL a form of fat that performs necessary functions in the body but can also cause heart disease; cholesterol is found in animal foods such as meat, fish, poultry, eggs, and dairy products <Back COAGULATION blood clotting <Back CORTICOSTEROIDS a category of immunosuppressive medications that includes prednisone and prednislone <Back CREATININE a substance found in blood and urine; it results from normal body chemical reactions; high blood creatinine levels are a sign of depressed kidney function <Back CROSSMATCH a test in which donor and recipient blood samples are mixed together. A "positive" crossmatch shows the donor and recipient are incompatible. A "negative" crossmatch shows there is no reaction between the donor and the recipient. This means that the donor and recipient are compatible and the transplant may proceed.
  • 28. <Back CYCLOSPORINE the immunosuppressive ingredient in Neoral® (cyclosporine capsules and oral solution for microemulsion) and Sandimmune® (cyclosporine), an earlier form of cyclosporine. Neoral® and Sandimmune are not bioequivalent and cannot be used interchangeably without physician supervision <Back CMV (CYTOMEGALOVIRUS) a virus infection that is very common in transplant recipients; it can affect the lungs and other organs as well; a member of the family of herpes viruses <Back DETOXIFY to change a harmful substance into a safer form <Back DIABETES a disease in which patients have high levels of sugar in their blood <Back DIALYSIS the process of cleansing and achieving chemical balance in the blood of patients whose kidneys have failed. Dialysis may refer to hemodialysis or peritoneal dialysis (PD) <Back DIASTOLIC the bottom of two blood pressure numbers, which measures blood pressure when the heart is at rest <Back EDEMA excess fluid in body tissues; swelling of the ankles, for example, is a sign of edema <Back ELECTROCARDIOGRAM a recording of the electrical activity of the heart <Back ELECTROLYTE generally refers to the dissolved form of a mineral such as sodium, potassium, magnesium, chlorine, etc.
  • 29. <Back ENZYME a protein made in the body and capable of changing a substance from one form to another <Back FETUS a human embryo in the mother's uterus <Back GASTROENTEROLOGIST a physician who specializes in the care of the digestive tract <Back GINGIVAL HYPERTROPHY enlargement of the gums. It is a common side effect of cyclosporine therapy, but can be managed with good oral hygiene <Back GLUCOSE a type of sugar found in the blood <Back GRAFT an organ or tissue that is transplanted <Back GRAFT SURVIVAL when a transplanted tissue or organ is accepted by the body and functions properly. The potential for graft survival is increased when the recipient and donor are closely matched, and when immunosuppressive therapy is used <Back HELPER T CELL the specialized white blood cell that tells other parts of the immune system to combat infection or foreign material <Back HEMATOCRIT a measure of the red-blood-cell content of blood <Back
  • 30. HEMODIALYSIS a method of dialysis in which blood is purified by circulating through an apparatus outside the body (sometimes called an "artificial kidney") <Back HERPES a family of viruses that infect humans; herpes simplex causes lip and genital sores; herpes zoster causes shingles <Back HIRSUTISM an excessive increase in hair growth - especially male-pattern hair growth in a female. Hirsutism is a common side effect of corticosteroids and can also occur with cyclosporine therapy, but is easily treated with depilatory creams or other methods of hair removal <Back HISTOCOMPATIBILITY the examination of human leukocyte antigens (HLA) in a patient, often referred to as "tissue typing" or "genetic matching". Tissue typing is routinely performed for all donors and recipients in kidney and pancreas transplantation to help match the donor with the most suitable recipients. This helps to decrease the likelihood of "rejecting" the transplanted organ. <Back HLA (human leukocyte antigens) system genetically determined series of antigens that are present on human white blood cells (leukocytes) and tissues <Back HYPERTENSION high blood pressure <Back IMMUNE RESPONSE any defensive reaction to foreign material by the immune system <Back IMMUNE SYSTEM the system that protects the body from invasion by foreign substances, such as bacteria and viruses, and from cancer cells <Back IMMUNITY a condition of being able to resist a particular infectious disease
  • 31. <Back IMMUNOSUPPRESSIVE AGENTS medications given to prevent rejection of a transplanted organ <Back IMURAN® an immunosuppressive drug used with other immunosuppressive drugs to help prevent the rejection of a transplanted organ. Also known by its chemical name, azathioprine <Back INCOMPATIBLE no likeness or similarity between donor or recipient blood type or organs <Back IV, or INTRAVENOUS refers to giving medicines or fluids directly through a vein <Back IV CATHETER a small needle with a hollow tube inserted into a vein and used to give medicines or fluids <Back KIDNEY one of the two kidney-bean-shaped organs located on both sides of the spine, just above the waist. They rid the body of waste materials and maintain fluid balance through the production of urine <Back LIVING-RELATED DONOR (LRD) a blood relative who donates an organ <Back MATCH the compatibility between recipient and donor. In general, the more closely the donor and recipient "match", the greater the potential for a successful transplant <Back MICROEMULSION a suspension or mixture of tiny droplets of one liquid in a second liquid, such as the smooth mixture that is formed when Neoral® (cyclosporine capsules and oral solution for microemulsion) combines with fluids in the digestive system <Back
  • 32. NEPHROLOGIST a physician who studies the kidney and treats kidney disease <Back NEUTROPHIL a type of white blood cell <Back NONCOMPLIANCE failure to follow the instructions of one's health care providers, such as not taking medicine as prescribed or not showing up for clinic visits <Back ORALLY by mouth <Back ORGAN PRESERVATION between organ procurement and transplant, organs require special methods of preservation to keep them viable. The length of time that organs and tissues can be kept outside the body varies, depending on the organ, the preservation fluid and the temperature. <Back ORGAN PROCUREMENT ORGANIZATION (OPO) OPO's serve as the integral link between the potential donor and recipient and are accountable for the retrieval, preservation and transportation of organs for transplantation. All OPOs are UNOS members. <Back ORGAN REJECTION an attempt by the immune system to reject or destroy what it recognizes to be a "foreign" presence (for example, a transplanted liver) <Back PANEL REACTIVE ANTIBODY (PRA) a way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. <Back PCP Pneumocystis carinii pneumonia, a type of pneumonia seen primarily in patients whose immune systems are suppressed
  • 33. <Back PERITONEAL DIALYSIS a method of purifying the blood by flushing the abdominal cavity with a dilute salt solution <Back PLATELET a small blood cell needed for normal blood clotting <Back POTASSIUM a mineral essential for body function <Back PREDNISONE a manufactured steroid hormone taken by most transplant recipients to help prevent rejections <Back PROPHYLACTIC MEDICATION medication that helps prevent disease <Back REJECTION an immune response against grafted tissue, which, if not successfully treated, results in failure of the graft to survive <Back RENAL refers to the kidney <Back RETRANSPLANTATION due to organ rejection or transplant failure, some patients need another transplant and return to the waiting list. Reducing the number of retransplants is critical when examining ways to maximize a limited supply of donor organs. <Back SANDIMMUNE® (cyclosporin) an earlier formulation of cyclosporine. An immunosuppressive drug used with other immunosuppressive drugs, that acts specifically to inhibit helper T cells, thereby helping prevent the rejection of a transplanted organ. Sandimmune and Neoral are not bioequivalent and cannot be used interchangeably without physician supervision
  • 34. <Back SENSITIZED being immunized, or able to mount an immune response, against an antigen by previous exposure to that antigen <Back SHINGLES a herpes virus infection (herpes zoster) that usually affects a nerve, causing pain in one area of the body <Back SODIUM a component of table salt (sodium chloride); an electrolyte that is the main salt in blood <Back STATUS indicates the degree of medical urgency for patients awaiting heart or liver transplants <Back STRICTURE or STENOSIS a narrowing of passage in the body <Back SURVIVAL RATES survival rates indicate how many patients or grafts (transplanted organs) are alive/functioning at a set time posttransplant. Survival rates are often given at one, three and five years. Policy modifications are never made without examining their impact on transplant survival rates. Survival rates improve with technological and scientific advances. Developing policies that reflect and respond to these advances in transplantation will also improve survival rates. <Back SYSTOLIC the top of the two blood pressure numbers, which measures the maximum blood pressure reached as blood is pumped out of the heart chambers <Back THRUSH a fungus infection in the mouth <Back
  • 35. TRIGLYCERIDES a form of fat that the body makes from sugar, alcohol, and excess calories <Back T CELLS a white blood cell responsible for the body's immunity. T cells can destroy cells infected by viruses, graft cells, and other altered cells <Back TISSUE TYPING a blood test (performed prior to transplantation) to evaluate the closeness of tissue match between donor's organ and recipient's HLA antigens. <Back ULTRASOUND a probe that uses high-frequency sound waves that pass into the body, are reflected back, to build an image of one's internal organs that is shown on a monitor <Back URETHRA a tube that drains urine from the bladder to the outside <Back URETERS tubes that drain urine from the kidneys to the bladder <Back URINARY TRACT INFECTION (UTI) an infection of one or more parts of the urinary tract <Back VIRUS a very small agent (germ) that causes infection <Back WAITING LIST after evaluation by the transplant physician, a patient is added to the national waiting list by the transplant center. Lists are specific to both geographic area and organ type: heart, lung, kidney, liver, pancreas, intestine, heart-lung, kidney-pancreas. Each time a donor organ becomes available, the UNOS computer generates a list of potential recipients based on factors that include genetic similarity, organ size, medical urgency and time on the waiting list. Through this process, a "new" list is generated each time an organ becomes available. <Back
  • 36. WHITE BLOOD CELLS cells in the blood that fight infection; part of the immune system <Back If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 37. Home Page Glossary About The Kidney q How the Kidneys Work Site Map q Symptoms of Kidney Disease Home Before Surgery q Why a Transplant is Necessary q Pretransplant Evaluation q The Transplant Team r Transplant Surgeon r Transplant Physician (Nephrologist) r Transplant Coordinator r Floor or Staff Nurse r Physical Therapist r Dietician r Psychologist / Psychiatrist r Social Worker r Pharmacist q Preparing and Waiting for a Transplant r The Telephone as a Lifeline r Make a List and Pack Ahead of Time r Getting to the Transplant Center r Dealing with Pretransplant Stress During Surgery q Getting the Go-Ahead q At the Hospital q Preparing the Patient for Surgery q The Kidney Transplant Surgery Procedure After Surgery q Waking Up in the Intensive Care Unit q Medical Management in the Acute Care Unit q Clinic and Follow-Up Visits q Lab Tests q Additional Tests and Procedures
  • 38. q Monitoring at Home q Resuming Normal Activities r Skin and Hair Care r Sexual Activity r Smoking r Vacations and Travel r Dental Care r Pregnancy r Exercise r Diet and Nutrition r Alcoholic Beverages q Avoiding Infection q Communicating with the Healthcare Team Medications & Complications q Medication Guidelines q Information About Specific Medications r CELLCEPT® (mycophenolate mofetil) r SANDIMMUNE® (cyclosporine A, CyA, or CsA) r PROGRAF (tacrolimus) r DELTASONE® r IMURAN® (azathioprine) r ORTHOCLONE OKT®3 (MUROMONAB-CD3) r BACTRIM - PCP (pneumocystis Carnii Penumonia) r CYTOVENE® (ganciclovir) r ZENAPAX® r ZOVIRAX® (acyclovir) r Antifungal drugs r Drugs that protect the digestive system q Postoperative Complications r Infections r High blood pressure r Rejection r Diabetes The Donation Process q Factors in the Donation Process q The Donor/Blood Type Compatibility
  • 39. q The Waiting List and Other Concerns q Organ Procurement Organization (OPO) q United Network of Organ Sharing (UNOS) Other Kidney Sources q Transplant and Medical Sources q Useful Web Links Glossary of Kidney Terms If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 40. THE TRANSPLANT TEAM (Click on each for more information) Why a Transplant q Transplant Surgeon is Necessary q Transplant Physician (Nephrologist) Pretransplant q Transplant Coordinator Evaluation q Floor or Staff Nurse q Physical Therapist Transplant Team q Dietician Preparing for q Psychologist / Psychiatrist a Transplant q Social Worker q Pharmacist Each of the skilled health care professionals who make up the Glossary transplant team take a personal interest in answering a patient's questions and taking care of his medical needs. They will also help Site Map the patient keep his spirits up along the way. The patient is the most important member of the transplant team. To Home a certain extent, all the other team members will respond to his cues. The patient's physical, emotional, and practical needs will help them shape a personalized pretransplant and posttransplant treatment program. <Back Next> Preparing and Waiting for A Kidney Transplant If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 41. THE TRANSPLANT TEAM Why a Transplant is Necessary Transplant Surgeon The transplant surgeon performs the actual Pretransplant transplantation procedure and monitors a patient's Evaluation medication before, during, and after surgery. He or she will assess the quality of the donor's kidney before Transplant Team surgery, and monitor the patient's general and kidney status following transplantation. Preparing for He or she will also check the patient's medication needs, a Transplant and periodically check the incision to make sure it is healing properly. Glossary <Back Return to: Transplant Team Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 42. PREPARING AND WAITING FOR A KIDNEY TRANSPLANT Days and weeks may pass while the transplant team Why a Transplant waits for UNOS to locate the right kidney for a specific is Necessary patient. During this time, the patient should prepare as much as possible and take positive steps to deal with the Pretransplant stresses of waiting, always staying focused on reaching Evaluation the goal of transplant. q The Telephone as a Lifeline Transplant Team q Make a List and Pack Ahead of Time q Getting to the Transplant Center Preparing for q Dealing with Pretransplant Stress a Transplant <Back Next> During Surgery: Getting the Go-Ahead Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 43. History of the National Organ Procurement and Transplantation Network Donation Factors In the early 1980s, the advent of the immunosuppressant drug cyclosporine made the transplantation of organs other than kidneys The Donor feasible. This development led individuals to appeal to the public through the media and their legislators for assistance in finding Waiting List suitable donor organs. The demand for these organs greatly exceeded the supply. OPO There was no centralized network to increase the utilization of scarce donated organs nor were there criteria governing how an individual obtained access to transplantation. To further complicate matters UNOS there was a growing concern that wealthy citizens of foreign countries were coming to the United States to take advantage of transplantation technology to the detriment of terminally ill U. S. citizens also in need of the same technology. Glossary These issues Site Map resulted in public demand for Home the implementation of a national system. Thus, the National Transplant Act of 1984 was passed by Congress. The act called for the creation of a national task force to study issues regarding transplantation and establishment of a new National Organ Procurement and Transplantation Network (OPTN). The OPTN includes all organ procurement organizations, transplant centers and tissue typing laboratories as well as patients, patient families, donor families, hospitals, voluntary health organizations and thousands of other dedicated individuals including physicians, other health care professionals, ethicists, clergy, social scientists, attorneys, health care management and government officials. The principal purpose of the OPTN is to ensure access to organs by critically ill patients and improve organ procurement and efficiency. Another key element of the OPTN is the development and administration of policy by the transplant community. The OPTN develops membership criteria standards based on training and experience of medical personnel. For example, an approved kidney transplant program should have a surgeon who has a year of training and a year of experience in kidney transplantation. In addition,
  • 44. centers approved for liver or pancreas transplants should have a surgeon with training and experience in the transplantation of the organ being transplanted. The National Transplant Act was passed in October 1984. This act created a task force on organ transplantation that met over a period of 18 months and issued its report in April 1986. The Department of Health and Human Services (DHHS) awarded a one-year contract for the development and implementation of the national network to the United Network for Organ Sharing (UNOS) on September 30, 1986. UNOS immediately implemented parts of the network but did not complete full implementation until the end of the first year, as called for in the contract. The entire system went into effect October 1, 1987. The network has been fully operational for nearly 10 years. All clinical transplant centers, organ procurement organizations and tissue typing laboratories in the United States belong to and participate in UNOS. UNOS members have developed membership criteria based on the education, training and experience of medical personnel and monitor compliance with those standards to ensure high quality and consistent patient care. A national waiting list of all patients in the country waiting for solid organ transplantation is maintained on the UNOS computer system. UNOS operates a 24-hour-a-day organ placement center and computer system to ensure efficient and optimal matching of donors and recipients. Policies ensuring access to and allocation of organs are in place and are monitored through the use of a national computer system. To facilitate the development of policy and improve scientific methods, UNOS maintains a Scientific Registry, which contains scientific and demographic data on all organ donors and tracks all organ recipients throughout their lives. Members of the UNOS Board of Directors and its 15 permanent and 4 ad hoc committees include members of the public as well as patients. Included are experts from the fields of medicine, law, ethics, theology, social and behavioral sciences and health care financing. UNOS distributes the scientific and medical rationale for its policies for public comment and, where appropriate, holds public hearings. UNOS operates as the OPTN under contract with the U. S. Department of Health and Human Services and submits to department oversight, providing extensive information to the department for its review regarding OPTN policies United Network of Organ Sharing (UNOS) Every patient waiting for an organ transplant in the United States is registered in the UNOS computerized data network. All have equal access to donated organs. The 68 organ recovery organizations across the country are members of UNOS. When an organ procurement organization coordinator contacts UNOS, the UNOS technician inputs the organ donor's medical history, physical measurements, and blood type, and prints a computerized list of likely transplant recipients. The list is printed in order of matching priority, which includes medical criteria, length of time waiting, blood type, body weight, size of recipient diseased organ, and severity of illness. Kidney and pancreas recipients are also
  • 45. matched by tissue (genetic) typing. If the first potential recipient does not match medically with the available organ, the OPO coordinator maintains the computer search in an assigned region or elsewhere in the nation for a potential recipient who most nearly matches the donor. Likewise, organ recovery organizations throughout the United States will notify each other when an organ becomes available for waiting recipients in their respective areas. Matching donor organs with recipients is critical. Transplant waiting times may vary from a few months to several years because of matching difficulties. <Back Next> Transplant and Medical Sources If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 46. FACTORS IN THE DONATION PROCESS Donation Factors When an organ is donated from a person who has died, it is made available to an eligible patient on the waiting list. Before the transplant can take place, however, several The Donor things happen. Waiting List 1. The local Organ Procurement Organization (OPO) gathers information about the organ - size, condition, blood and tissue type - and sends this to the United OPO Network for Organ Sharing (UNOS). UNOS is a national organization that operates the patient waiting list, UNOS assuring equal and fair access for all patients to organs for transplantation. 2. A patient on the UNOS list who is most qualified for the organ - due to waiting time, blood and tissue match, and Glossary other factors - is selected and his or her center is notified. Site Map 3. Although a patient meets all the criteria and appears to be a good match for the organ, the organ still has to be accepted by the transplant center. The transplant team Home has a very short time to consider several factors before accepting that organ for the particular patient. If, in the physician's judgment, the organ offered presents undue risks to the patient, it may be refused. There are a number of reasons for refusing an organ, such as: q Patient condition - The patient may currently be too ill to undergo surgery. Or, the patient may be out of town or otherwise unavailable for surgery at that time. q Donor condition - The donor might have had high blood pressure, diabetes or some other illness that might have harmed the donated organ. q Organ condition - If an organ has been outside the donor's body for too long it might not work as well and may not help the patient. Or, the organ might have been damaged during recovery from the donor or during transit to the transplant center. Sometimes, final examination of the organ shows previously unseen risks, such as too much fatty tissue or badly formed blood vessels. q Donor/recipient compatibility - Critical "matching" tests, done just prior to surgery, sometimes reveal unknown incompatibilities that would result in failure of the transplant. q Transplant center factors - Geography may be a factor, as it may not be possible to get the organ to the center within a desirable amount of time.
  • 47. There are some differences among transplant centers overall in terms of how often organs are accepted or refused. But recent studies have found that how often a center accepts or refuses transplant organs does not seem to affect such important factors as how long patients wait for transplant or how well those patients do either before or after transplant.* * From the United Network for Organ Sharing (UNOS') Summary of Key Findings 1113197. The UNOS 1997 Report on Center-Specific Organ Acceptance Rates. <Back Next> The Donor If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 48. ORGAN PROCUREMENT ORGANIZATION (OPO) Donation Factors Each organ procurement organization (OPO) is one of 69 federally designated organ procurement centers across the United States. An OPO is responsible for matching The Donor organs from a patient who has died as a result of traumatic head injury with an individual awaiting a Waiting List life-saving organ - the gift of life. When a staff member at one of the hospitals affiliated OPO with an OPO calls to say that a potential organ donor has been identified, the donation process is set in motion. A procurement coordinator offers the next-of-kin the option UNOS of organ donation. If the family agrees, the coordinator calls the national computerized registry of the United Network of Organ Sharing (UNOS), in an effort to match medically and physically the organ donor with a waiting Glossary transplant recipient. The Role of the OPO Coordinator Site Map When a suitable recipient is found, the OPO coordinator Home notifies the surgeon who will transplant the organ. If the organ is indeed suitable, the transplant surgeon accepts the organ for transplantation at the recipient's transplant center. The OPO coordinator schedules the use of an operating room suite for the recovery of the donor organ(s) at the hospital where the donor remains. The coordinator also oversees the medical evaluation of each organ and assists in its surgical recovery. When the transplant surgeon accepts an organ offered by the coordinator, the transplant center's coordinator calls the waiting recipient, prepares the transplant center's operating suite, and coordinates the transportation of the organ procurement surgical team to the transplantation center. Individuals awaiting transplantation, as well as those who have received a transplant, are monitored medically by the transplant recipient coordinators at each transplantation center. <Back Next> UNOS: United Network of Organ Sharing If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721
  • 49. E-mail: usckidney@surgery.hsc.usc.edu
  • 50. THE DONOR Donation Factors Once doctors feel sure that someone is a good transplant candidate, the search for a new kidney will begin. The donor must be: The Donor q Free from disease, infection, or injury that affects the kidney Waiting List q Usually of the same or a compatible blood type (see table below) OPO BLOOD TYPE COMPATIBILITY CHART UNOS Can receive Generally can Blood Type kidney from: donate a kidney to: Glossary O O O, A, B, AB Site Map A A, O A, AB Home B B, O B, AB AB O, A, B, AB AB There are 3 different kinds of kidney donors: 1. Cadaveric Donor: A cadaver donor kidney (kidney/pancreas) is one that comes from a person who has just died. The family of this person has given permission for the kidneys, and possible other organs, to be donated for someone who needs a transplant. 2. Live Related Donor: A live related donor kidney comes from a blood relative, like a parent, brother, sister, or an adult child. Points to remember: q A kidney from a relative will be a better match. This means that there is less chance of rejection and you will not have to take as much (immunosuppressive) medicines. q There is no waiting time after the evaluation for a living related transplant unless the donor needs to have some medical problems taken care of. q You and the transplant team can plan when you will have the transplant surgery. q Fewer people need temporary dialysis after a living related transplant than after a cadaver
  • 51. transplant. q The donor will need about 6-8 weeks to recover. 3. Live Unrelated Donor: A live unrelated donor kidney comes from someone who is not related to the person, like a spouse or a friend. Points to remember: q There is no waiting time after the evaluation for a living unrelated transplant unless the donor needs to have some medical problems taken care of. q You and the transplant team can plan when you will have the transplant surgery. q Less people need temporary dialysis after a living unrelated transplant than after a cadaver transplant. q The donor will need about two months to recover. q If you are thinking about a live donor transplant, there is one basic rule: The Donor Must Be Willing To Give You The Kidney Without Pressure From Anyone. Other information that might be helpful to know q The donor will not have to pay for the testing or the surgery. This is paid for through your health insurance. q The donor will need to have 6-8 weeks off from work to recover from the surgery. If the donor has been working before the surgery, it may be possible for them to receive state disability payments while they are recovering. q The donor will have many tests before the surgery. There will be laboratory tests, x-rays, a physical exam and a visit with the social worker. This testing is done to make sure that the donor is healthy. It helps to limit complications for both the donor and for you. q The transplant coordinator will arrange for testing of the potential donor. <Back Next> The Waiting List If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 52. THE WAITING LIST AND OTHER CONCERNS Many waiting transplant recipients erroneously believe Donation Factors that the waiting list is like a ladder - that they are added to the bottom of the list and move up as recipients ahead The Donor of them receive their transplants. Not so. The list is in order of matching priority as indicated, according to length of time waiting, blood type, and tissue type. The Waiting List list is blind to age, sex, and race. The average waiting time is about 1 year, depending on blood type. OPO Recipients do not necessarily move up the list. For example, if a waiting recipient has blood type O, his or UNOS her name will not appear on the list as a potential recipient for a donor with blood type B. Even though one may have waited longer than another, he or she may not receive the next available organ(s). The list is constantly Glossary changing. Each potential recipient has an equal chance at receiving Site Map a transplant. Many medical factors related to a proper match enter the equation. The UNOS registry was designed to assure the equitable sharing of available Home transplantable organs. Publicity The media may help boost the general awareness of the need for organ donation, but they do not enhance a particular patient's chances of receiving an organ. Some waiting transplant recipients publicize their need through radio and television. Others send letters to physicians and transplant centers describing their medical condition. Well-intentioned letters and media coverage have no influence on the distribution of available organs. All matches are made from the UNOS national registry. Preferential treatment does not exist. Organ Donation Awareness OPO's (organ procurement centers) communicate the importance of organ donation through a network of volunteers, donor family members, waiting transplant patients and their families. These volunteers participate in a speaker's bureau and help staff booths at health fairs. Donor Family Identity The identities of donor families and transplant recipients are kept anonymous and confidential. The donor family that decides to contribute at a time of great personal loss makes a deeply personal and private decision. If a recipient chooses to write to the donor family, he or she may give or send the card or letter to the transplant
  • 53. coordinator, who will forward the correspondence to an organ procurement center, which in turn will send it on. Many donor families gain a sense of comfort knowing that their gift of life has made a difference. <Back Next> OPO: Organ Procurement Organization If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 54. KIDNEY TRANSPLANT SOURCES Transplant American Kidney Foundation Centers 6110 Executive Boulevard Rockville, MD 20852-3903 Main: (800) 638-8299 Useful Links Fax: (301) 881-0898 International Transplant Nurses Society Foster Plaza 5, Suite 300 Glossary 651 Holiday Drive Pittsburgh, PA 15220 (412) 928-3667 Site Map Transplant Recipients International Organ (TRIO) Home 1735 I Street NW, Suite 917 Washington, DC 20006 (202) 293-0980 (800) 874-6386 United Network for Organ Sharing (UNOS) The National Organ Procurement and Transplantation Network 1100 Boulders Parkway, Suite 500 P.O. Box 13770 Richmond, VA 23225-8770 (804) 330-8500 OTHER MEDICAL SOURCES AGING National Council on the Aging 800-424-9046 American Association of Retired Persons (AARP) 800-441-AARP AIDS National AIDS Hotline 800-342-2437 (AIDS) 800-344-7432 (Spanish) National Association of People with AIDS (NAPWA) 202-898-0414 National Institute of Allergy & Infectious Diseases AIDS Clinical Trials Information Service 800-874-2572 CDC National AIDS Clearinghouse 800-458-5231
  • 55. The Foundation for Children with AIDS 617-442-7442 ALCOHOL Women for Sobriety 800-333-1606 Alcoholics Anonymous (AA) (see white pages in phone book for local chapter) Al-Anon Family Group Hotline 800-356-9996 National Council on Alcoholism and Drug Dependence 800-NCA-CALL Recovering Network 800-527-5344 Alcohol Rehabilitation for the Elderly 800-354-7089 or 800-344-0824 (Illinois) MADD Victim Hotline 800-438-6233 ALLERGY/ASTHMA The Anerican Academy of Allergy and Immunology 800-822-2762 The Asthma and Allergy Foundation of America 800-727-8462 National Allergy and Asthma Network 703-383-4403 American Lung Association 212-315-8700 ALZHEIMER'S DISEASE Alzheimer's Association 800-272-3900 ANOREXIA/BULIMIA Bulimia Anorexia Self-Help 800-227-4785 Eating Disorders Helpline Unit 800-382-2832 ARTHRITIS The Arthritis Foundation 800-283-7800 National Clearing House on Arthritis, Muscular, Skeletal, and
  • 56. Skin Diseases 301-495-4484 BIRTH DEFECTS National Clearinghouse for Infants with Disabilities and Life-threatening Conditions 800-922-9234 March of Dimes 914-997-4415 BLADDER HEALTH Bladder Health Council of the American Foundation for Urologic Disease 800-242-2383 BLIND/VISION IMPAIRED American Council of the Blind 800-424-8666 Blind Children's Center 800-222-3566 or 800-222-3567 (California) Guide Dog Foundation for the Blind 800-548-4337 National Retinitis Pigmentosa Foundation 800-683-5555 National Society to Prevent Blindness 800-331-2020 The National Eye Institute of NIH 301-496-5248 CANCER Cancer Information Service of the National Cancer Institute 800-4-CANCER or 800-524-1234 (Hawaii) 800-638-6070 (Alaska) AMC Cancer Research Center Information and Counseling Line 800-525-3777 or 303-233-6501 (Colorado) American Cancer Society 800-227-2345 Candlelighters Childhood Cancer Foundation 800-366-2223 National Hospice Organization 800-658-8898 CEREBRAL PALSY United Cerebral Palsy Association
  • 57. 800-872-5827 Easter Seals 312-726-6200 CHILDREN'S HEALTH Hotline of Child Help USA 800-422-4453 Parents Anonymous 800-421-0353 National Council on Child Abuse 800-222-2000 National Runaway Switchboard 800-621-4000 Sudden Infant Death Sundrome (SIDS) Alliance 800-221-SIDS CHRONIC FATIGUE SYNDROME Centers for Disease Control and Prevention (CDC) 404-332-4555 CROHN'S/COLITIS Crohn's and Colitis Foundation of America 800-343-3637 CYSTIC FIBROSIS Cystic Fibrosis Foundation 800-344-4823 DEPRESSION National Foundation for Depressive Illness 800-248-4344 Depression after Delivery 800-944-4773 DIABETES American Diabetes Association (ADA) 800-232-3472 Juvenile Diabetes Foundation (JDF) 800-223-1138 National Diabetes Information Clearinghouse 301-468-2162 DOWN'S SYNDROME National Down's Syndrome Congress 800-232-NDSC
  • 58. DRUG ABUSE/COUNSELING American Council for Drugs 800-488-DRUG Narcotics Anonymous Cocaine Hotline 800-347-8998 National Institute on Drug Abuse 800-662-HELP Clearinghouse for Alcohol and Drug Information 800-729-6686 DYSLEXIA Orton Dyslexia Society 800-ABCD-123 or 410-337-9459 (Maryland) EPILEPSY Epilepsy Foundation of America 800-332-1000 National Easter Seals Society 312-243-8400 GUILLAIN-BARRE SYNDROME Guillain-Barre Syndrome (GBS) Foundation International 215-667-0131 HEADACHE National Headache Foundation 800-843-2256 or 800-523-8858 HEAD INJURY National Head Injury Foundation 202-296-6443 HEARING IMPAIRMENT National Hearing Aid Helpline 800-521-5247 Better Hearing Institute 800-EAR-WELL HEART American Heart Association (AHA) National Center 7272 Greenville Avenue Dallas, TX 75231-4596
  • 59. (800) 242-8721 (Local and national AHA and the AHA Cookbook are good sources of nutritional advice.) HOSPICE National Hospice Organization (NHO) 800-658-8898 Children's Hospice International 800-242-4453 HUNTINGTON'S DISEASE Huntington's Disease Society of America 800-343-4372 KIDNEY DISEASE American Kidney Fund 800-638-8299 National Kidney Foundation 800-622-9010 LANGUAGE DISORDERS American Speech-Language-Hearing Association 800-638-TALK LYME DISEASE Centers for Disease Control and Prevention (CDC) (information on Lyme Disease) 404-332-4555 LUNG DISEASE Lunglife 800-222-5864 American Lung Association 212-315-8700 LUPUS Lupus Foundation of America 800-558-0121 MENTAL HEALTH National Mental Health Association Information Center 800-969-6642 National Alliance for Mental Illness 800-969-NAMI Obsessive-Compulsive Foundation 201-878-5669
  • 60. The National Resource Center on Homelessness & Mental Illness 800-444-7415 Food & Drug Administration (information on Panic Disorder) 301-443-3170 MUSCULAR DYSTROPHY Muscular Dystrophy Association (MDA) 602-529-2000 MYASTHENIA GRAVIS Myasthenia Gravis Foundation 800-541-5454 PARKINSON'S DISEASE The American Parkinson Disease Association 800-223-2732 The National Parkinson Foundation 800-327-4545 or 800-433-7022 (Florida) 305-547-6666 (Miami) Parkinson's Education Program 800-344-7872 POISON Emergency number(s) can be found on the first page of your local phone book PREGNANCY, PRENATAL CARE (See Women's Health) PROSTATE HEALTH Prostate Health Council 800-242-2383 RARE DISEASES Centers for Disease Control and Prevention (information on Rabies) 404-332-4555 National Organization for Rare Disorders (NORD) 800-999-6673 National Information Center for Orphan Drugs and Rare Diseases 800-456-3505 National Institute of Allergy and Infectious Diseases of the
  • 61. National Institutes of Health 301-496-5717 REYE'S SYNDROME National Reye's Syndrome Foundation 800-233-7393 SCLERODERMA United Scleroderma Foundation 800-722-HOPE or 408-728-2202 (California) SEXUALLY TRANSMITTED DISEASES National STD Hotline 800-227-8922 Sex Information and Education Council 212-819-9770 SICKLE CELL DISEASE National Association of Sickle Cell Disease 800-421-8453 SLEEP DISORDERS American Sleep Disorders Association 507-287-6006 SPINAL INJURIES Spina Bifida Assoiation of America 800-621-3141 National Spinal Cord Injury Association 800-962-9639 American Paralysis Association Hotline 800-526-3456 STROKE National Stroke Association and the Alliance for Aging 800-423-1925 National Institute of Neurological Diseases and Stroke (NIDS) of the National Institutes of Health (NIH) 301-496-5924 TAY-SACHS DISEASE Tay-Sachs Disease NIH, Child Health and Human Development 301-496-5133
  • 62. TOURETTE'S SYNDROME Tourette's Syndrome Association 800-237-0717 or 718-224-2999 (New York) TOXIC SHOCK SYNDROME Toxic Shock Syndrome FDA 301-443-3170 TUBERCULOSIS American Lung Association 212-315-8700 TUBEROUS SCLEROSIS National Tuberous Sclerosis Association 800-225-6872 or 301-459-9888 (Maryland) WOMAN'S HEALTH Food & Drug Administration (information on Birth Control) 301-443-3170 Planned Parenthood Information Line 800-248-7797 National Women's Health Network 202-347-1140 PMS Access 800-222-4767 or 608-833-4767 The International Childbirth Education Association 800-624-4934 Pregnancy Counseling Services 800-542-4453 National Abortion Federation 800-771-9100 Planned Parenthood Birth Control 212-541-7800 (for local chapter, look in the white pages of phone book) OTHER USEFUL RESOURCES Centers for Disease Control (CDC) 404-332-4555 Center for Proper Medication Use P.O. Box 13329 Philadelphia, PA 19101-3329 215-895-1131
  • 63. Disease Prevention and Health Promotion Center 800-336-4797 National Library of Medicine 800-272-4787 National Institutes of Health (NIH) 301-368-6553 Publications: Consumer Reports on HEALTH 513-860-1178 National Information Center for Children and Youth with Handicaps 800-999-5599 National Coalition of Hispanics and Health and Human Services Organization 202-387-5000 National League of Nursing/American Public Health Association 212-582-1022 American Kidney Fund Financial Assistance 800-638-8299 Food & Drug Administration General Information: 301-443-3170 Reporting adverse reaction to drugs MEDWATCH 800-fda-1088 FAX 800-FDA-0178 FDA Regional Office (see white pages in phone book) National Organization for Rare Diseases (NORD) 800-999-6673 President's Council of Physical Fitness and Sports (Department of Health and Human Services) 202-272-3430 National Center on Child Abuse and Neglect (Department of Health and Human Services) 202-245-0586 National Health Information Center (Department of Health and Human Services) 301-565-4167 800-336-4797 <Back Next> Useful Web Links
  • 64. If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 65. USEFUL KIDNEY LINKS Transplant Centers Kidney Transplant Foundations Useful Links q Facts About Organ Donation and Transplatation q M.O.R.E. Program of Ontario Glossary q CenterSpan Site Map q United Network for Organ Sharing (UNOS) Home q TX Links - Web Sites related to Transplantation q National Transplant Assistance Fund q TransWeb: All About Transplantation and Donation q Roche Organ Transplantation Research Foundation q COMET: The National Council On Minority Education in Transplantation q First Family Pledge q The Nicholas Effect q Tia Nedd Organ Donor Foundation q Transplant Awareness q Organdonor.gov q American Share Foundation q Fondation Diane Hébert q The Living Bank - Organ and Tissue Donor Registry q The Mickey Mantle Foundation q Canadian Transplant Games Association
  • 66. q Anatomic Gift Foundation q Transplant Recipients International Organization, Inc. (TRIO) q Don D'Organes q American Society of Transplant Surgeons Organ Transplant and Donation q Coalition on Donation q Children's Organ Transplant Association, Inc. q United Network for Organ Sharing (UNOS) q Japan Network for Organ Sharing q Hong Kong Medical Association Organ Donation Register q British Organ Donor Society q British Organ Donor Society - Links q American Share Foundation q California Transplant Donor Network q TransWeb - Transplantation and Donation q Partnership for Organ Donation q Hepatitis C Forum q CenterSpan Government and National Organizations q U.S. Department of Health and Human Services q Health Resources and Services Administration q American Liver Foundation q The PBC Foundation (Primary Biliary Cirrhosis)
  • 67. q Hepatitis Foundation International q Hepatitis B Foundation q National Institute of Diabetes and Digestive and Kidney Diseases Search Engines and Indexes q MedExplorer Search Engine q HospitalWeb - USA Hospitals on the World Wide Web q Yahoo - Health Links Commercial Organizations q Tenet Healthcare Corporation q HepNet - Hepatitis Information Network q Bloodless Medicine and Surgery Network q RENALNET Online Journals q Hepatology Journal <Back Next> Glossary of Kidney Terms If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 68. PREPARING AND WAITING FOR A KIDNEY TRANSPLANT The Telephone as a Lifeline Why a Transplant is Necessary As soon as a donor kidney becomes available, the coordinator will call the recipient to get ready. Since this Pretransplant call could come at any time during the day or night, the transplant team should be able to reach the patient Evaluation whether he is at home, at school, at work, or on vacation. If possible, the patient should invest in a telephone Transplant Team answering machine with remote control so he can check messages while away from home. Preparing for The patient should provide his team with the phone a Transplant numbers of family members and close friends as well, and do everything he can to make sure that he can be contacted immediately. Glossary When the Phone Call Comes When that phone call comes, everything will seem like a Site Map blur. The coordinator will advise the patient when to be present at the transplant center. The patient must move quickly, getting to the transplant center without delay. Home When a kidney becomes available, there is a time limit! <Back Return to: Preparing for a Transplant If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 69. THE TRANSPLANT TEAM Why a Transplant is Necessary Transplant Coordinator This team member, usually a registered nurse, will have Pretransplant two key responsibilities: Evaluation q First, he or she will coordinate all the events leading up to and following surgery. These may include Transplant Team scheduling pretransplant testing, locating donor kidney, testing for donor compatibility, contacting the patient once a kidney has been found, and Preparing for making sure that the patient has proper follow-up a Transplant care. q Second, the coordinator will teach the patient how to take care of himself before and after Glossary transplantation, including how to take medication and when to return to the transplant center for follow-up visits. He or she can put the patient in Site Map touch with community services that will make life easier for him and his family. Home q Makes all communications between patients, hospital, clinics and doctors. <Back Return to: Transplant Team If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 70. PREPARING AND WAITING FOR A KIDNEY TRANSPLANT Make a List and Pack Ahead of Time Why a Transplant is Necessary The patient should pack an overnight bag in advance as soon as his name is put on the waiting list. He should make a list of items he will need in the hospital after Pretransplant surgery, as well as a list of people to be contacted when Evaluation the kidney becomes available. The patient should give this list ahead of time to a trusted family member or Transplant Team friend to pack any last-minute items and make the calls while the patient is on his way to the transplant center. Preparing for a Transplant <Back Return to: Preparing for a Transplant Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 71. PREPARING AND WAITING FOR A KIDNEY TRANSPLANT Getting to the Transplant Center Why a Transplant is Necessary If the transplant center is nearby, the patient should plan to have a designated driver - if possible, someone who will be standing by when the phone call comes. This Pretransplant person should be available at all times and reachable by Evaluation phone. The route to the transplant center should be mapped out in advance. Transplant Team If the transplant center is farther away, the coordinator can assist the patient and family with transportation Preparing for arrangements. a Transplant If the patient chooses to make his own travel arrangements, he should call the airlines in advance, and get regularly updated information about flight times and routes every month. If possible, a direct flight is the best Glossary option. Because flights might be delayed, the patient should have a backup plan. Choose another airline as a Site Map backup, or another mode of travel (bus, train, etc.). To make it easier on loved ones, they should arrange to Home stay within driving distance of the transplant center. <Back Return to: Preparing for a Transplant If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 72. PREPARING AND WAITING FOR A KIDNEY TRANSPLANT Dealing With Pretransplant Stress Why a Transplant is Necessary Waiting for a transplant can trigger a patient's feelings of stress and anxiety. To help manage stress, the patient should: Pretransplant Evaluation q eat right, take prescribed medications, and follow a daily exercise program. The transplant team will create a plan based on his medical needs. Transplant Team q keep up with studies, work, and leisure activities, to the best of his abilities. The patient shouldn't have Preparing for to put everything on hold. a Transplant q share his feelings if he feels depressed or uneasy. The transplant team can answer questions, and help alleviate fears. The social worker is more than a good listener -- he or she can put the patient in Glossary touch with a support group in the area. q find a creative outlet, enjoying a hobby to the Site Map fullest. This will distract and help a patient relax. Or the patient could pursue a new interest - something that will absorb pent-up energy and leave positive Home feelings of fulfillment. The patient should ask his doctor for guidelines on these activities. q spend time with family and friends. Good company will take a patient's mind off waiting. Laughter really is the best medicine. q learn relaxation techniques, like reading and listening to music or relaxation tapes. <Back Return to: Preparing for a Transplant If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 73. GETTING THE GO-AHEAD When that important phone call comes, the patient Getting the should make sure to bring the following to the hospital: Go-Ahead q A list of all the medications the patient is taking At the Hospital q A list of the patient's drug allergies, if he has any q The patient's health insurance information Preparing IMPORTANT: As soon as a kidney is available, the the Patient patient should stop all eating and drinking immediately. The patient's stomach must be empty when he is taken Kidney Transplant into the operating room. Surgery Procedure <Back Next> At the Hospital Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 74. AT THE HOSPITAL After admission, the patient will have a thorough Getting the physical examination, including more blood work, a Go-Ahead chest x-ray, and EKG, dialysis and, possibly, other tests. Unfortunately, surgery must be postponed in some At the Hospital cases. The patient will be sent home again if: q he has an infection or has developed any other Preparing medical problem that would interfere with surgery the Patient or recovery q The donor kidney shows signs of deterioration or Kidney Transplant poor function Surgery Procedure If surgery is postponed, the transplant team can help the patient through the disappointment. This is only a temporary setback, and the search for a new kidney will Glossary go on. Site Map <Back Next> Preparing the Patient for Surgery Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 75. PREPARING THE PATIENT FOR SURGERY Before the operation, the patient may receive an enema Getting the or a laxative to clean out his intestines and prevent Go-Ahead constipation after surgery. Hair from the chest and abdomen will be shaved to prevent infection, and an At the Hospital intravenous (IV) line will be inserted in the arm or just under the collarbone to give medication and prevent dehydration. The patient will also be given a sedative to Preparing help him relax and feel sleepy before going to the the Patient operating room. IMPORTANT: Kidney Transplant Because transplantation is a major surgical procedure, Surgery Procedure the patient may need a transfusion. Today, all blood is screened very carefully; the likelihood of contracting a disease is very small. Any concerns that the patient has regarding the source of the blood should be relayed to Glossary the transplant team during the waiting period, before getting to the hospital. Most hospitals offer the option of "autotransfusion" - this is when the patient donates his Site Map own blood before surgery. His own blood is stored and then used during transplantation. Home <Back Next> The Kidney Transplant Surgery Procedure If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 76. THE KIDNEY TRANSPLANT SURGERY PROCEDURE The patient will be under general anesthesia throughout Getting the the surgery. Once asleep, the transplant surgeon will Go-Ahead make an incision on the right or left side of the lower abdomen just above the groin. At the Hospital Preparing the Patient Kidney Transplant Surgery Procedure Glossary Site Map Home The surgical team will then place the donor kidney into the abdomen and connect the kidney's blood vessels to the recipient's iliac artery and vein. The surgeons will then connect the ureter to the bladder. A small drain, called a Jackson Pratt, may be placed into the abdominal cavity to drain any excess fluid. <Back Next> After Surgery: Waking Up in the Intensive Care Unit If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 77. WAKING UP IN THE INTENSIVE CARE UNIT (ICU) After the surgery, the patient will wake up in the Waking Up in the intensive care unit (ICU) after the anesthesia wears Intensive Care Unit off. Medical Management This is what the patient should expect: in the Acute Care Unit q Some pain and discomfort, which medication will help to relieve. Clinic Visits q The patient will be asked to cough periodically to keep his lungs clear. If it hurts to cough, the patient should ask someone to support his Lab Tests abdomen. q The patient will have an IV line in his arm or Additional Tests neck under the collarbone, which will be used to give fluids and medication for the first few days after surgery. Monitoring at Home q For several days after surgery, the patient will have a catheter in his bladder to drain urine. He Resuming Activities may feel uncomfortable, and may feel that he has to urinate constantly, but it is only Avoiding Infection temporary. q During surgery, one drain may be placed in or near the incision. The drain will be removed 5 Communicating with to 10 days after surgery. Healthcare Team q Dialysis may still be needed to help clear excess fluid and toxins in the body until the kidney recovers from the procurement process. Glossary The length of a hospital stay will depend on a patient's progress. A patient is encouraged to talk to Site Map someone on his transplant team if he is uneasy or uncomfortable. Home <Back Next> Medical Management in the Acute Care Unit If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 78. MEDICAL MANAGEMENT IN THE ACUTE CARE UNIT After the patient's medical condition has stabilized, he Waking Up in the will be transferred from the ICU to the acute care Intensive Care Unit unit. During the patient's stay on this unit, his laboratory studies, medications, nutritional status and Medical Management exercise tolerance will be monitored. As soon as the in the Acute Care Unit patient is able, discharge instructions will begin to prepare him for going home. Clinic Visits <Back Next> Clinic Visits Lab Tests Additional Tests Monitoring at Home Resuming Activities Avoiding Infection Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 79. CLINIC VISITS Upon leaving the hospital, the patient will receive a Waking Up in the schedule of follow-up clinic visits for lab tests and Intensive Care Unit checkups. The purpose is to track your progress and detect potential complications as early as possible. Medical Management Follow-up visits in the Acute Care Unit On days when the patient is scheduled for follow-up Clinic Visits visits, he should bring his medication list and his surgery handbook. He will be given specific instructions for routine lab work or special tests that Lab Tests he might need. Additional Tests <Back Next> Lab Tests Monitoring at Home Resuming Activities Avoiding Infection Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 80. LAB TESTS Waking Up in the A usual lab test monitors blood count, kidney function, Intensive Care Unit electrolytes, and medication levels in the patient's blood. Other tests may be ordered as necessary. Medical Management Tests for BLOOD COUNT: in the Acute Care Unit q WBC tell if the patient's white blood Clinic Visits cells have increased (usually a sign of infection) or decreased Lab Tests (indicating a lower defense against Additional Tests infection). q HCT measures the hematocrit, which is Monitoring at Home the percentage of red blood cells in the blood. Resuming Activities Red blood cells carry oxygen to all parts of the body. When a Avoiding Infection patient's HCT is low, he may feel tired or have Communicating with little energy. Healthcare Team q PLT measures the level of platelets. Platelet cells form a blood clot when the body is Glossary injured. Low platelet levels may cause someone to bruise Site Map easily and to bleed for a longer time when injured. Home Test for KIDNEY FUNCTION: Creatinine and BUN tell how well the kidneys work by measuring levels of creatinine and blood urea nitrogen, waste products normally removed from the blood by the kidneys. Tests for ELECTROLYTES (dissolved minerals): q Ca measures calcium, which is necessary for strong bones and teeth, blood clotting, and heart and nerve function. q PO4 measures phosphate, which works closely with calcium to strengthen bones. q Mg measures magnesium, which is necessary for normal functioning of muscles and for blood clotting. q K measures potassium, which is needed for normal heart
  • 81. and muscle function. q Na measures sodium, which helps maintain the balance of salt and water in the body. q CO2 measures bicarbonate, which helps maintain acid balance in the body. q Creatinine measures how well the kidneys are functioning. When this number rises, the cause may be rejection or a side effect of medication. Other blood tests: Drug levels measure PROGRAF® or SANDIMMUME® in the blood. PROGRAF or SANDIMMUNE blood levels must be checked regularly to avoid levels that are too high or too low. High levels could lead to toxicity or over-immunosuppression, and low levels may lead to rejection. NOTE: The desired level (normal range) will differ for each person, depending on the combination of immunosuppressive medications and the length of time since the transplant. Glu measures glucose, levels of sugar in the blood; some medications may produce a diabetes-like condition in which blood-sugar levels are too high. <Back Next> Additional Tests and Procedures If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 82. ADDITIONAL TESTS AND PROCEDURES The transplant team may perform one or more of the Waking Up in the following tests and procedures to monitor a patient's Intensive Care Unit transplant: Ultrasound - This test is performed to make sure all Medical Management the main blood vessels leading to the kidney are in the Acute Care Unit functioning normally. This test is also used to check for collections of fluid, such as blood. The procedure Clinic Visits consists of placing a cool gel on the patient's abdomen, over which a wand (transducer) is moved to transmit sound waves. These are converted into Lab Tests images of the kidney and projected onto a television screen. Additional Tests Kidney biopsy (test sample) - This test is usually performed to check for rejection, or other possible Monitoring at Home problems. This may be done in the hospital or in the outpatient/short-stay unit. The patient will receive special instructions regarding the procedure. Before Resuming Activities the procedure, the patient will receive a numbing injection (local anesthetic) on the right side of his Avoiding Infection abdomen. Then a special needle will be inserted to withdraw a small sample of kidney tissue that will be examined with a microscope. Communicating with Healthcare Team Computerized tomography (CT) scan - This is a type of X ray that allows the physician to view the patient's kidney from many different angles to detect infections, fluid collections, or other problems. The Glossary procedure requires that the patient drink a liquid that outlines his stomach and intestines and makes his kidney more visible; then he lies flat for 1 hour while Site Map the machine takes X rays around him. Magnetic resonance imaging (MRI) - This is Home another type of test that produces an image. Somewhat like a CT scan, it also allows a patient's kidney to be viewed from different angles and in three-dimensional images. An MRI shows soft tissues, such as the kidney, more clearly than a CT scan does. <Back Next> Monitoring Health and A New Kidney at Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 83. MONITORING HEALTH AND A NEW KIDNEY AT HOME After a patient is discharged from the hospital, he Waking Up in the may be asked to monitor: Intensive Care Unit q temperature q pulse Medical Management in the Acute Care Unit q blood pressure q weight Clinic Visits Temperature - A patient should check and record temperature any time he feels chilled, hot, achy, or Lab Tests ill. This may be the first sign of infection. WARNING: DO NOT USE TYLENOL®, ADVIL® Additional Tests (Ibuprofen), aspirin, or other such products except under the direction of a physician, as these drugs may cause further symptoms. Monitoring at Home If a patient's temperature is higher than normal at Resuming Activities any time, he should notify his transplant coordinator immediately. This is considered an emergency, because an elevated temperature could indicate a Avoiding Infection serious infection or rejection. Blood pressure - A nurse or transplant coordinator Communicating with will show how to measure blood pressure, if Healthcare Team necessary. The top number (systolic) is noted at the first sound, and the bottom number (diastolic) is noted when the sound changes (not stops). It is important that a patient knows his normal blood Glossary pressure, normal changes, and when he should be concerned. Site Map Pulse - If a patient is taking medication that affects heart rate, the nurse or coordinator will show how to Home check his own pulse at home. NOTE: If a patient experiences chest pain or has difficulty breathing, he should call 911 for an ambulance and go to the nearest emergency room. He SHOULD NOT attempt to drive himself. Weight - The patient may weigh himself on a standard bathroom scale at the same time every morning (after going to the toilet). If he gains more than 2 pounds per day, he could be retaining fluid. This should be reported to the transplant coordinator. <Back Next> Resuming Normal Activities
  • 84. If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 85. RESUMING NORMAL ACTIVITIES Waking Up in the Although the patient is encouraged to Intensive Care Unit resume normal activities after recovery, it is important to understand that having a new kidney brings new responsibilities. Medical Management q Skin and Hair Care in the Acute Care Unit q Sexual Activity Clinic Visits q Smoking q Vacations and Travel Lab Tests q Dental Care q Pregnancy Additional Tests q Exercise Monitoring at Home q Diet and Nutrition q Alcoholic Beverages Resuming Activities Signs to Watch Out For Avoiding Infection While primary concerns involve infection and rejection, many other problems, such as colds or flu, adjustment of other Communicating with medications, and minor infections can be Healthcare Team handled by a local physician. A patient needs to take precautions and learn to watch for signs of infection and rejection that necessitate notifying a local physician or transplant team Glossary immediately. These include: q a fever that continues for more than 2 days Site Map q shortness of breath q a cough that produces a yellowish or greenish substance Home q a dry cough that continues for more than 1 week q prolonged nausea, vomiting, or diarrhea q an inability to take prescribed medication q a rash or other skin changes q vaginal discharge or itching q burning discomfort with urination q exposure to mumps, measles, chicken pox, or shingles q unusual weakness or light-headedness q emergency-room treatment or hospitalization q pain, redness, tenderness or swelling at the incision site q fluid retention/weight gain (2 lbs. in 24 hours)
  • 86. q decrease in urine output q pain or burning during urination q blood in the urine q strong odor to the urine q feeling urgent need to urinate or need to urinate frequently <Back Next> Avoiding Infection If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 87. RESUMING NORMAL ACTIVITIES Skin and Hair Care Waking Up in the Intensive Care Unit A patient will not need any special skin care unless he develops acne or dry skin. Generally, he should shower or bathe as often as necessary to keep his Medical Management skin clean. Most soaps are appropriate. in the Acute Care Unit Acne - Prednisone can cause acne on the face, chest, Clinic Visits shoulders, or back. Cyclosporine can make the skin more oily. If acne develops, the patient should wash the area three times per day with a mild soap, Lab Tests scrubbing gently with a clean, wet washcloth. Rinse the soap completely from the skin to leave the pores open and clean. Additional Tests Ways to control acne: Monitoring at Home q Keep hands away from the face and avoid rubbing the affected area. To avoid infections, do not pick or touch the acne. Resuming Activities q Do not use cosmetics. q Avoid the use of medicated hypoallergenic Avoiding Infection cosmetics intended to cover acne. Wearing makeup will prevent acne from going away. Communicating with q Do not rub or scrub the skin vigorously. This Healthcare Team can irritate the skin. q Avoid soaps that contain creams and oils, because they will aggravate acne. Glossary q Do not use lotions for dry skin. q If the skin becomes very dry, stop washing those areas temporarily so the skin can recover Site Map its natural moistness. q Do not use RETIN-A® (tretinoin cream) on the Home skin without consulting a physician, because it will increase the sun sensitivity caused by prednisone. WARNING: Remember that severe or infected acne must be treated by a dermatologist. If acne remains a problem, a member of the transplant team should be contected for advice. Dry skin care - For problems with dry skin, use a mild soap and apply body lotion after bathing Cuts and scratches - Wash minor cuts and scratches daily with soap and water. For treatment of large cuts, contact a physician immediately.
  • 88. Skin growths - The transplant team should be notified if the patient discovers any unusual skin growths, rash, or discoloration. Hair care - Prednisone will probably affect the condition of hair. Permanent hair dyes, tints, wave lotions, and bleach may cause hair to become brittle and to break. It is recommended that the patient waits until the prednisone dosage is lower than 10 mg per day before having a permanent or coloring the hair. The patient's hairdresser should be advised that the patient is taking prednisone and to use a good conditioner on the patient's hair. Unwanted hair growth - If facial hair increases, use a hair-removal cream (depilatory). Be sure to follow directions carefully to avoid eye or lip irritation. An alternative is to bleach extra hair growth with a 50% peroxide solution. The patient might consider waxing or electrolysis to remove extra hair. Even if hair growth is excessive, do not alter medication. Contact the transplant team. Sun exposure - Transplant patients have an increased chance of developing skin and lip cancers. Since the risk increases with time, the patient must always protect his skin from the ultraviolet rays of the sun that cause skin cancers. q Avoid midday (10 am to 3 pm sun, when ultraviolet rays are strongest. q Wear a hat, long sleeves, and slacks when outdoors unless using a sunscreen. q Use a sunscreen lotion with sun protective factors (SPF) rated at least 15. q Use a sunscreen lotion and lip balm every day (rain or shine) and apply to exposed areas, especially face, neck, and hands. NOTE: Remember that sunscreen lotions wash off. Reapply the lotion as needed, especially after swimming. <Back Return to: Resuming Normal Activities If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 89. AVOIDING INFECTION Waking Up in the Because Intensive Care Unit immunosuppressive medications interfere with a patient's natural Medical Management immune system, he needs in the Acute Care Unit to protect himself consciously from infection after the surgery by Clinic Visits taking the following precautions: Lab Tests q Wash hands often. q Keep hands away Additional Tests from face and mouth. Monitoring at Home q Stay away from people with colds or other infections. Resuming Activities q Ask friends to visit only when they are Avoiding Infection well. q If the patient has a Communicating with wound and must Healthcare Team change his own dressing, wash hands before and after. Glossary q Wash hands after coughing or sneezing, and throw Site Map tissues into the trash immediately. Home q If someone in the patient's family becomes ill with a cold of flu, have that individual follow normal precautions (use separate drinking glasses, covering their mouths when coughing, etc.) q Avoid working in the soil for 6 months after the transplant. Thereafter, wear gloves.
  • 90. q Avoid handling animal waste and avoid contact with animals who roam outside. Do not clean bird cages or fish or turtle tanks or cat litter. The cat litter box should be covered and taken out of a patient's home before it is changed. q Avoid vaccines that consist of live viruses, such as Sabin oral polio, measles, mumps, German measles, yellow fever, or smallpox. The live virus can cause infections. If a patient or any family member intends to receive any vaccinations, they should notify the transplant team or local physician. q Take good care of your teeth by brushing two times a day and seeing the dentist twice a year for cleaning and checkup. SPECIAL WARNING TO PARENTS OF CHILDREN WHO HAVE HAD TRANSPLANTS: Ask the school nurse or other official to notify you immediately of any communicable diseases (for example, measles, chicken pox) that may be circulating in your school. <Back Next> Communicating with the Healthcare Team If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 91. COMMUNICATING WITH THE HEALTHCARE TEAM Communication and cooperation between the Waking Up in the transplant team, local physician, pharmacist, dentist, Intensive Care Unit and the patient himself is vital to his well-being. Having a transplanted kidney and taking the Medical Management medications needed to prevent rejection put a patient in the Acute Care Unit at risk for a number of complications. It is important to follow the instructions that will help prevent or lessen complications. Clinic Visits One of a patient's most important jobs is to make Lab Tests certain that all members of his local healthcare team - family physician, dentist, local pharmacist, and any other healthcare professionals he sees - are aware of Additional Tests the transplant, the medications he takes each day, and the precautions he must follow to stay healthy. Each of his local healthcare providers should be given Monitoring at Home the telephone number of his transplant team. He should ask that they contact the transplant center for Resuming Activities specific information. Anxiety and Depression Avoiding Infection A serious procedure such as the one just experienced can create many personal and family stresses. It is Communicating with not uncommon for transplant patients to experience Healthcare Team anxiety and perhaps depression following their surgery, hospital confinement, and return home. To help a patient adjust to life at home and an eventual return to work or school, counseling services are Glossary available. He should consult the transplant coordinator or social worker for information regarding Site Map services available to help resolve stress and anxiety. Home <Back Next> Medication Guidelines If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 92. INFORMATION ABOUT SPECIFIC MEDICATIONS Medication Guidelines Including: infection-fighting drugs, antifungal drugs, drugs that protect the digestive system, and nutritional supplements. Medications CELLCEPT® (mycophenolate mofetil) Complications Fights rejection by decreasing the number of white blood cells the immune system produces. More information Glossary SANDIMMUNE® (cyclosporine A, CyA, or CsA) Used to prevent rejection of a transplanted organ. It Site Map is used for long-term (perhaps lifetime) immunosuppression. More information Home PROGRAF (tacrolimus) PROGRAF is prescribed to prevent or treat organ rejection in people who have received kidney transplants. It is used for long-term (perhaps lifetime) immunosuppression. More information DELTASONE® (prednisone) - prednisoine, a related drug, is used for some patients. DELTASONE is a corticosteroid that helps prevent and treat rejection of transplanted organs. It may be used for long-term (perhaps lifetime) immunosuppression or, in higher doses, for treatment of rejection. More information IMURAN® (azathioprine) IMURAN is given with other immunosuppressants to help prevent rejection of the new kidney. It may be used for long-term (perhaps lifetime) immunosuppression. More information ORTHOCLONE OKT®3 (MUROMONAB-CD3) OKT3 may be given immediately following kidney transplant to prevent rejection. It may also be used to treat rejection. More information
  • 93. ZENAPAX ® (Daclizumab) Used in combination with standard immunosuppressive agents. It is the first genetically engineered drug to reduce the risk of organ rejection in kidney transplant patients without increasing overall side effects. More information Return to Top INFECTION-FIGHTING DRUGS Bactrim - PCP (pneumocystis Carnii Penumonia) Bactrim is used to prevent and treat PCP and other infections. The risk of PCP is increased for transplant patients because of the drugs taken to suppress their immune systems, which reduce their bodies' ability to fight infection. More information CYTOVENE® (ganciclovir) CYTOVENE is used to prevent or treat CMV infection. More information ZOVIRAX® (acyclovir) ZOVIRAX is used to prevent or treat herpes simplex and shingles. ZOVIRAX will not get rid of the herpes viruses, but it will lessen the pain and help heal the sores. It may be used to decrease the severity of CMV infections. More information Return to Top ANTIFUNGAL DRUGS Various drugs are used to treat or prevent fungus infections. More information Return to Top DRUGS THAT PROTECT THE DIGESTIVE SYSTEM Because some medications can cause ulcers in the stomach and upper intestine, a patient may need to take other medications to help protect the digestive system. These drugs will be prescribed by the transplant team when necessary. More information Return to Top NUTRITIONAL SUPPLEMENTS The transplant team may recommend that a patient take vitamin, iron, magnesium, and/or calcium supplements in case his diet is not providing adequate amounts of the nutrients that is needed. Return to Top
  • 94. <Back Next> Postoperative Complications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 95. MEDICATIONS CELLCEPT® (mycophenolate mofetil) Medication Guidelines Purpose: Medications Fights rejection by decreasing the number of white blood cells the immune system produces. Complications How to take: q Capsules - 250 mg blue and brown; Tablets - 500 mg lavender. q CellCept should be taken twice a day on an Glossary empty stomach. Site Map Precautions: Increased susceptibility to infection and the possible Home development of lymphoma may result from immunosuppression. Only physicians experienced in immunosuppressive therapy and management of renal or cardiac transplant patients should use CellCept. Patients receiving the drug should be managed in facilities equipped and staffed with adequate laboratory and supportive medical resources. The physician responsible for maintenance therapy should have complete information requisite for the follow-up of the patient. Principal Side effects: These include, but are not limited to, diarrhea, leukopenia (a decrease in the number of white blood cells which can increase the chance of infection), sepsis (a condition associated with a bacterial infection of the blood), vomiting and an increased susceptibility to certain types of infections and lymphoma. Patients receiving CellCept should be monitored for neutropenia. Immediately report to your doctor any evidence of infection (for example, fever, chills, sore throat, cough, unexplained bruising or bleeding). <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 96. MEDICATION GUIDELINES Medication Guidelines The patient is responsible for Medications taking the medications that have been Complications prescribed for him. He should talk to his physician, Glossary pharmacist, transplant Site Map nurse, and/or coordinator to understand Home fully: q the name and purpose of each medication q when to take each medication q how to take each medication q how long to continue taking each medication q principal side effects of each medication q what to do if he forgets to take a dose q when to order more medication so it
  • 97. doesn't run out q how to order or obtain medications q what to avoid while taking medications At home, the recovering patient will continue taking most of the medicines he began taking in the hospital after the transplant surgery, especially the anti-rejection medications. His immune system recognizes the new liver as foreign and will try to reject it. Therefore, his immune system must be controlled with immunosuppressive medications. The patient probably will have to take one or more of these drugs for the rest of his life, in addition to other medications. REMINDER: Never stop taking medication or change the dosage without a physician's approval.
  • 98. Before taking medications: q Ask the nurse, coordinator, or pharmacist to help in selecting the best times to take medications. q Try to take each medication at the same time every day. q Follow a written schedule. q DO NOT cut or crush a tablet unless advised to do so. General Guidelines for Storing Your Medications q Keep all of your medications in the original container. q Make sure the cap is on tightly. q Store the medication containers in a cool (<80° F), dry place away from direct sunlight. q Do not store
  • 99. medications in the bathroom - moisture can cause medications to lose their strength. q Keep all medications away from children. q Do not store medications in your car. q Ask your nurse, coordinator, or pharmacist to help you pick the best times to take your medications. q Take each medication at the same time every day. q Follow a written schedule. q DO NOT cut or crush a pill unless you are told to do so. Important Medication Tips q Take Prograf® on an empty stomach. q Take your
  • 100. Prograf® or Cyclosporine doses 12 hours apart. q Take Prograf®, Neoral®, or Cyclosporine AFTER the lab draws blood for a level. q Bring the medication with you and take it after your blood has been drawn. q Bring all of your medications to your first clinic appointment. <Back Next> Information About Specific Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 101. POSTOPERATIVE COMPLICATIONS Medication Guidelines A number of postoperative complications are possible: q Infections Medications q High blood pressure q Rejection Complications q Diabetes There is no way to predict accurately which patients will have problems. The transplant team will do their best to reduce the Glossary likelihood of complications and to treat them promptly if they occur. Following instructions carefully and keeping the transplant Site Map team informed of any difficulties will help a patient return quickly to a normal, active life. Home A patient should notify the transplant team if he: q has prolonged illness (nausea, vomiting, diarrhea) q is unable to take medicines by mouth due to illness q thinks the directions on the label may be different from what he was told q has trouble removing child-resistant caps q has a reason to take aspirin, TYLENOL® (acetaminophen), other pain relievers, cold remedies, or diet pills q feels he is having a reaction to the medications q has had a change in health or eating habits q has a new prescription from his local doctor or a change in a current prescription q experiences any unusual symptoms or side effects, as they may be related to the medications he is taking q is undergoing dental work of any kind <Back Next> Factors in the Donation Process If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 102. POSTOPERATIVE COMPLICATIONS INFECTIONS Medication Guidelines Immunosuppressive medications interfere with a Medications patient's natural immunity; therefore, the patient will be more susceptible to infections after transplant surgery. The following are some of the most common Complications infections: Viral Infections: Glossary Cytomegalovirus (CMV) - CMV is one of the viral infections that occur most frequently in transplant patients. The risk of CMV is highest in the first Site Map months after transplantation. Signs include fatigue, high temperature, aching joints, headaches, visual disturbances, and pneumonia. Treatment may Home include hospitalization. Herpes-simplex virus type I and II - These viruses most often infect the skin but can also occur in other areas such as the eyes and lungs. Type I typically causes cold sores and blisters around the mouth, and type II causes genital sores. Herpes is an infectious disease and can be transmitted sexually. Herpes infections in transplant patients, however, were not necessarily transmitted sexually. Most herpes-simplex infections are mild, but occasionally they can be severe. Although there is no cure for herpes, it can be treated. Depending on the severity of the infection, the treatment is either topical, oral, or intravenous (IV). A patient should contact the transplant team immediately if he believes he has herpes. Symptoms of herpes include feeling weak and having painful fluid-filled sores in the mouth or genital area. Women should also be aware of any unusual vaginal discharge. Herpes zoster (shingles) - Shingles appear as a rash or small water blisters, usually on the chest, back, or hip. The rash may or may not be painful. A patient should notify the transplant office if such a rash ocurs. Fungal Infections: Candida (yeast) - Candida is a fungus that can cause a variety of infections in transplant patients. It usually appears in the mouth and throat but may also be in the surgical wound, eyes, or respiratory and
  • 103. urinary tracts. Candida is most severe in the bloodstream. If infection occurs in the mouth or throat, it is called thrush. Thrust produces white, patchy lesions (raw areas), pain or tenderness, a white film on the tongue, and difficulty swallowing. Candida can also infect the esophagus (the tube from your mouth to your stomach) or, in women, the vagina. Vaginal infections usually produce an abnormal discharge that may be yellow or white. A patient should notify the transplant office if a Candida infection ocurs. Bacterial Infections: Wound infections - Bacterial wound infections occur at the surgical site. If a patient has a fever or notices redness, swelling, tenderness, or drainage at the incision, he should notify the transplant team. After a wound culture (a test for bacteria) is taken, an antibiotic will be prescribed if infection is present. Other Infections: Pneumocystis carinii is a germ similar to a fungus, and it is normally found in the lung. In people whose immune systems are suppressed, it may cause a type of pneumonia (PCP). Early in the illness, a mild, dry cough and a fever may occur. If a patient suspects that he has a cold or flulike illness, he should contact his physician immediately. <Back Return to: Complications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 104. POSTOPERATIVE COMPLICATIONS High Blood Pressure Medication Guidelines High blood pressure and heart disease are common Medications disorders that become more frequent as people grow older. High blood pressure is also a side effect of some medications. A patient may need to take a Complications medication to control his blood pressure. There are many different types of drugs available to control high blood pressure. A patient may need to Glossary try several different medications. The transplant team or local physician will select the one that works best for each specific patient. Site Map A diuretic (water pill) may also be prescribed to lower blood pressure, increase urine output, and remove Home extra fluid. <Back Return to: Complications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 105. POSTOPERATIVE COMPLICATIONS Rejection Medication Guidelines This happens when your body's immune system Medications thinks your new organ is "foreign" and attempts to destroy it. You will take immunosuppressive medications for the rest of your life to prevent Complications rejection. There are several types of rejection: Glossary Hyperacute rejection - happens when the body immediately destroys the new kidney, this is rare because of the crossmatch testing used before Site Map transplant. Acute rejection - although this can happen at any Home time after the transplant, most often it happens during the first several months. This can be treated by giving you higher doses of medication by mouth or by intravenous infusion. You may get this treatment as an outpatient if it is recognized early. Chronic rejection - this may happen months or years after the transplant. This type of rejection is resistant to treatment with current medications. This will cause your new organ to slowly stop working. Diabetes The term diabetes means that your blood sugar levels are too high. This can be caused by some of the medications you are taking for your transplant, such as Prednisone, Prograf®, and/or Cyclosporine. You may need to start taking insulin or increase your dose to help control your blood sugar. Acute Tubular Necrosis (ATN) This is a condition when the kidney doesn't work right away after transplant. ATN is usually temporary. It can be caused by a long organ storage time on ice before transplant or by medications. The symptoms are treated in two ways: 1) By limiting the salt, protein, potassium in your diet, and fluid intake, or by dialysis. 2) The transplant team will look at the lab results, your weight, your limiting fluid intake, urine output, and vital signs to decide which treatment you will need. <Back Return to: Complications If you have any questions, please contact us:
  • 106. USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 107. POSTOPERATIVE COMPLICATIONS Diabetes Medication Guidelines Some of the immunosuppressive medications may Medications cause diabetes. Diabetes is an increased level of sugar in the blood. Complications Symptoms of diabetes may include: increased thirst, increased frequency of urination, blurred vision, and confusion. A patient should notify his transplant team or local physician if he experiences any of these Glossary symptoms. Blood sugar can be reduced through weight loss, Site Map careful diet, and exercise. An oral diabetes drug or insulin injections may be necessary. Home If a patient develops diabetes, he will receive specialized teaching about how to deal with this problem. <Back Return to: Complications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 108. MEDICATIONS SANDIMMUNE® (cyclosporine A, CyA, or CsA) Medication Guidelines Purpose: Medications SANDIMMUNE is used to prevent rejection of a transplanted organ. It is used for long-term (perhaps lifetime) immunosuppression. Complications How to take: q Capsules - 25 mg, 50 mg, and 100 mg; liquid - 100 mg per mL (milliliter). If SANDIMMUNE is Glossary taken twice daily, doses should be 12 hours apart. A patient may be given IV SANDIMMUNE initially for a few days after transplantation. Site Map q The liquid form will taste better if mixed with milk, chocolate milk, or orange juice. It can be Home mixed with a room-temperature liquid in a glass or hard plastic container and stirred with a metal spoon. Do not use a styrofoam container. q The transplant team will determine proper dosage based on the patient's weight, blood levels, other laboratory tests, and the possible side effects of SANDIMMUNE. Precautions: q SANDIMMUNE is usually taken with corticosteroids, such as prednisone and azathioprine. q The patient is likely to have frequent lab tests during the first few months to monitor the effectiveness and side effects of SANDIMMUNE. q On a day when the SANDIMMUNE level is to be measured, a patient should not take his morning SANDIMMUNE dose until his blood has been drawn. q Store SANDIMMUNE capsules below 77 º F; store liquid below 86º F. Do not leave SANDIMMUNE in the car or store it in a refrigerator or a bathroom medicine cabinet or exposed to direct light. Appropriate places to store this drug include the kitchen or the bedroom - away from heat, cold, moisture, and children. q An open bottle of SANDIMMUNE is good for 2 months. The capsule should not be removed from the wrapper until it is ready to be used. q SANDIMMUNE interacts with many commonly
  • 109. used medications. Check with the transplant team before starting any new medications. q The benefits of taking this medication if the patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. She should consult her transplant team immediately if she thinks she's pregnant. Principal side effects: These include, but are not limited to, headaches, tremor, abnormal kidney function, high blood pressure, high potassium levels, excess hair growth, swelling or overgrowth of the gums, and sleep disturbances. <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 110. MEDICATIONS PROGRAF (tacrolimus) Medication Guidelines Purpose: Medications PROGRAF is prescribed to prevent or treat organ rejection in people who have received liver transplants. It is used for long-term (perhaps Complications lifetime) immunosuppression. How to take: q Capsules 1 mg (milligram) and 5 mg. If Glossary PROGRAF is taken twice daily, doses should be 12 hours apart. Either oral or IV PROGRAF may be given immediately after transplantation. Site Map q The transplant team will determine the dosage appropriate for each patient based on weight, Home blood levels, other laboratory tests, and the possible side effects of PROGRAF. q PROGRAF should be taken 1 hour before meals or 2 hours after meals. Precautions: q Initially, the patient should also be taking corticosteroids, such as prednisone and/or azathioprine, when he takes PROGRAF. q The patient is likely to have frequent lab tests during the first few months to monitor the effectiveness and side effects of PROGRAF. q On a day when PROGRAF level is to be measured, the patient should not take his morning PROGRAF dose until after his blood has been drawn. q Store PROGRAF at room temperature (59º to 86º F). q PROGRAF may interact with some commonly used medications. Check with the transplant team before starting any new medications. q The benefits of taking this medication if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. A woman who thinks she is pregnan should consult the transplant team immediately. Principal side effect: These include, but are not limited to, headaches, nausea, diarrhea, tremor, high blood sugar, high potassium levels, decreased magnesium levels,
  • 111. abnormal kidney function, hair loss, sleep disturbances, and numbness and tingling of hands or feet. Conversion: The transplant team may decide to give the patient PROGRAF instead of cyclosporine, or vice versa, because of side effects or rejection. If this occurs, the patient should follow the instructions of the transplant team. <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 112. MEDICATIONS DELTASONE® (prednisone) - prednisone, a Medication Guidelines related drug, is used for some patients. Medications Purpose: DELTASONE is a corticosteroid that helps prevent and treat rejection of transplanted organs. It may be Complications used for long-term (perhaps lifetime) immunosuppression or, in higher doses, for treatment of rejection. Glossary How to take: q Tablets are available in several different strengths; the transplant team will determine Site Map the preferred tablet strength; liquid - 5 mg per mL; IV forms are also available. Home q It is best to take DELTASONE with food. q Avoid taking DELTASONE within 1 hour of taking antacids or CARAFATE®, an antiulcer medication. q If DELTASONE is taken once a day, it should be taken in the morning - consult with the transplant team for specific directions. q The transplant team will determine the proper dosage according to weight, how well the transplant is functioning, and the length of time since the transplant. Precautions: The benefits of taking this medication if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. She should consult her transplant team immediately if she thinsk she's pregnant. Principal side effects: These include, but are not limited to, fluid and sodium (salt) retention, high blood sugar, muscle weakness, bone disease, stomach ulcers, impaired wound healing, acne, mood swings, anxiety, cataracts, glaucoma, weight gain, hormone disorders, and growth suppression in children. <Back Return to: Medications If you have any questions, please contact us:
  • 113. USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 114. MEDICATIONS IMURAN® (azathioprine) Medication Guidelines Purpose: Medications IMURAN is given with other immunosuppressants to help prevent rejection of the new liver. It may be used for long-term (perhaps lifetime) Complications immunosuppression. How to take: q Tablets - 50 mg; liquid - 10 mg per mL. IV Glossary IMURAN may be given for the first few days after transplantation. Site Map q The transplant team will determine the dosage appropriate for each patient based on weight and white blood cell count. Home Precautions: q IMURAN may lower white blood cell and platelet counts. The patient should report any unusual bruising or bleeding to the transplant team. q The benefits of taking this medication if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. A patient should consult her transplant team immediately if she thinks she's pregnant. Principal side effects: These include, but are not limited to, nausea, vomiting, and reduced white blood cells and/or platelets. <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 115. MEDICATIONS ORTHOCLONE OKT®3 (MUROMONAB-CD3) Medication Guidelines Purpose: Medications OKT3 may be given immediately following liver transplant to prevent rejection. It may also be used to treat rejection. Complications How to take: q This medication is given only in the IV form. It is generally given once per day for 5 to 14 Glossary days. q To reduce side effects, the patient may receive Site Map TYLENOL® or BENADRYL® before treatment with OKT3. Home q The transplant team will determine the dosage appropriate for the patient based on weight, how the transplant is functioning, white blood cell count, platelet count, and the possible side effects of OKT3. Precautions: q The patient should notify his transplant team at the first sign of wheezing, difficulty breathing, rapid heartbeat, difficulty swallowing, rash, or itching. q The transplant team may change the dosages of other medications during the course of treatment with OKT3. q The benefits of taking OKT3 if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. She should consult her transplant team immediately if she thinks she's pregnant. Principal side effects: These include, but are not limited to, wheezing, difficulty in breathing, chest pain, fever, chills, nausea, vomiting, diarrhea, tremor, headache, rapid heart rate, muscle stiffness, and high or low blood pressure. The most uncomfortable side effects generally occur only during the first few doses or in the first 1 to 4 days. <Back Return to: Medications If you have any questions, please contact us:
  • 116. USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 117. MEDICATIONS ZENAPAX® (Daclizumab) Medication Guidelines Purpose: Medications Used in combination with standard immunosuppressive agents. It is the first genetically engineered drug to reduce the risk of organ rejection Complications in kidney transplant patients without increasing overall side effects. How to take: Glossary ZENAPAX is used as part of an immunosuppressive regimen that includes cyclosporine and corticosteroids. The recommended dose for ZENAPAX Site Map is 1.0 mg/kg. The calculated volume of ZENAPAX should be mixed with 50 mL of sterile 0.9% sodium chloride solution and administered via a peripheral or Home central vein over a 15-minute period. Based on the clinical trials, the standard course of ZENAPAX therapy is five doses. The first dose should be given no more than 24 hours before transplantation. The four remaining doses should be given at intervals of 14 days. No dosage adjustment is necessary for patients with severe renal impairment. No dosage adjustments based on other identified covariates (age, gender, proteinuria, race) are required for renal allograft patients. No data are available for administration in patients with severe hepatic impairment. Precautions: General: It is not known whether ZENAPAX use will have a long-term effect on the ability of the immune system to respond to antigens first encountered during ZENAPAX-induced immunosuppression. Re-administration of ZENAPAX after an initial course of therapy has not been studied in humans. The potential risks of such re-administration, specifically those associated with immunosuppression and/or the occurrence of anaphylaxis/anaphylactoid reactions, are not known. Principal Side effects: The following adverse events occurred in >5% of ZENAPAX-treated patients. q Gastrointestinal System: constipation, nausea, diarrhea, vomiting, abdominal pain, pyrosis,
  • 118. dyspepsia, abdominal distention, epigastric pain not food-related q Metabolic and Nutritional: edema extremities, edema q Central and Peripheral Nervous System: tremor, headache, dizziness q Urinary System: oliguria, dysuria, renal tubular necrosis q Body as a Whole -- General: post-traumatic pain, chest pain, fever, pain, fatigue q Autonomic Nervous System: hypertension, hypotension, aggravated hypertension q Respiratory System: dyspnea, pulmonary edema, coughing q Skin and Appendages: impaired wound healing without infection, acne q Psychiatric: insomnia; Musculoskeletal System: musculoskeletal pain, back pain q Heart Rate and Rhythm: tachycardia; Vascular Extracardiac: thrombosis q Platelet, Bleeding and Clotting Disorders: bleeding q Hemic and Lymphatic: lymphocele <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 119. MEDICATIONS Bactrim - PCP Medication Guidelines (pneumocystis Carnii Penumonia) Medications Purpose: Bactrim is used to prevent and treat PCP and other infections. The risk of PCP is increased for transplant Complications patients because of the drugs taken to suppress their immune systems, which reduce their bodies' ability to fight infection. Glossary How to take: q This medication is taken by mouth and is available in pill or liquid form. Site Map q The transplant team will determine the proper dosage and length of time to take Bactrim. Home q Take plenty of fluids with this medication - check with the transplant team about the amount. Precautions: q Do not take Bactrim if allergic to sulfa. In that case the transplant team may prescribe another drug. q The benefits of taking Bactrim if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. A patient should consult her transplant team immediately if she thinks she's pregnant. Principal side effects: These include, but are not limited to, decreased white blood cell count, nausea, vomiting, rash, itching, and loss of appetite. <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 120. MEDICATIONS CYTOVENE® (ganciclovir) Medication Guidelines Purpose: Medications CYTOVENE is used to prevent or treat CMV infection. How to take: Complications q CYTOVENE is given intravenously. The first few doses are generally given in the hospital. q The transplant team will determine the proper dosage and the length of time a patient should Glossary take CYTOVENE. q Take plenty of fluids with this medication - Site Map check with the transplant team about the amount. Home Precautions: q CYTOVENE may reduce white blood cell count and lead to increased risk of infection. q The benefits of taking CYTOVENE if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. A patient should consult her transplant team immediately if she thinks she's pregnant. Principal side effects: These include, but are not limited to, reduced white blood cell and platelet counts, abnormal kidney function, fever, rash, headaches, and confusion. <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 121. MEDICATIONS ZOVIRAX® (acyclovir) Medication Guidelines Purpose: Medications ZOVIRAX is used to prevent or treat herpes simplex and shingles. ZOVIRAX will not get rid of the herpes viruses, but it will lessen the pain and help heal the Complications sores. It may be used to decrease the severity of CMV infections. How to take: Glossary q Capsules - 200 mg; tablets - 400 mg and 800 mg; liquid - 200 mg per 5 mL; and ointment. If taking ZOVIRAX by mouth, take it with food to Site Map reduce stomach upset. q The transplant team will determine the proper Home dosage and length of time to take ZOVIRAX. Precautions: q Keep the affected areas as clean and dry as possible. q Wear loose-fitting clothing to avoid irritating the infected area and spreading the virus. q ZOVIRAX will not prevent herpes from spreading to others. It is best not to have sex if either partner has any symptoms of genital herpes. q Condoms may help prevent the spread of genital herpes, but vaginal jellies and diaphragms will not. q Avoid kissing or having oral sex with someone who has a cold sore. q The benefits of taking ZOVIRAX if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. A patient should consult her transplant team immediately if she thinks she's pregnant. Principal side effects: These include, but are not limited to, nausea, vomiting, diarrhea, headache, and rash. <Back Return to: Medications If you have any questions, please contact us:
  • 122. USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 123. ANTIFUNGAL DRUGS The reduced ability of the immune system to fight Medication Guidelines infection puts a recovering patient at higher risk of getting a serious fungus infection. This may take the Medications form of thrush or, in women, vaginal yeast infections. Purpose: Complications Various drugs are used to treat or prevent fungus infections. How to take: Glossary q Liquid - swish and swallow. q Troche or Lozenge - dissolve in the mouth. Site Map q The liquid or the lozenge should be taken after meals and other medications to allow liquids Home and lozenges to work in the mouth. q Vaginal suppository or cream - use as directed. q The transplant team will determine the proper dosage and length of time to take antifungal medications. Precautions: The benefits of taking these medications if a patient is pregnant or breast feeding must be weighed against the potential hazards to her, her fetus, or her infant. A woman should consult the transplant team immediately if she thinks she is pregnant. Principal side effects: These include, but are not limited to, nausea, vomiting, diarrhea, a metallic taste, and unpleasant mouth sensations. <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 124. DRUGS THAT PROTECT THE DIGESTIVE SYSTEM Because some medications can cause ulcers in the Medication Guidelines stomach and upper intestine, a patient may need to take other medications to help protect his digestive Medications system. These drugs will be prescribed by the transplant team when necessary. Complications ANTACIDS DI-GEL®, MYLANTA®, ROLAIDS®, MAALOX®, and TUMS® are a few of the over-the-counter Glossary medications available. The ingredients in them vary. They should not be taken with immunosuppressive medications. Check with the transplant team before Site Map taking any medication! ANTI-ULCER MEDICINES Home TAGAMENT® (cimetidine), ZANTAC® (ranitidine), PEPCID® (famotidine), PRILOSEC® (omeprazole), and CARAFATE® (sucralfate) are medications used to prevent and sometimes treat ulcers of the stomach of upper intestine. How to take: q It is important to follow instructions about meals and other medications when taking any of these drugs. q The transplant team will determine a patient's proper medication, dosage, and length of treatment time. Precautions: q Some of these drugs interact with other medications. q The patient should not make changes in doses on his own. q The patient should consult the transplant team immediately if she thinks she is pregnant. Principal side effects: These include, but are not limited to, headache, nausea, vomiting, diarrhea, constipation, and gas. <Back Return to: Medications If you have any questions, please contact us: USC Kidney Transplant Program
  • 125. Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 126. RESUMING NORMAL ACTIVITIES Sexual Activity Waking Up in the Intensive Care Unit In addition to returning to work or school as soon as possible, a patient may resume sexual activity as soon as he feels well enough. How quickly he feels Medical Management ready will depend largely on his recovery progress. in the Acute Care Unit This is a subject that should be discussed during clinic visits. Clinic Visits When people experience transplantation, sexual functioning may be affected. Likewise, certain Lab Tests medications can interfere with sexual functioning. Some people avoid sexual activity because they are afraid of organ rejection or infection. If a patient has Additional Tests any of these concerns, he may want to check with his transplant team. If he is sexually active and does not Monitoring at Home have a steady sexual partner, it is essential to use condoms to reduce the risk of sexually transmitted diseases such as AIDS, syphilis, herpes, hepatitis, or Resuming Activities gonorrhea. Avoiding Infection <Back Return to: Resuming Normal Activities Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 127. RESUMING NORMAL ACTIVITIES Smoking Waking Up in the Intensive Care Unit The Surgeon General has determined that smoking can be harmful to health. If the patient is a smoker, he may wish to join a stop-smoking group in his area. Medical Management He should consult the Yellow Pages of your telephone in the Acute Care Unit book of the American Heart Association, American Lung Association, or American Cancer Society to find Clinic Visits a local group. Lab Tests <Back Return to: Resuming Normal Activities Additional Tests Monitoring at Home Resuming Activities Avoiding Infection Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 128. RESUMING NORMAL ACTIVITIES Vacations and Travel Waking Up in the Intensive Care Unit If planning a trip to a foreign country that requires immunization for smallpox, measles, German measles, or any other vaccine containing a live virus, Medical Management the patient should ask the transplant team to send a in the Acute Care Unit letter to his local passport bureau stating that he cannot receive these vaccines. Because he is not Clinic Visits immunized, however, travel to these countries may not be safe. Lab Tests <Back Return to: Resuming Normal Activities Additional Tests Monitoring at Home Resuming Activities Avoiding Infection Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 129. RESUMING NORMAL ACTIVITIES Dental Care Waking Up in the Intensive Care Unit Precautions for dental care - Before the kidney transplant, the patient may have received a dental consultation to ensure that all dental work would be Medical Management completed before surgery. If the patient has dental in the Acute Care Unit pain, he should consult his dentist immediately. Before he has dental work done (including cleaning Clinic Visits and polishing), he should check with his transplant team to see if he needs to take antibiotics. Lab Tests <Back Return to: Resuming Normal Activities Additional Tests Monitoring at Home Resuming Activities Avoiding Infection Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 130. RESUMING NORMAL ACTIVITIES Pregnancy Waking Up in the Intensive Care Unit There have been a number of successful pregnancies among women who have had kidney transplants, although pregnancy may have special risks for both Medical Management the transplant recipient and the baby. Women should in the Acute Care Unit avoid pregnancy for at least 1 year following transplant surgery. Risks related to birth control Clinic Visits should be discussed with the transplant team. Thereafter, the decision to have children must take a number of factors into account. This is a question that Lab Tests should be discussed with the transplant team. Additional Tests <Back Return to: Resuming Normal Activities Monitoring at Home Resuming Activities Avoiding Infection Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 131. RESUMING NORMAL ACTIVITIES Exercise Waking Up in the Intensive Care Unit After transplant surgery, exercise is critical to mental health and physical well-being. Physical activity is also very important in helping decrease the effects of Medical Management prednisone, which causes muscle weakness. in the Acute Care Unit A daily exercise routine is essential to avoiding the Clinic Visits muscle and total-body weakness that often occurs after a long illness or period of confinement. The program should be a progressive one in which the Lab Tests patient builds or increases his levels of exercise. In this way, he will obtain the full benefits of exercise without causing strain or serious injury to his body. Additional Tests Before starting on any exercise program, he should remember to check with his transplant team. They Monitoring at Home will give him advise regarding an exercise routine that will best meet his needs. Resuming Activities WARNING: If a patient experiences any of the following symptoms, he should stop or delay exercise until he consults his physician: Avoiding Infection q pain or pressure in the chest, neck, or jaw q excessive fatigue that is not related to lack of Communicating with sleep Healthcare Team q unusual shortness of breath q dizziness or light-headedness during or after exercise Glossary q persistent rapid or irregular heart rate, new since the transplant, during or after exercise. Site Map <Back Return to: Resuming Normal Activities Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 132. RESUMING NORMAL ACTIVITIES Diet and Nutrition Waking Up in the Intensive Care Unit Eating properly is an important part of the recovery process. A nutritionist can help in developing an eating plan that provides a balanced diet to meet a Medical Management certain patient's needs. The number of calories a in the Acute Care Unit patient requires will be based on whether he needs to gain, maintain, or lose weight and on his level of Clinic Visits activity. Healthful food - Diet should include a variety of Lab Tests foods, such as: q fruits Additional Tests q vegetables q whole-grain cereals and breads Monitoring at Home q low-fat mile and dairy products or other sources of calcium Resuming Activities q lean meats, fish, and poultry or other sources of protein Avoiding Infection Use of sodium (salt), sugar, and fat - Use of salt may be restricted to help limit fluid retention and to control blood pressure and blood sugar. A low-fat, Communicating with low-sugar diet will help control weight and blood Healthcare Team sugar. Consult a nutritionist regarding the use of salt, sugar, and fat in a diet. Glossary <Back Return to: Resuming Normal Activities Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 133. RESUMING NORMAL ACTIVITIES Alcoholic Beverages Waking Up in the Intensive Care Unit Medications such as PROFRAF®, SANDIMMUNE®, IMURAN®, and BACTRIM® are broken down by the liver and, if combined with alcohol, could harm the Medical Management liver and eventually lead to abnormal blood levels of in the Acute Care Unit these medications. This can compromise the function of the kidney. Clinic Visits <Back Return to: Resuming Normal Activities Lab Tests Additional Tests Monitoring at Home Resuming Activities Avoiding Infection Communicating with Healthcare Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 134. THE TRANSPLANT TEAM Why a Transplant is Necessary Transplant Physician (Nephrologist) A transplant physician monitors all non-surgical aspects of Pretransplant patient care. A transplant patient will see this doctor Evaluation often. The transplant physician will perform examinations, check test results, and adjust medication as needed. A Transplant Team patient should not be shy in asking questions and alerting his physician regarding changes in the way he feels, no matter how insignificant it may seem. Preparing for a Transplant <Back Return to: Transplant Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 135. THE TRANSPLANT TEAM Why a Transplant is Necessary Floor or Staff Nurse This nurse will help coordinate the activities of the Pretransplant transplant patient's other caregivers, as well as tending to Evaluation the patient's needs during his hospital stay and preparing him for discharge. The staff nurse will also keep the lines Transplant Team of communication open between the patient and the other members of the transplant team. Preparing for a Transplant <Back Return to: Transplant Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 136. THE TRANSPLANT TEAM Why a Transplant is Necessary Physical Therapist Exercise will improve a transplant patient's circulation, Pretransplant making him feel stronger, helping him avoid excessive Evaluation weight gain, and increasing his sense of well-being. He or she will set the patient's exercise limits after surgery and Transplant Team will advise when it is safe to increase activity. A patient should ask his therapist to help devise an exercise plan that will be beneficial. Preparing for a Transplant <Back Return to: Transplant Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 137. THE TRANSPLANT TEAM Why a Transplant is Necessary Dietician Following doctor's orders, a registered clinical dietitian will Pretransplant create a special diet plan that will help a patient stay Evaluation healthy and avoid excessive weight gain after surgery. The patient should follow the diet plan prepared for Transplant Team specifically for him. Proper nutrition can speed recovery and help a patient to stay healthy. Preparing for a Transplant <Back Return to: Transplant Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 138. THE TRANSPLANT TEAM Why a Transplant is Necessary Psychologist/Psychiatrist A patient and his family members may find it helpful to Pretransplant talk about their feelings with a professional before and Evaluation after surgery. Frank discussion may help cope with the transplant experience and with the changes it will make in Transplant Team a transplant patient's life. The psychologist or psychiatrist can offer insight and support along every step of the way. Preparing for For information on how to cope before a transplant, a Transplant please visit Preparing and Waiting for a Kidney Transplant. Glossary <Back Return to: Transplant Team Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 139. THE TRANSPLANT TEAM Why a Transplant is Necessary Social Worker The social worker will link the patient to services and Pretransplant people in the community who can help with his recovery Evaluation after leaving the hospital. If the patient needs transportation, help at home, or a hand when he goes Transplant Team back to school or work, the social worker will help arrange it. The social worker can also advise about Medicare, Medicaid, and other insurance coverage, as well as Preparing for helping with psychosocial and family matters. a Transplant <Back Return to: Transplant Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 140. THE TRANSPLANT TEAM Why a Transplant is Necessary Pharmacist Since medication will become a regular part of a patient's Pretransplant life before and after surgery, the pharmacist will be Evaluation available to educate the patient and family. He or she can give advice about drugs, including the Transplant Team immunosuppressive medications that will help prevent the body from rejecting a new kidney. Preparing for a Transplant <Back Return to: Transplant Team Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 141. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Opened in 1991, Transplant USC University Kidney-Pancreas Transplant Hospital is a Pancreas Transplant private, 284-bed research, referral Information for Patients and Transplant Patient Guide tertiary/quaternary About the USC care teaching University Hospital hospital staffed by Financial Considerations the faculty of the renowned Keck Kidney Glossary School of Medicine Features of the University of What's New Southern California. Kidney Research The hospital offers medical expertise and Development and sophisticated Calendar of Events technology, Kidney Newsletter combined with a Downloads personalized approach to health General Information care. Faculty and Staff Contact Information Care services provided at USC University Hospital: Web Links q Medical/surgical acute care Site Map q Medical/surgical intensive care Search this site q Cardiothoracic intensive care q Neurosciences intensive care Submit q Comprehensive medical rehabilitation q Psychiatric care Special diagnostic and treatment services at USC University Hospital: q Cardiac catheterization and interventional cardiology q Open heart surgery q Kidney stone lithotripsy q Solid Organ Transplantation q Gamma Knife q Stereotactic Visualization Laboratory q 24-hour Epilepsy Monitoring Center q Magnetic Resonance Imaging (MRI) with multiplanar image
  • 142. reconstruction capabilities q Hand Rehabilitation Center q Neurointerventional Radiology q Noninvasive Vascular Laboratory q Neurophysiology/Electromyography Laboratory q Center for Liver Disease q Center for Stroke q Center for Arthritis and Joint Implant Surgery q Center for Lung Diseases q Center for Pancreatic and Biliary Diseases q Center for Athletic Medicine q Multiple Sclerosis Comprehensive Care Program q Center for Orthopaedic Spine Surgery q Transfusion Free Medicine USC Healthcare Consultation Center Constructed as part of the Richard K. Eamer Medical Plaza, the seven-floor adjacent USC Healthcare Consultation Center houses the private offices of the USC University Hospital Faculty, including clinical facilities for examinations and ancillary services. Leased by the University for these purposes, this facility also accommodates USC health administrative services. q Examination and consultation suites q Minor procedure rooms q Outpatient pharmacy q Faculty physician offices q Covered multi-level parking Available Services in the Healthcare Consultation Center: q Positron Emission Tomography (PET) q Esophageal and Gastric Motility Laboratory q Colorectal Laboratory USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 143. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Transplant Financial Services as well as a social worker will work Transplant together to help transplant patients develop a financial plan. This would include understanding how transplant-related charges will be Kidney-Pancreas Transplant paid as well as how to cope with such things as transportation and Pancreas Transplant caring for children or other family members during this time. Information for Patients Costs related to transplant include evaluation and testing, transplant Transplant Patient Guide surgery and hospitalization, follow-up care and medication. Transplant About the USC Financial Services will assist each patient in developing a plan for University Hospital addressing these financial obligations. A patient's insurance coverage Financial Considerations plays a vital role, whether it is through a private company or a Kidney Glossary governmental program. So, it is important that each patient fully understand his or her coverage. Features What's New Here are some of the most important questions to ask your insurance Kidney Research company as you begin to consider transplant as a treatment option. and Development q Is transplant a covered benefit? Calendar of Events q Is there a maximum allowance on transplant and Kidney Newsletter transplant-related services? Downloads q Is there a maximum allowance on procurement of the organ? General Information q Is there a lifetime maximum or "cap" on the policy? Faculty and Staff q Is there adequate coverage for post-transplant medications? Contact Information q What is the annual "out of pocket" maximum amount on the Web Links policy? Site Map In the event that the patient does not have access to adequate Search this site insurance coverage for transplant, there may be other avenues to obtaining support to offset the expenses related to transplantation. These include charitable organizations, advocacy groups, or Submit fund-raising campaigns. Again, Transplant Financial Services and/or a social worker can help identify what option is best for you. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 144. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Transplant Kidney-Pancreas Transplant Pancreas Transplant Information for Patients Transplant Patient Guide ABSORPTION About the USC the degree and speed at which a drug enters the bloodstream from the University Hospital small intestine Financial Considerations <Back Kidney Glossary Features ACUTE TUBULAR NECROSIS (ATN) What's New Kidney Research reversible kidney damage resulting in delayed kidney function. Among other factors, it may be caused by quality of donor organ, time of and Development organ storage before transplantation, or medications to prevent Calendar of Events rejection. Kidney Newsletter <Back Downloads General Information ALKALINE PHOSPHATASE Faculty and Staff an enzyme produced by liver (and other) cells; elevated blood levels of Contact Information this substance may indicate abnormal function of the liver or other Web Links organs Site Map <Back Search this site ALLOGRAFT (allogenetic graft or homograft) a graft between two individuals who are of the same species (eg. Submit human) but have genetic differences <Back ANEMIC low red blood cell count <Back ANESTHETIC medication that reduces pain by dulling sensation <Back
  • 145. ANTACID a drug that aids in protecting the digestive system and relieves heartburn and digestive discomfort <Back ANTIBODY a protein produced by the body to eliminate foreign substances, such as bacteria <Back ANTIGEN a foreign molecule or substance, such as a transplant, that triggers an immune response. This response may be the production of antibodies, which, in turn, try to inactivate or destroy the antigen (transplanted organ) <Back ARTERIOGRAM (angiogram) an x-ray of the arteries taken with the aid of a dye <Back ATHEROSCLEROSIS a buildup of fats in the lining of the arteries that may interfere with the flow of blood <Back B Cell a specialized white blood cell responsible for the body's immunity. B cells play a central role in antibody production <Back BACTERIA small organisms (germs) that can cause disease <Back BIOAVAILABILITY a measure of how much of an administered drug is absorbed into the bloodstream, actually reaching the intended site of action in the body. For example, medicine is absorbed from the GI tract, travels through the bloodstream, and reaches the organ tissues, where it works to fight infection, prevent rejection, etc. <Back
  • 146. BIOPSY the removal and examination of tissue for diagnosis <Back BLADDER the part of the urinary tract that receives urine from the kidneys and stores it until urination <Back BLOOD UREA NITROGEN a byproduct of protein breakdown in the body <Back BRAIN DEATH when the brain has permanently stopped working, as determined by a neurological surgeon, artificial support systems may maintain functions such as heartbeat and respiration for a few days <Back BUN BUN stands for blood urea nitrogen, a waste product normally excreted by the kidney. Your BUN value represents how well the kidneys function <Back CADAVERIC DONOR an individual who has recently died of causes that do not affect the function of an organ to be transplanted. Either the person or the person's family has generously offered organs and/or tissues for transplantation <Back CELLCEPT® an immunosuppressive drug used with other immunosuppressants to prevent the rejection of the transplanted organ. Also known by its chemical name, myophenolate mofetil <Back CHOLESTEROL a form of fat that performs necessary functions in the body but can also cause heart disease; cholesterol is found in animal foods such as meat, fish, poultry, eggs, and dairy products <Back
  • 147. COAGULATION blood clotting <Back CORTICOSTEROIDS a category of immunosuppressive medications that includes prednisone and prednislone <Back CREATININE a substance found in blood and urine; it results from normal body chemical reactions; high blood creatinine levels are a sign of depressed kidney function <Back CROSSMATCH a test in which donor and recipient blood samples are mixed together. A "positive" crossmatch shows the donor and recipient are incompatible. A "negative" crossmatch shows there is no reaction between the donor and the recipient. This means that the donor and recipient are compatible and the transplant may proceed. <Back CYCLOSPORINE the immunosuppressive ingredient in Neoral® (cyclosporine capsules and oral solution for microemulsion) and Sandimmune® (cyclosporine), an earlier form of cyclosporine. Neoral® and Sandimmune are not bioequivalent and cannot be used interchangeably without physician supervision <Back CMV (CYTOMEGALOVIRUS) a virus infection that is very common in transplant recipients; it can affect the lungs and other organs as well; a member of the family of herpes viruses <Back DETOXIFY to change a harmful substance into a safer form <Back DIABETES a disease in which patients have high levels of sugar in their blood <Back
  • 148. DIALYSIS the process of cleansing and achieving chemical balance in the blood of patients whose kidneys have failed. Dialysis may refer to hemodialysis or peritoneal dialysis (PD) <Back DIASTOLIC the bottom of two blood pressure numbers, which measures blood pressure when the heart is at rest <Back EDEMA excess fluid in body tissues; swelling of the ankles, for example, is a sign of edema <Back ELECTROCARDIOGRAM a recording of the electrical activity of the heart <Back ELECTROLYTE generally refers to the dissolved form of a mineral such as sodium, potassium, magnesium, chlorine, etc. <Back ENZYME a protein made in the body and capable of changing a substance from one form to another <Back FETUS a human embryo in the mother's uterus <Back GASTROENTEROLOGIST a physician who specializes in the care of the digestive tract <Back GINGIVAL HYPERTROPHY enlargement of the gums. It is a common side effect of cyclosporine therapy, but can be managed with good oral hygiene <Back
  • 149. GLUCOSE a type of sugar found in the blood <Back GRAFT an organ or tissue that is transplanted <Back GRAFT SURVIVAL when a transplanted tissue or organ is accepted by the body and functions properly. The potential for graft survival is increased when the recipient and donor are closely matched, and when immunosuppressive therapy is used <Back HELPER T CELL the specialized white blood cell that tells other parts of the immune system to combat infection or foreign material <Back HEMATOCRIT a measure of the red-blood-cell content of blood <Back HEMODIALYSIS a method of dialysis in which blood is purified by circulating through an apparatus outside the body (sometimes called an "artificial kidney") <Back HERPES a family of viruses that infect humans; herpes simplex causes lip and genital sores; herpes zoster causes shingles <Back HIRSUTISM an excessive increase in hair growth - especially male-pattern hair growth in a female. Hirsutism is a common side effect of corticosteroids and can also occur with cyclosporine therapy, but is easily treated with depilatory creams or other methods of hair removal <Back HISTOCOMPATIBILITY the examination of human leukocyte antigens (HLA) in a patient, often referred to as "tissue typing" or "genetic matching". Tissue typing is
  • 150. routinely performed for all donors and recipients in kidney and pancreas transplantation to help match the donor with the most suitable recipients. This helps to decrease the likelihood of "rejecting" the transplanted organ. <Back HLA (human leukocyte antigens) system genetically determined series of antigens that are present on human white blood cells (leukocytes) and tissues <Back HYPERTENSION high blood pressure <Back IMMUNE RESPONSE any defensive reaction to foreign material by the immune system <Back IMMUNE SYSTEM the system that protects the body from invasion by foreign substances, such as bacteria and viruses, and from cancer cells <Back IMMUNITY a condition of being able to resist a particular infectious disease <Back IMMUNOSUPPRESSIVE AGENTS medications given to prevent rejection of a transplanted organ <Back IMURAN® an immunosuppressive drug used with other immunosuppressive drugs to help prevent the rejection of a transplanted organ. Also known by its chemical name, azathioprine <Back INCOMPATIBLE no likeness or similarity between donor or recipient blood type or organs <Back
  • 151. IV, or INTRAVENOUS refers to giving medicines or fluids directly through a vein <Back IV CATHETER a small needle with a hollow tube inserted into a vein and used to give medicines or fluids <Back KIDNEY one of the two kidney-bean-shaped organs located on both sides of the spine, just above the waist. They rid the body of waste materials and maintain fluid balance through the production of urine <Back LIVING-RELATED DONOR (LRD) a blood relative who donates an organ <Back MATCH the compatibility between recipient and donor. In general, the more closely the donor and recipient "match", the greater the potential for a successful transplant <Back MICROEMULSION a suspension or mixture of tiny droplets of one liquid in a second liquid, such as the smooth mixture that is formed when Neoral® (cyclosporine capsules and oral solution for microemulsion) combines with fluids in the digestive system <Back NEPHROLOGIST a physician who studies the kidney and treats kidney disease <Back NEUTROPHIL a type of white blood cell <Back NONCOMPLIANCE failure to follow the instructions of one's health care providers, such as not taking medicine as prescribed or not showing up for clinic visits
  • 152. <Back ORALLY by mouth <Back ORGAN PRESERVATION between organ procurement and transplant, organs require special methods of preservation to keep them viable. The length of time that organs and tissues can be kept outside the body varies, depending on the organ, the preservation fluid and the temperature. <Back ORGAN PROCUREMENT ORGANIZATION (OPO) OPO's serve as the integral link between the potential donor and recipient and are accountable for the retrieval, preservation and transportation of organs for transplantation. All OPOs are UNOS members. <Back ORGAN REJECTION an attempt by the immune system to reject or destroy what it recognizes to be a "foreign" presence (for example, a transplanted liver) <Back PANEL REACTIVE ANTIBODY (PRA) a way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. <Back PCP Pneumocystis carinii pneumonia, a type of pneumonia seen primarily in patients whose immune systems are suppressed <Back PERITONEAL DIALYSIS a method of purifying the blood by flushing the abdominal cavity with a dilute salt solution <Back PLATELET a small blood cell needed for normal blood clotting
  • 153. <Back POTASSIUM a mineral essential for body function <Back PREDNISONE a manufactured steroid hormone taken by most transplant recipients to help prevent rejections <Back PROPHYLACTIC MEDICATION medication that helps prevent disease <Back REJECTION an immune response against grafted tissue, which, if not successfully treated, results in failure of the graft to survive <Back RENAL refers to the kidney <Back RETRANSPLANTATION due to organ rejection or transplant failure, some patients need another transplant and return to the waiting list. Reducing the number of retransplants is critical when examining ways to maximize a limited supply of donor organs. <Back SANDIMMUNE® (cyclosporin) an earlier formulation of cyclosporine. An immunosuppressive drug used with other immunosuppressive drugs, that acts specifically to inhibit helper T cells, thereby helping prevent the rejection of a transplanted organ. Sandimmune and Neoral are not bioequivalent and cannot be used interchangeably without physician supervision <Back SENSITIZED being immunized, or able to mount an immune response, against an antigen by previous exposure to that antigen <Back
  • 154. SHINGLES a herpes virus infection (herpes zoster) that usually affects a nerve, causing pain in one area of the body <Back SODIUM a component of table salt (sodium chloride); an electrolyte that is the main salt in blood <Back STATUS indicates the degree of medical urgency for patients awaiting heart or liver transplants <Back STRICTURE or STENOSIS a narrowing of passage in the body <Back SURVIVAL RATES survival rates indicate how many patients or grafts (transplanted organs) are alive/functioning at a set time posttransplant. Survival rates are often given at one, three and five years. Policy modifications are never made without examining their impact on transplant survival rates. Survival rates improve with technological and scientific advances. Developing policies that reflect and respond to these advances in transplantation will also improve survival rates. <Back SYSTOLIC the top of the two blood pressure numbers, which measures the maximum blood pressure reached as blood is pumped out of the heart chambers <Back THRUSH a fungus infection in the mouth <Back TRIGLYCERIDES a form of fat that the body makes from sugar, alcohol, and excess calories <Back
  • 155. T CELLS a white blood cell responsible for the body's immunity. T cells can destroy cells infected by viruses, graft cells, and other altered cells <Back TISSUE TYPING a blood test (performed prior to transplantation) to evaluate the closeness of tissue match between donor's organ and recipient's HLA antigens. <Back ULTRASOUND a probe that uses high-frequency sound waves that pass into the body, are reflected back, to build an image of one's internal organs that is shown on a monitor <Back URETHRA a tube that drains urine from the bladder to the outside <Back URETERS tubes that drain urine from the kidneys to the bladder <Back URINARY TRACT INFECTION (UTI) an infection of one or more parts of the urinary tract <Back VIRUS a very small agent (germ) that causes infection <Back WAITING LIST after evaluation by the transplant physician, a patient is added to the national waiting list by the transplant center. Lists are specific to both geographic area and organ type: heart, lung, kidney, liver, pancreas, intestine, heart-lung, kidney-pancreas. Each time a donor organ becomes available, the UNOS computer generates a list of potential recipients based on factors that include genetic similarity, organ size, medical urgency and time on the waiting list. Through this process, a "new" list is generated each time an organ becomes available. <Back
  • 156. WHITE BLOOD CELLS cells in the blood that fight infection; part of the immune system <Back USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 157. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant q L.A. Mom Has Dual Organ Transplant - Conventional Kidney March 24, 2001 Transplant In what doctors at the University of Southern California’s Kidney-Pancreas Transplant University Hospital are calling "first of its kind surgery" after she Pancreas Transplant spent four years on dialysis, Maria Alvarez received a kidney from her 35-year-old daughter and part of a liver from her Information for Patients 37-year-old son. More... Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 158. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor L.A. Mom Has Dual Organ Transplant Laparoscopic Transplant By Tom Harrigan, Associated Press Writer Conventional Kidney Transplant LOS ANGELES (AP) - When her children offered their own organs to Kidney-Pancreas Transplant save her life, Maria Alvarez was terrified - not for herself but for them. Pancreas Transplant Information for Patients The Transplant Patient Guide 57-year-old About the USC had been on dialysis for University Hospital 31/2 years Financial Considerations after kidney Kidney Glossary failure, and her liver was more Features than twice What's New normal size Kidney Research and barely and Development functioning due Calendar of Events to polycystic Kidney Newsletter disease. Fluid from the liver Downloads had already caused one infection that had nearly killed her. General Information Faculty and Staff But despite the pain, Alvarez was reluctant when doctors told her that dual transplants - a kidney from Rosario Proscia, 34, and part of the Contact Information liver of son Jose Alvarez, 36 - could help her become healthy again. Web Links Site Map ``She didn't want us to suffer, or possibly even die,'' said Proscia, who had urged the doctors at University of Southern California University Search this site Hospital to consider the transplants. ``It took her a few months to get used to the idea.'' Submit Five months after the dual surgeries, all three are recovering well, their doctors said Wednesday. ``I believe it is the first of this particular kind of transplant, when one child donates a liver and another child donates a kidney to a parent,'' said the surgeon in both operations, Dr. Rick Selby. Proscia said she had been inspired by her mother's refusal to give up. ``My surgery was nothing compared to what she has been going through,'' she said. Jose Alvarez said pain from removal of less than half of his liver ended in about eight days.
  • 159. ``We feel privileged that we were able to do this,'' he said. ``Mom was very sick for 31/2 years, and we nearly saw her die.'' Their mother, meanwhile, said she hoped other people would be encouraged by her story to donate organs. According to the United Network for Organ Sharing, 48,245 people are currently on waiting lists for kidney transplants and 17,286 are awaiting liver transplants. ``I'm proud of my children,'' she said. ``I'm so happy God gave me such good children.'' Related links: q USC Liver Transplant Program q USC Kidney Transplant Program Faculty & Staff USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 160. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Rick Selby, M.D. Conventional Kidney Professor of Surgery Director, Abdominal Organ Transplant Transplantation Kidney-Pancreas Transplant Pancreas Transplant Phone: (323) 442-5908 Fax: (323) 442-5721 Information for Patients E-mail: Transplant Patient Guide usckidney@surgery.hsc.usc.edu About the USC University Hospital Curriculum Vitae - Rick Selby, Financial Considerations M.D. Kidney Glossary Dr. Selby is a Professor of Features Surgery and Chief of What's New Hepatobiliary/Pancreas Surgery Kidney Research and Abdominal Organ and Development Transplantation at the USC University Hospital and the Los Calendar of Events Angeles County+USC Medical Center. Kidney Newsletter Downloads Dr. Selby completed his medical school training at the University of Missouri at Columbia where he graduated cum laude. His medical and General Information surgical training took place at Good Samaritan Hospital and Phoenix Faculty and Staff Integrated Surgical Residency in Arizona. Following this initial training, Contact Information Dr. Selby completed a surgical fellowship in liver transplantation. Web Links Site Map From January 1989 to 1995, Dr. Selby served as an attending member of the faculty at the Pittsburgh Transplantation Institute, Search this site University of Pittsburgh. As a member of Dr. Thomas Starzl's team, Dr. Selby cared for hundreds of pre- and post-abdominal organ transplant patients, and performed more than 850 orthotopic Submit abdominal organ transplants. During these years, Dr. Selby also administered in the clinical trials of FK 506 (Tacrolimus), an immunosuppressive drug that markedly improved the outcome for liver transplant patients. Dr. Selby was instrumental in developing a liver resection service at Pittsburgh, which offered hope and recovery to many patients suffering from tumors involving the liver. Dr. Selby also has extensive experience in the transplantation of kidneys, small bowels and pacreata. In his role as the Director of the Multiorgan Transplantation Fellowship at the University of Pittsburgh, Dr. Selby trained more than 25 transplant surgeons who are now participating in transplant programs throughout the world. In addition to his surgical expertise, Dr. Selby is board certified in
  • 161. critical care and acted as the Director of Patient Care in the 32-bed liver ICU at the University of Pittsburgh Medical Center. In September 1995, Dr. Selby joined the faculty at USC to apply his considerable expertise to developing a center of excellence for liver transplantation. Joining him at USC is a highly talented team of clinical and administrative staff that brings experience from various transplant centers. Together, they form an outstanding group with a tremendous command of the clinical, scientific and administrative intricacies of running an effective abdominal organ transplant program. Name: Robert Rick Selby, M.D. Title: Professor of Surgery Chief, Division of Hepatobiliary/Pancreas Surgery and Liver Transplantation Director, Abdominal Organ Transplantation Service Date of Employment: 9/11/95 Board Certification: Surgery - Certified 1989 Surgery Critical Care - Certified 1991 Specialty: Abdominal Organ Transplantation and Liver Resection Post-Residency Training: Abdominal Organ and Multivisceral Transplantation Presbyterian University Hospital, Pittsburgh 1987-89 Abdominal Organ and Multivisceral Transplantation Childrens Hospital of Pittsburgh, 1987-89 Return to Faculty and Staff USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 162. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Transplant Kidney-Pancreas Transplant Pancreas Transplant Information for Patients Transplant Patient Guide Rick Selby, M.D. About the USC Curriculum Vitae University Hospital Financial Considerations Personal Information Kidney Glossary Name Robert Rick Selby, M.D. Features What's New Business Address Kidney Research USC Healthcare Consultation Center and Development 1510 San Pablo St., Suite 430 Calendar of Events Los Angeles, California 90033-4612 Kidney Newsletter Business Telephone Downloads (323) 442-5908, FAX (323) 442-5721 General Information Faculty and Staff Contact Information Education Web Links High School Site Map Maryville High School Maryville, Missouri Search this site Graduated 1968 University Submit University of Missouri at Columbia B.A., Zoology, 1975 Graduate School Autonomous University of Guadalajara Guadalajara, Mexico, 1975-76 Medical School University of Missouri at Columbia M.D., 1979, cum laude Medical Internship Good Samaritan Hospital
  • 163. Phoenix, Arizona, 1979-1980 Medical Residency Good Samaritan Hospital Phoenix, Arizona, 1980-1981 Surgical Internship Phoenix Integrated Surgical Residency Phoenix, Arizona, 1981-1982 Surgical Residency Phoenix Integrated Surgical Residency Phoenix, Arizona, 1982-1986 Fellowship University of Pittsburgh Medical Center (Presbyterian University Hospital and Children's Hospital of Pittsburgh) Pittsburgh, Pennsylvania, 1987-1989 Honors and Awards q Medicine Intern of the Year Good Samaritan Hospital Phoenix, Arizona, 1980 q Surgical Intern of the Year Phoenix Integrated Surgical Residency Phoenix, Arizona, 1982 q Chief Surgical Resident of the Year Good Samaritan Hospital and Phoenix Integrated Surgical Residency, 1986 q Resident Teaching Prize University of Pittsburgh, Department of Surgery, 1992-1993 q Outstanding Surgical Service, Hepatobiliary University of Southern California School of Medicine Residents Department of Surgery, 1997 Licensure q California q Pennsylvania Board Certification q American Board of Surgery, November 1989 q American Board of Surgery, Recertification October 1999 q American Board of Surgery, Surgical Critical Care, October 1991 Professional Background
  • 164. Academic Appointments q Assistant Professor of Surgery, University of Pittsburgh Pittsburgh, Pennsylvania, 1/89-12/93 q Associate Professor of Surgery, University of Pittsburgh Pittsburgh, Pennsylvania, 1/94-8/95 q Associate Professor of Surgery, University of Southern California, School of Medicine Los Angeles, California, 9/95-12/98 (Pending) q Associate Professor of Surgery, University of Southern California, School of Medicine Los Angeles, California, 1/99 Hospital Appointments q Chinle Public Health Service Hospital, Chief of Surgery Chinle, Arizona, 8/86-8/87 q Staff, Presbyterian University Hospital Pittsburgh, Pennsylvania, 9/87-3/95 q Staff, Children's Hospital of Pittsburgh Pittsburgh, Pennsylvania, 1/88-3/95 q Transplant Surgeon, Baylor University Medical Center Dallas,Texas, 8/90-12/90 q Temporary Staff, USC University Hospital, 1995-1996 q Provisional Staff, USC University Hospital, 1996-1998 q Attending Staff, USC University Hospital, 1998- q Provisional Staff, USC/Norris Cancer Center and Hospital, 1995-1997 q Active Staff, USC/Norris Cancer Center and Hospital, 1998- q Provisional Staff, Attending Staff Association Los Angeles County+University of Southern California Medical Center, 1995-1996 q Active Staff, Attending Staff Association Los Angeles County+University of Southern California Medical Center, 1997- q Associate Staff, Childrens Hospital Los Angeles, 1996-1998 q Active Staff, Childrens Hospital Los Angeles, 1999- q Provisional Staff, Good Samaritan Hospital, 1998-1999 q Courtesy Staff, Good Samaritan Hospital, 1999- Specific Teaching Responsibilities
  • 165. University of Pittsburgh q Teaching surgical transplant and critical care fellows the pre/intra/and postoperative techniques in transplantation and immunosuppression, Department of Surgery, University of Pittsburgh, 1989-1995 Teaching surgical residents the q techniques of hepatic resection and hepatobiliary surgery, Department of Surgery, University of Pittsburgh, 1989-1995 LAC+USC Medical Center q Formal lectures, conferences, seminars, bedside rounds, operating room instruction, surgery residents, Hepatobiliary/Pancreas Surgery Service, Department of Surgery, University of Southern California School of Medicine, 1995- q Conferences, bedside rounds, operating room instruction, hepatobiliary surgery elective clerkship. USC Department of Surgery, 1995- q Formal lectures, conferences, bedside rounds, operating room instruction, surgery year III clerkship, Department of Surgery, University of Southern California School of Medicine, 1995- q Postgraduate education lectures on hepatobiliary/pancreas surgery and liver transplantation coordinated through University of Southern California School Medicine Postgraduate Medical Education, USC University Hospital or other CME Programs, 1995- q Student Mentor, Year III medical students, general surgery service, Department of Surgery, University of Southern California School of Medicine, 1996- q Resident Advisor, Department of Surgery, University of Southern California, 1996- Specific Administrative Responsibilities University of Pittsburgh q Surgical Director, Liver Transplant
  • 166. ICU at Presbyterian University Hospital of Pittsburgh, 1989-1992 qDirector, Multi-Organ Transplant Fellowship at the University of Pittsburgh, 1992-1993 Departmental Interviewer, yearly involvement in the selection process for applicants for the surgical residency at University of Pittsburgh, 1990-1995 USC School of Medicine Facilitator, Physician in Society, Policy Task Force Group, 1997- Departmental q Division Chief, Hepatobiliary/Pancreas Surgery and Liver Transplantation Department of Surgery, University of Southern California, 1995-1999 q Division Chief, Hepatobiliary/Pancreas Surgery and Abdominal Organ Transplantation Department of Surgery, University of Southern California, 1999- q Surgical Council Member Department of Surgery, University of Southern California School of Medicine, 1995- q Member, Business Caucus Committee Department of Surgery, University of Southern California School of Medicine, 1995- Faculty Member, attendance at q monthly faculty meetings, annual resident evaluation sessions, intern interviews and ranking sessions, weekly grand rounds, weekly morbidity and mortality conferences, yearly departmental retreat, residents banquet Department of Surgery, University of Southern California School of Medicine, 1995- LAC+USC Medical Center q Chief, Hepatobiliary/Pancreas Surgery and Liver Transplantation Service, 1995-
  • 167. q Member, Faculty Quality Improvement Committee, Department of Surgery 1996- qChairmanship, Organ Procurement Council Committee, 1999- USC University Hospital q Director, Liver Transplantation Service, 1995-1999 q Director, Abdominal Organ Transplantation, 1999- q Voting Member, Critical Care Committee, 1996- q Chairmanship, Tissue and Transfusion Committee, 1996- q Member, Committee of the Future, 1997- q Member, Infection Control Committee, 1999- q Vice-Chairman, Transfusion-Free Medicine Advisory Committee, 1999- Childrens Hospital Los Angeles q Liver Transplant Task Force Committee, 1996- q Surgical Director, Liver Transplant Program, June 1997- Other Activities q Member, Medi-Cal Advisory Committee on Anatomical Transplant (MACAT), 1995- q Reviewer, Peer Review Process, Archives of Surgery, 1996- q Reviewer, Peer Review Process, Gastroenterology, 1996- q Volunteer, CALTECH Medical Screenings, California Institute of Technology, 1996- q Reviewer, Peer Review Process, Hepatology, 1997- q Member, Norris Medical Library Focus Group, 1997- q Board Committee, US-Japan Medical Exchange Project, Japan International Medical Clinic, 1997- q Reviewer, United Network For Organ Sharing (UNOS) Regional Review Board, 1997-1998 q Member, Ad Hoc Task Force, Joint
  • 168. Operations Committee, Southern California Organ Procurement Center (SCOPC) and Regional Organ Procurement Agency (ROPA), 1997-1999 q Liver Subcommittee Appointment, Southern California Organ Procurement Center (SCOPC), 1999- q Member, Board of Advisors, Southern California Organ Procurement Center (SCOPC), 2000- Society Memberships Regional q Attending Staff Association, Los Angeles County+University of Southern California Medical Center, 1995- q Society of Graduate Surgeons of the Los Angeles County/University of Southern California, 1996- q California Hispanic-American Medical Association, 1996- q Los Angeles Academy of Medicine, 1997- q Pacific Coast Surgical Association, 2000- National q Society of Critical Care Medicine, 1991- q American Society of Transplant Surgeons, 1994- q American Association for the Study of Liver Diseases, 1994- q Transplant Recipients International Organization, Inc. (TRIO) 1996- q The Society for Surgery of the Alimentary Tract, Inc., 1996- Research Activities Complete Bibliography Appended Major Areas of Research Interest q Transplantation for primary and metastatic tumors of the liver q Live donor liver transplantation q Transplantation using bloodless medical and surgical techniques q Repair of injuries to the biliary tree after
  • 169. laparoscopic cholecystectomy q Recurrent pyogenic cholangitis Research in Progress Use of venous allograft for venous substitution Research Activities Articles Peer Review *Medical Student, Fellow or Resident 1. Selby RR, Mertz GH, Gilsdorf RB: Spontaneous resolution of intestinal obstruction while receiving home parenteral nutrition. Am J Surg 146(6):742-745, 1983 2. Gilsdorf RB, Selby RR, Tillach P: Systemic appearance of nutrients placed in the peritoneal cavity. J Parenteral Enteral Nutr 9(2):148-152, 1985 3. Gilsdorf RB, Selby RR, Schon DA, Potter JD: Total nutritional support through the peritoneal cavity. J Am Col Nutr 4:461-469, 1985 4. *Massaferro V, Makowka L, Enrichens F, *Kahn D, Ferla G, Banner B,*Olivero G, Selby RR, Stevenson WX, Todo S, Starzl TE: A modified technique of orthotopic transplant of the kidney in rabbits. J Invest Surg 2(3):293-303, 1989 5. Starzl TE, Todo S, Tzakis AG, Podesta L, Mieles L, Demetris A, Teperman L, Selby RR, Stevenson W, Stieber A, Gordon R, Iwatsuki S: Abdominal organ cluster transplantation for the treatment of upper abdominal malignancies. Ann Surg 210(3):374-385; discussion 385-386, 1989 6. Miyata T, Yokoyama I, Todo S, Tzakis AG, Selby RR, Starzl TE: Endotoxemia, pulmonary complications and thrombocytopenia in liver transplantation. Lancet 2(8656):189-191, 1989 7. Koneru B, Selby RR, *O'Hair DP, Tzakis AG, Hakala TR, Starzl TE: Nonobstructing colonic dilatation and colon perforations following renal transplantation. Arch Surg 125(5):610-613, 1990 8. Selby RR, Starzl TE, Yunis E, Brown BI, Kendall RS, Tzakis AG: Liver transplantation for type IV glycogen storage disease. N Eng J Med 324(1):39-42, 1991 9. Stieber AC, Zetti G, Todo S, Tzakis AG, Fung JJ, *Marino IR, *Casavilla A, Selby RR, Starzl TE: The spectrum of portal vein thrombosis in liver transplantation. Ann Surg 213(3):199-206, 1991 10. Gordon RD, Hartner CM, Casavilla A, Selby RR, Bronsther O, Mieles L, Martin M, Fung JJ, Tzakis
  • 170. AG, Starzl TE: The liver transplant waiting list-a single-center analysis. Transplantation 51(1):128-134, 1991 11. Stieber AC, Gordon RD, Todo S, Tzakis AG, Fung JJ, *Casavilla A, Selby RR, Mieles L, Reyes J, Starzl TE: Liver transplantation in patients over sixty years of age. Transplantation 51(1):271-273, 1991 12. Iwatsuki S, Starzl TE, Sheahan DG, Yokoyama I, Demetris AJ, Todo S, Tzakis AG, Van Thiel DH, Carr B, Selby RR, Madariaga J: Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 214(3):221-228; discussion 228-229, 1991 13. Kusne S, Schwartz M, Breinig MK, Dummer JS, Lee RE, Selby RR, Starzl TE, Simmons RL, Ho M: Herpes simplex virus hepatitis after solid organ transplantation in adults. J Infect Dis 163(5):1001-1007, 1991 14. Fung JJ, Demetris A, Todo S, Tzakis AG, Bronsther O, Casavilla A, Doyle H, Gordon R, Iwatsuki S, Selby RR, Imventarza O, Martin M, Reyes J, Stieber A, Starzl TE: Use of FK 506 in the treatment of liver allograft rejection. Transplantation Sci 1:50-54, 1991 15. Fung JJ, Abu-Elmagd K, Todo S, Shapiro R, Tzakis AG, Jordan M, Armitage J, *Jain A, Martin M, Bronsther O, Stieber A, Kormos R, Selby RR, Gordon R, Starzl TE: FK 506 in clinical organ transplantation. Clin Transplant 5:517-522, 1991 16. Asonuma K, Takaya S, Selby RR, Okamoto R, Yamamoto Y, Yokoyama T, Todo S, Ozawa K, and Starzl TE: The clinical significance of the arterial ketone body ratio as an early indicator of graft viability in human liver transplantation. Transplantation 51(1):164-171, 1991 17. Fung JJ, Abu-Elmagd K, Jain A, Gordon R, Tzakis A, Todo S, Takaya S, Alesiani M, Demetrios A, Bronsther O, Martin M, Mieles L, Selby RR, Reyes J, Doyle H, Stieber A, Casavilla A and Starzel TE: A randomized trial of primary liver transplantation under immunosuppression with FK 506 versus cyclosporine. Transplantation 23:2977-2983, 1991 18. Nussler AK, DiSilvio M, Billiar TR, Hoffman RA, Geller DA, Selby RR, Madariaga J, Simmons RS: Stimulation of the nitric oxide synthase pathway in human hepatocytes by cytokines and endotoxin. J Exp Med 176(1):261-264, 1992 19. Casavilla A, Selby RR, Abu-Elmagd K, Tzakis AG, Todo S, Reyes J, Fung JJ, Starzl TE: Logistics and technique for combined hepatic-intestinal retrieval. Ann Surg 216(5):605-609, 1992
  • 171. 20. Todo S, Tzakis AG, Abu-Elmagd K, Reyes J, Nakamura K, Casavilla A, Selby RR, Nour BM, Wright H, Fung JJ, et al: Intestinal transplantation in composite visceral grafts or alone. Ann Surg 216(3):223-233; discussion 233-234, 1992 21. *Takaya S, Nonami T, Selby RR, Doyle H, Murray G, Kramer D, Kang Y, Starzl TE: The relationship of systemic hemodynamics and oxygen consumption to early allograft failure after liver transplantation. Transpl Int 6(2):73-76, 1993 22. Tzakis AG, Todo S, Reyes J, Nour B, Abu-Elmagd K, Selby RR, Casavilla A, Kocoshis S, Demetris AJ, Yunis E, Van Thiel DH, Starzl TE: Intestinal transplantation in children under FK 506 immunosuppression. J Ped Surg 28(8):1040-1043, 1993 23. Madariaga JR, Iwatsuki S, Starzl TE, Todo S, Selby RR, Zetti G: Hepatic resection for cystic lesions of the liver. Ann Surg 218(5):610-614, 1993 24. Abu-Elmagd K, Bronsther O, Jain A, Irish W, Ramos H, Marino IR, Dodson F, Selby RR, Doyle H, Furukawa H, et al: Recent advances in hepatic transplantation at the University of Pittsburgh. Clin Transpl 137-152, 1993 25. Van Thiel DH, Carr B, Iwatsuki S, Selby RR, Fung JJ, Starzl TE: The 11-year Pittsburgh experience with liver transplantation for hepatocellular carcinoma: 1981-1991. J Surg Oncol Suppl 3:78-82, 1993 26. Carr BI, Iwatsuki S, Starzl TE, Selby RR, Madariaga JR: Regional cancer chemotherapy for advanced stage hepatocellular carcinoma. J Surg Oncol Suppl 3:100-103, 1993 27. Madariaga JR, Dodson SF, Selby RR, Todo S, Iwatsuki S, Starzl TE: Corrective treatment and anatomic considerations for laparoscopic cholecystectomy injuries. J Am Col Surg 179(3):321-325, 1994 28. Gayowski TJ, Iwatsuki S, Madariaga JR, Selby RR, Todo S, Irish W, Starzl TE: Experience in hepatic resection for metastatic colorectal cancer; analysis of clinical and pathologic risk factors. Surg 116(4):703-710; discussion 710-711, 1994 29. Todo S, Fung JJ, Starzl TE, Tzakis AG, Doyle H, Abu-Elmagd K, Jain A, Selby RR, Bronsther O, Marsh W, et al: Single-center experience with primary orthotopic liver transplantation with FK 506 immunosuppression. Ann Surg 220(3):297-308; discussion 308-309, 1994 30. Schwarz RE, Posner MC, Plunkett MB, Selby RR, Landreneau RJ: Needle-localized thoracoscopic resections of small indeterminate pulmonary
  • 172. nodules in transplant patients. Clin Transplant 8(4):378-381, 1994 31. Casavilla FA, Selby RR, Abu-Elmagd K, Reyes J, Nakamura K, Wright HI, Tzakis AG, Todo S, Demetris AJ, Fung JJ, et al: Early clinical and histologic viability of human liver-small intestinal allografts after implantation. Clin Transpl 8(1):49-53, 1994 32. Selby RR, Madariaga JR, Iwatsuki S: Liver resectability based on physical characteristics. Cancer Treatment & Research 69:291-292, 1994 33. Bennett BC, Selby RR, Bahnson RR: Surgical resection for management of renal cancer with hepatic involvement. J Urol 154(3):972-974, 1995 34. *Rodriguez Rilo HL, Subbotin VM, Selby RR, Thomson AW: Rapid hair regrowth in refractory alopecia universalis associated with autoimmune disease following liver transplantation and tacrolimus (FK506) therapy. Transplantation 59(9):1350-1353, 1995 35. Orons PD, Zajko AB, Bron KM, Trecha GT, Selby RR, Fung JJ: Hepatic artery angioplasty after liver transplantation: experience in 21 allografts. J Vasc Interv Radiol 6(4):523-529, 1995 36. Selby RR, *Kadry Z, Carr B, Tzakis AG, Madariaga JR, Iwatsuki S: Liver transplantation for hepatocellular carcinoma. World J Surg 19(1):53-58, 1995 37. *Tepetes K, Selby RR, *Webb M, Madariaga JR, Iwatsuki S, Starzl TE: Orthotopic liver transplantation for benign hepatic neoplasms. Arch Surg 130(2):153-156, 1995 38. Jabbour N, Todo S, Selby RR, Starzl TE: Venovenous bypass using inferior mesenteric vein for portal decompression during orthotopic hepatic transplantation. J Am Col Surg 180(1):100, 1995 39. Merhav HJ, Mieles LA, Ye Y, Selby RR, Snowden G: Alternative procedure for failed reconstruction of a right replaced hepatic artery in liver transplantation. Transpl Inter 8(5):414-417, 1995 40. Selby RR, *Ramirez CB, Singh R, *Kleopoulos I, Kusne S, Starzl TE, Fung JJ: Brain abscess in solid organ transplant recipients receiving cyclosporine-based immunosuppression. Arch Surg 132:304-310, 1997 41. Jabbour N, Zajko A, Orons P, Irish W, Fung JJ, Selby RR: Does transjugular intrahepatic portosystemic shunt (TIPS) resolve thrombocytopenia associated with cirrhosis? Dig Dis and Sci 43(11):2459-2462, 1998 42. *Stein JP, Selby RR, Cote RJ, Hopkins B,
  • 173. Figueroa AJ, Skinner DG: Adrenal cortical carcinoma associated with a splenic vein tumor thrombus: a case report. Scandinavian J Urology and Nephrology, 32(2):140-142, 1998 43. *Cosenza CA, Durazo F, Stain SC, Jabbour N, Selby RR: Current management of recurrent pyogenic cholangitis, Am Surg 65(10):939-943, 1999 44. *Baril NB, Ralls PW, Wren, Selby RR, Radin R, Parekh D, Jabbour N, Stain SC: Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg 231(3):361-367, 1999 45. *Cosenza CA, Saffari B, Jabbour N, Stain SC, Garry D, Parekh D, Selby RR: Surgical management of biliary gallstone disease during pregnancy, Am J Surg 178:546-548, 1999 46. Reyes JD, Carr B, Dvorchik I, Kocoshis S, Jaffe J, Gerber D, Mazariegos GV, Bueno J, Selby RR: Liver transplantation and chemotherapy for hepatoblastoma and hepatocellular cancer in childhood and adolescence. J Pedric 136(6):795-804, 2000 47. *Stapher M, Selby RR, Stain SC, Katkhouda N, Parekh D, Jabbour N, Garry D: Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 232 (2):191-198, 2000 48. *Kassabian A, Stein J, Jabbour N, *Parsa K, Skinner D, Parekh D, Cosenza CA, Selby RR: Renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. Urology 56(2):211-215, 2000. Articles Non-Peer Review *Medical Student, Fellow or Resident 1. *Yokoyama I, Todo S, Miyata T, Selby RR, Tzakis AG, Starzl TE: Endotoxemia and human liver transplantation. Transplant Proc 21(5):3833-3841, 1989 2. Yokoyama I, Sheahan DG, Carr B, Kakizoe S, Selby RR, Tzakis AG, Todo S, Iwatsuki S, Starzl TE: Clinicopathologic factors affecting patient survival and tumor recurrence after orthotopic liver transplantation for hepatocellular carcinoma. Transplant Proc 23(4):2194-2196, 1991 3. Fung JJ, Abu-Elmagd K, Jain A, Gordon R, Tzakis AG, Todo S, Takaya S, Alessiani M, Demetris A, Bronsther O, Martin M, Mieles L, Selby RR, Reyes J, Doyle H, Stieber A, Casavilla A, Starzl TE: A randomized trial of primary liver transplantation under immunosuppression with FK 506 versus cyclosporine. Transplant Proc 23:3038-3039, 1991
  • 174. 4. Yagihashi A, Yoshida Y, Terasawa K, Ujike Y, Konno A, Ogura K, Kobayashi M, Takenaka T, Hayashi S, Selby RR, Warty V, Noguchi K, Iwaki Y, Starzl TE: The effect of FK 506 on peripheral blood T-lymphocyte subsets in orthotopic liver transplant patients. Transplant Proc 23(6):2937-2938, 1991 5. Todo S, Tzakis AG, Reyes J, Abu-Elmagd K, Casavilla A, Nour BM, Selby RR, Fung JJ, Van Thiel D, Starzl TE: Clinical small bowel or small bowel plus liver transplantation under FK 506. Transplant Proc 23(6):3093-3095, 1991 6. Takaya S, Bronsther O, Todo S, Abu-Elmagd K, Jain A, Alessiani M, Madariaga J, Marino IR, Selby RR, Fung JJ, Gordon RD, Starzl TE: Retransplantation of liver: a comparison of FK 506- and cyclosporine-treated patients. Tranplant Proc 23(6):3026-3028, 1991 7. Fung JJ, Abu-Elmagd K, Todo S, Shapiro T, Tzakis AG, Jordan M, Armitage J, Jain A, Martin M, Bronsther O, Stieber A, Kormos R, Selby RR, Gordon R, Starzl TE: Current status on FK 506 in organ transplantation. Seminaires D'Uro-Nephrologie, Publies Sous La Direction de Christian Chatelain et Claude Jacobs, 196-201, 1991 8. Yagihashi A, Takenaka T, Noguchi K, Kobayashi M, Konno A, Hayashi S, Yoshida Y, Terasawa K, Nakamura K, Selby RR, Demetris AJ, Abu-Elmagd K, Reyes J, Tzakis AG, Todo S, Iwaki Y, Starzl TE: Changes in cell surface markers in human small bowel transplantation (SBTx) with FK 506. Transplant Proc 24(3):1203, 1992 9. *Fontes PA, *Rilo HL, Carroll PB, Tzakis AG, Selby RR, Demetris AJ, Starzl TE, Ricordi C: Human islet isolation and transplantation in chronic pancreatitis using the automated method. Tranplant Proc 24(6):2809, 1992 10. Fung JJ, Thomson AW, *Pinna A, Selby RR, Starzl TE: State of immunosuppressive agents in organ transplantation. Transplant Proc 24(6):2372-2374, 1992 11. Selby RR, Starzl TE, Yunis E, Todo S, Tzakis AG, Brown BI, Kendall RS: Liver transplantation for type I and type IV glycogen storage disease. Eur J Pediatr 152(Suppl 1):S71-76, 1993 12. Casavilla A, Selby RR, Abu-Elmagd K, Tzakis AG, Todo S, Starzl TE: Donor selection and surgical technique for "en bloc" liver-small bowel procurement. Transplant Proc 25:2638-2639, 1993 13. Carr BI, Selby RR, Madariaga JR, Iwatsuki S,
  • 175. Starzl TE: Prolonged survival after liver transplantation and cancer chemotherapy for advanced-stage hepatocellular carcinoma. Transplant Proc 25(1):1128-1129, 1993 14. Abu-Elmagd K, Selby RR, Iwatsuki S, Fung JJ, Tzakis AG, Todo S, Demetris AJ, Baddour N, Irish W, Van Thiel DH, Starzl TE: Cholangiocarcinoma and sclerosing cholangitis: Clinical characteristics and effect on survival after liver transplantation. Transplant Proc 25(1):1124-1125, 1993 15. *Ukah FO, Merhav H, Kramer D, *Eghtesad B, Samimi F, Frezza E, Linden P, Mieles L, Selby RR: Early outcome of liver transplantation in patients with a history of spontaneous bacterial peritonitis. Transplant Proc 25(1):1113-1115, 1993 16. Fung JJ, Todo S, Abu-Elmagd K, Jain A, Tzakis AG, Martin M, Selby RR, Bronsther O, Doyle H, Gayowski T, et al: Randomized trial in primary liver transplantation under immunosuppression with FK 506 or cyclosporine. Tranplant Proc 25(1):1130, 1993 17. Scott V, Miro A, Kang Y, DeWolf A, Bellary S, Martin M, Kramer D, Selby RR, Doyle H, Paradis I, et al: Reversibility of the hepatopulmonary syndrome by orthotopic liver transplantation. Transplant Proc 25(2):1787-1788, 1993 18. Scott V, DeWolf A, Kang Y, Martin M, Selby RR, Fung JJ, Doyle H, Ziady G, Paradis I, Miro A, et al: Reversibility of pulmonary hypertension after liver transplantation: a case report. Transplant Proc 25(2):1789-1790, 1993 19. Casavilla A, Selby RR, Abu-Elmagd K, Tzakis A, Todo S, Starzl TE: Donor selection and surgical technique for en bloc liver-small bowel graft procurement. Transplant Proc 25(4):2622-2623, 1993 20. Madariaga JR, Selby RR, Iwatsuki S, Carr B, Starzl TE: Hepatocellular carcinoma: Hepatic resection versus transplantation. Proceedings of UICC Kyoto International Symposium on Recent Advances in Management of Digestive Cancers: 121-124, 1993 21. Jain AB, Fung JJ, Todo S, Reyes J, Selby RR, Irish W, Doyle H, Abu-Elmagd K, Casavilla A, Nour B, et al: One thousand consecutive primary orthotopic liver transplants under FK 506; survival and adverse events. Transplant Proc 27(1): 1099-1104, 1995 22. Merhav HJ, Mieles LA, Ye Y, Selby RR, Snowden G: Alternative procedure for failed reconstruction of a right replaced hepatic artery in liver transplantation. Transplant International
  • 176. 8(5):414-417-1995 23. *Siegler EA, Selby RR: Orthotopic liver transplantation for unresectable, benign hepatic neoplasms. Chirurgia International Vol III(5):9-12, 1996 24. *Arnold W, Jabbour N, Selby RR: Hepatic resection for metastatic lesions. Prac Gastroenterology XX (12):6-10, 1996 25. *Siegler EA, Selby RR, Jabbour N: Controversies in the optimal surgical management of gallstone ileus. Surgical Rounds 20(9):359-363, 1997 26. *Mimran RI, *Freeman J, *Gong I, Selby RR, Jabbour N: Benign cystic teratoma arising from the common bile duct: a case report. Surgical Rounds October:463-467, 1998 Articles in Preparation 1. Selby RR, Todo T, Marsh JW, Madariaga J, Carr BI, Tsamandas AC, Fung JJ, Iwatsuki S, Starzl TE: 15 Year experience and follow-up of liver transplantation for metastatic hepatic malignancy. 2. Carr BI, Selby RR: Treatment of advanced stage hepatocellular carcinoma with liver transplantation and neo-adjuvant chemotherapy: a pilot study. 3. Jabbour N, Genyk Y, Palmer S, Mateo R, Selby RR: Splenic artery aneurysm: can we afford to ignore it in liver transplantation? 4. Jabbour N, Genyk Y, Mateo R, Korula J, Delich P, Henderson R, Selby RR: Live donor liver transplantation in adult Jehovah’s Witness patients: surgical management techniques. Articles Submitted 1. *Chou J, Selby RR, Jabbour N: Mycotic aneurysm of the hepatic artery: a case report and review of the literature. Digestive Diseases and Sciences, December 1999. 2. Jabbour N, *Shirazi S, Genyk Y, Mateo R, Pak E, Cosenza CA, Selby RR: Surgical management of complicated hydatid disease of the liver. The American Surgeon, February 2000. 3. Jabbour N, Genyk Y, Mateo R, Korula J, Thomas D, Ralls P, Palmer S, Kanel G, Patel RV, Selby RR: Live donor liver transplantation: the USC experience. Acta Chirurgica Belgica (official journal of the Royal Belgian Society for Surgery), August 2000. 4. *Peyre CG, Jabbour N, Selby RR, Watkim M, Mateo R: Unusual cases of jaundice secondary to non-neoplastic bile duct. Archives of Surgery, August 2000.
  • 177. Abstracts *Medical Student, Fellow or Resident 1. Bellary SV, Carr B, Selby RR, Van Thiel DH: Predictive factors for hepatotoxicity in patients with hepatocellular carcinoma undergoing intra-arterial chemotherapy. American Association for the Study of Liver Disease, Hepatology, 1992. 2. Casavilla A, Julian T, Dodson F, Stieber A, Selby RR: Diagnostic and staging laparoscopy in liver transplant candidates with suspected hepatobiliary malignancy. Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Scientific session, April 1-3, 1993, Phoenix, AZ. 3. Carr BI, Iwatsuki S, Baron R, Jain A, Selby RR, Madariaga JR, Tuttle H, Barnes J: Intrahepatic arterial cis-platinum and doxorubicin with or without lipoidal for advanced hepatocellular carcinoma (HCC): A prospective randomized study. ASCO Meeting, May 16-19, 1993, Orlando, Florida. 4. Selby RR, Carr B, Flickinger J, Frezza E, Dekker A, Abu-Elmagd K, Barnes J, Tuttle H, Iwatsuki S, Starzl TE: Liver transplantation after neoadjuvant radiochemotherapy for Klatskin tumor. International Liver Transplantation Society, October 6-8, 1993, Toronto, Ontario Canada. 5. Gayowski T, Selby RR, Demetris AJ, Ramos H, Takaya S, Starzl TE: Hepatic central venulitis and ascites syndrome: a clinicopathologic syndrome of liver transplant rejection. International Liver Transplantation Society, October 6-8, 1993, Toronto, Ontario Canada. 6. Carty SE, Frezza EE, Selby RR, Both A, Brumfield AM, Lotze MT: Marked elevation of serum IL-6 levels in patients with cholangiocarcinoma. American Association for Cancer Research, 1993. 7. Iwatsuki S, Starzl TE, Gayowski T, Todo S, Madariaga JR, Selby RR: Proposed TNM staging for metastatic colorectal cancer to the liver. American Surgical Association 114th Annual Meeting, April 7-9, 1994, San Antonio, Texas. 8. Jain A, Fung J, Todo S, Selby RR, Ramos H, Gayowski T, Abu-Elmagd K, Bronsther O, Jabbour N, et al: Conversion from FK506 to cyclosporine due to FK 06 toxicity following orthotopic liver transplantation. American Society of Transplant Physicians, Chicago, Illinois, May, 19994. 9. Jain A, Fung JJ, Todo S, Ramos H, Selby RR, Irish W, Reyes J, Jabbour N, Venkataramanan R, Starzl TE: Adult primary orthotopic liver transplantation under FK 506:four-year follow-up.
  • 178. American Association of Liver Diseases, Chicago, Illinois, November, 1994 10. Jain A, Fung JJ, Todo S, Selby RR, Casavilla F, Jabbour N, Doyle H, Kramer D, Kang Y, Irish W, Kusne S, Starzl TE: Morbidity other than rejection with primary liver transplantation: 1,000 consecutive cases. The American Society of Transplant Physicians, May, 1995 11. *Baril NB, Ralls PW, Wren SM, Selby RR, Radin R, Parekh D, Jabbour N, Stain SC: Does an infected peripancreatic fluid collection or abscess mandate operation? Pacific Coast Surgical, Third Scientific Session, February 14-18, 1998, Maui, Hawaii. 12. *Stapfer MV, Cohen H, Jabbour N, Stain SC, Selby RR, *Garry D: Management of duodenal perforation after endoscopic retrograde cholangiopancreatography. Digestive Disease Week, May 17-20, 1998, New Orleans, Louisiana. 13. *Cosenza CA, Stain SC, Durazo F, Jabbour N, Selby RR: Current management of recurrent pyogenic cholangitis. Southern California Chapter, American College of Surgeons, January 22-24, 1999, Santa Barbara, California. 14. *Cosenza CA, *Saffari B, *Garry D, Stain SC, Parekh D, Jabbour N, Selby RR: The surgical management of biliary gallstone disease during pregnancy. Scientific Session, 51st Annual Meeting of the Southwestern Surgical Congress, April 18-21, 1999, Loews Coronado By Resort, Coronado, California. 15. Selby RR, Korula J, Mateo R, Selby B, Durazo F, Wueste D, Ahluwalia A, Moser J, Genyk Y, Jabbour N: Comparison of the pre-transplant costs and medical acuity between adult cadaveric versus live-donor transplant recipients. Poster presentation at 51st Annual Meeting of the American Association for the Study of Liver Diseases, October 27-31, 2000, Wyndham Anatole Hotel, Dallas, Texas. 16. Korula J, Pak E, Selby RR, Beringer P, Jabbour N, Genyk Y, Mateo R, Valinluck B, Govindarajan S: Individualized hepatitis B immunoglobulin dosing in liver transplant recipients with hepatitis B using a pharmacokinetic model is cost effective. Poster presentation at 51st Annual Meeting of the American Association for the Study of Liver Diseases, October 27-31, 2000, Wyndham Anatole Hotel, Dallas, Texas. 17. Selby RR, Korula J, Mateo R, Selby B, Durazo F, Wueste D, Ahluwalia A, Moser J, Genyk Y, Jabbour N: Comparison of the pre-transplant costs and medical acuity between adult cadaveric
  • 179. versus live-donor transplant recipients. Poster presentation at the Living Donor Liver Transplantation Workshop, December 4-5, 2000, Natcher Conference Center, NIH Campus, Bethesda, Maryland. 18. Korula J, Selby RR, Durazo F, Genyk G, Delich P, *Ahluwalia A, Mateo R, Jabbour N: Evaluation of donors for live donor liver transplantation: a simple and cost minimizing protocol. Poster presentation at the Living Donor Liver Transplantation Workshop, December 4-5, 2000, Natcher Conference Center, NIH Campus, Bethesda, Maryland. Abstract Submitted 1. Selby RR, Jabbour N, Korula J, Thomas D, Henderson R, Durazo F, Genyk Y: Live donor liver transplantation and hepatic resection in Jehovah’s witness patients. Pacific Coast Surgical Association, September 2000. Chapters 1. Kramer DJ, Selby RR, Murray GC: Perioperative intensive care of liver transplant patients. In Rippe JM, Irwin RS, Alpert JS, Fink MP (eds), Intensive Care Medicine, Second Edition. Little, Brown and Company, Boston, Chapter 171, pp 1631-1645, 1991. 2. Fung JJ, Abu-Elmagd K, Todo S, Shapiro R, Tzakis AG, Jordan M, Armitage J, Jain A, Alessiani M, Martin M, Bronsther O, Stieber A, Kormos R, Selby RR, Gordon R, Przepiorka D, Bloom E, Starzl TE: Overview of FK 506 in transplantation. In Terasaki PI (ed), Clinical Transplants 1990 . UCLA Tissue Typing Laboratory, Los Angeles, CA, pp 115-121, 1991. 3. Abu-Elmagd K, Bronsther O, Jain A, Irish W, Ramos H, Marino IR, Dodson F, Selby RR, Doyle H, Furukawa H, et al: Recent advances in hepatic transplantation at the University of Pittsburgh. In Terasaki and Cecka (eds), Clinical Transplants. UCLA Tissue Typing Laboratory, Los Angeles, California, Chapter 12, pp 137-152, 1993. 4. Kramer DJ, Selby RR, Fung JJ: Intensive care of liver transplant recipients. In Ayres SM, Grenvik A, Holbrook PR, Shoemaker WC (eds), Textbook of Critical Care, Third Edition. W.B. Saunders Company, Philadelphia, Chapter 181, pp 1638-1649, 1995. 5. Reyes JD, Selby RR, Abu-Elmagd K, Tzakis AG, Todo S, Casavilla A, Starzl TE: Intestinal and multiple organ transplantation. In Ayres SM, Grenvik A, Holbrook PR, Shoemaker WC (eds), Textbook of Critical Care, Third Edition. W.B.
  • 180. Saunders Company, Philadelphia, Chapter 185, pp 1678-1686, 1995. 6. Stain SC, Parekh D, Selby RR: Tumors of the gallbladder and biliary tract. In Kaplowitz N (ed), Liver and Biliary Diseases, Second Edition. Williams and Wilkens, Philadelphia, Chapter 42, pp 725-738, 1996. 7. Stain SC, Selby RR: Repair of bile duct injuries. In Berci G, Cuschieri A (eds), Bile Ducts and Bile Duct Stones. W.B. Saunders Company, Philadelphia, Chapter 20, pp 143-153, 1997. 8. Jabbour N, Korula J, Selby RR: Portal hypertension: management of variceal bleeding. In Eton D (ed), Vascular Disease: A Multi-Specialty Approach to Diagnosis and Management. R.G. Landes Bioscience Publishers, Austin, Texas, Chapter 18, pp 222-233, 1998. 9. Jabbour N, Zajko A, Orons P, Irish W, Fung JJ, Selby RR: Does transjugular intrahepatic portosystemic shunt (TIPS) resolve thrombocytopenia associated with cirrhosis? In: Aliperti G, et al (eds). 1999 The Year Book of Gastroenterology, Mosby, Inc., St. Louis, MO, Chapter 6, pp 274-276, 1999. Chapter Accepted for Publication 1. Reyes J, Selby RR, Abu-Elmagd K, Todo S, Mazariegos G, Bueno J, Starzl TE: Intestinal and multiple organ transplantation. In Shoemaker WC, Ayres SM, Grenvik A, and Holbrook PR (eds), Textbook of Critical Care, Fourth Edition. W.B. Saunders Company, Philadelphia, Chapter 185, May 1999. Chapter In Preparation 1. Selby RR: Liver transplantation for cholangiocarcinomas. Letters to Editors 1. Selby RR, Genyk Y, Jabbour N. Organs for transplantation. NEJM 343(23):1731, 2000 2. Selby RR: Invited Critique: Impact of histological grade of hepatocellular carcinoma on the outcome of liver transplantation. Arch Surg 136:31, 2001 Miscellany 1. Selby RR, Trump DS: Appendicitis in the child. Good Samaritan Medical Center, Phoenix, AZ, Samaritan Medicine Volume Three, Issue One, 1985 2. Miyata T, Yokoyama I, Todo S, Tzakis A, Selby RR, Starzl TE: Endotoxaemia, pulmonary
  • 181. complications, and thrombocytopenia in liver transplantation. Comment in: Lancet 2(8668):927-928, 1989 3. Selby RR, Starzl TE, Yunis E, Brown BI, Kendall RS, Tzakis A: Liver transplantation for type IV glycogen storage disease. Comment in: N Engl J Med 324(1):55-56, 1991 4. Mieles, LA, Orenstein, DM, Toussaint, R.M. Selby RR, Gordon RD, Starzl TE:Outcome after liver transplantation for cystic fibrosis. 1991 Cystic Fibrosis Conference, Transplantation Division, Department of Surgery, University of Pittsburgh, Symposia Session Summaries, 130-133, 1991 5. Madariaga JR, Dodson SF, Selby RR, Todo S, Iwatsuki S, Starzl TE: Corrective treatment and anatomic considerations for laparoscopic cholecystectomy injuries. Comment in: J Am Coll Surg 180(6):765-766, 1995 6. Symposium: Bleeding and Transfusions in Surgery. Moderator: Seymour I. Schwartz, M.D., Participants: Ronald Hinder, M.D., Robert Rick Selby, M.D., William Shoemaker, M.D. Contemporary Surgery, 47(3):165-174, September 1995 7. Symposium: Management of Liver Abscesses. Moderator: Seymour I. Schwartz, M.D., Participants: Henry R. Pitt, M.D., Telfer Reynolds, M.D., Robert Rick Selby, M.D. Contemporary Surgery, 47(5):267-298, November 1995 8. Interview featuring Drs. Selby RR and Durazo F on Hispanic Talk Radio Station (KTNQ-AM1020) Educational Community Radio, Questions and Answers, Liver Transplantation, March 30, 1999 9. News conference featuring Drs. Selby RR, Genyk Y, Jabbour N, Korula J: Conference focused on Southern California’s first adult living-related liver transplant (Alva Mejia and Fernando Mejia) at USCUH –Media coverage (KNBC-Ch.4, KCAL-CH.9, KTTV-Ch.11, and KVEA-Ch.52. Radio coverage KFWB-AM980 and KNX-AM1070, May 6, 1999 10. News conference featuring Drs. Selby RR, Genyk Y, Jabbour N, Korula J: Conference focused on USC Surgeons perform world’s first living-related bloodless liver transplant (William Jennings) at USCUH- Media coverage (KNBC-Ch.4, KABC-Ch.7, KCBS-Ch.2, KCAL-Ch.9 and TV Regional affiliates. Radio coverage NPR, KFI-AM, KNX-AM, KFWB-AM, July 20, 1999 11. Interview by Russian TV Film crew, Russian Television Show – “A Stranger’s Blood” Coverage pertaining to “bloodless” living –related liver transplant operations, USC University Hospital,
  • 182. December 12, 1999 12. Press conference featuring Drs. Selby RR, Korula J. Historic surgery at USC University Hospital: Man donates portion of liver to stranger (Donor-Bludworth), USC University Hospital, Media coverage (KNBC-Ch 4, KCOP-TV-Ch 13 (UPN), KABC-TV Ch 7, KCBS-TV Ch 2. Radio coverage KNX 1070, KFWB-News 98, May 19, 2000 13. Interview and article by Carrie St. Michel, “My mother saved my daughter’s life, Parents Magazine, pp. 171-174, September 2000 issue. 14. Press conference featuring Drs. Selby, RR, El-Shahawy, M. Media coverage on recent dual organ transplant involving a mother and two of her children. Event attended by TV stations KNBC-Ch 4, KTLA-Ch 5, KABC-Ch 7, KCAL-Ch 9, KTTV Ch 11, KCOP-Ch 13 and KVEA-Ch 52, along with reporters from La Opinion, the Los Angeles Times, the Associated Press, KNX-AM radio and the French Press Agency. Scientific Presentations/Invited Lectures and Seminars *Medical Student, Fellow or Resident 1. Treatment of Recurrent Peritoneal Adhesions. Presented at the Fall Meeting of the Southwest Surgical Congress, Phoenix, Arizona 1983. 2. Treatment of Type I and Type IV Glycogen Storage Disease with Liver Transplantation. Presented at the Pediatric Society Meeting, Fulda, Germany, November 1990. 3. Tumor Board: Liver Resection. Presented at Latrobe Area Hospital, Latrobe, Pennsylvania, March 19, 1992. 4. Innovations in Immunology in Transplant Surgery. Presented at the Pittsburgh/Japanese Conference, Honolulu, Hawaii, April 2, 1992. 5. Preventing and Treating Infections in Liver Transplants. Presented at the Latter Day Saints (LDS) Hospital, Salt Lake City, Utah, May 1, 1992. 6. What to Expect with FK 506 in Liver Transplant Patients. Presented at the Latter Day Saints (LDS) Hospital, Salt Lake City, Utah, May 1, 1992. 7. Transplantation for Hepatobiliary Tumor. Presented at the Children's Hospital of Pittsburgh, Pennsylvania, April 24, 1992. 8. Cancer and Liver Transplant. Presented at the Medenica Clinic, Hilton Head, South Carolina, June 4, 1992. 9. Liver Resection. Presented at the East Liverpool City Hospital, East Liverpool, Ohio, August 20,
  • 183. 1992. 10. The Pre-Transplant and Post-Operative Management of Liver Transplantation. Presented at I Congreso Venezolano de Trasplante, Caracas, Venezuela, September 5-9, 1992. 11. Liver Transplantation Experience. Presented at the I Congreso Venezolano de Trasplante, Caracas, Venezuela, September 5-9, 1992. 12. Donor Selection and Surgical Technique for "En Bloc" Liver Small Bowel Graft Procurement. Presented at the International Symposium on Transplantation of Abdominal Organs, Essen, Germany 1992. 13. Liver Transplantation. Presented at the III Congress of the Panamerican Society for Dialysis and Transplantation/I Venezuelan Transplant Congress, Caracas, Venezuela, September 8, 1992. 14. Liver Resection. Presented at the East Liverpool City Hospital, East Liverpool, Ohio, August 20, 1992. 15. Infection, After Liver Transplantation. Presented at the Panamerican Congress on Transplantation, Caracas, Venezuela, September 1992. 16. Transplantation Requirements and Blood Usage in Liver Transplantation. Presented at the Japanese Society of Blood Banking, Tokyo, Japan, January 1993. 17. Liver Transplantation. Presented at the University at Osaka Surgical Residency, Osaka, Japan, January 1993. 18. Liver Transplantation-slide presentation for South Fayette High School Students, Biology II, February 19, 1993. 19. Liver Transplantation-How We Do It In Pittsburgh. Presented at Duke University, Durham, North Carolina, April 1993. 20. Transplant Tumor-slide presentation for 1993 Transplant Lecture Series, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, April 30, 1993. 21. Procurement and Transplantation of Livers. Presented at the Military Hospital of Mexico, June 1993. 22. Critical Care Management of Patients with Liver Transplantation. Presented at the Military Hospital of Mexico, June 1993. 23. Liver Transplantation. Presented at the Mexican Society of Pediatric Surgeons, Huatuleo, Oaxaca, Mexico, September 1993. 24. Critical Care and Liver Transplantation. Presented
  • 184. at the Mexican Society of Pediatric Surgeons, Huatuleo, Oaxaca, Mexico, September 1993. 25. Evaluation and Procurement of Donor Organs and Preservation Techniques. Presented at the Mexican Society of Pediatric Surgeons, Huatuleo, Oaxaca, Mexico, September 1993. 26. Advances in Immunosuppression. Presented at the Mexican Society of Pediatric Surgeons, Huatuleo, Oaxaca, Mexico, September 1993. 27. Liver Transplantation for Metastatic Cancer. Presented at the International Liver Transplantation Society, Toronto, Canada, October 1993. 28. How to Become a Donor and the Beauty of Liver Transplantation. Presented at Beth Sinai Synagog Men's League, Pittsburgh, Pennsylvania, October 1993. 29. The Treatment of Small Hepatocellular Carcinoma - Resection vs. Transplant. Presented at the American Association for the Study of Liver Diseases, 44th Annual Meeting, Chicago, Illinois, November 6, 1993. 30. Liver Transplantation and ICU Care of Recipients. Presented at the Mexican Society for Critical Care Medicine, Mazatlan, Mexico, October 1994. 31. Infections in the Postoperative Liver Transplant Recipient. Presented at the Mexican Society for Critical Care Medicine, Mazatlan, Mexico, October 1994. 32. Opportunistic Infections. Mexican Society of Critical Care Medicine, Mazatlan, Mexico, November 1994. 33. Management of the Liver Transplant ICU Patient. Mexican Society of Critical Care Medicine, Mazatlan, Mexico, November 1994. 34. Hepatic Resection. Presented at the Phoenix Surgical Society in Phoenix, Arizona, January 1995. 35. Liver Transplantation for Primary and Metastatic Tumor. Presented at the Phoenix Surgical Society in Phoenix, Arizona, January 1995. 36. ICU Care of the Liver Transplant Recipient. Presented at the Phoenix Surgical Society in Phoenix, Arizona, January 1995. 37. Surgical Treatment of Injuries after Laparoscopic Cholecystectomy. Presented at the Phoenix Surgical Society in Phoenix, Arizona, January 1995. 38. Intraoperative Treatment of Coagulopathic Conditions Related to Liver Disease. Presented at the Phoenix Surgical Society in Phoenix, Arizona,
  • 185. January 1995. 39. Treatment of Liver Abscesses. Presented at the Phoenix Surgical Society in Phoenix, Arizona, January 1995. 40. Organ Donation. Presented to the USC University Hospital Guild/Women’s Auxiliary, Los Angeles, California, December 1995. 41. Cholangiocarcinoma and Hepatic Resection for Metastatic Colorectal Cancer. Presented at the Southern California Society of Gastroenterology, Los Angeles, California, January 1996. 42. Controversies in Liver Transplantation. Presented at the Southern California Society of Gastroenterology (Post AGA-DDW Review), Newport Beach, California, July 1997. 43. Introduction to USC Center for Liver Disease. Presented to Universal Primary Care, Eagle Rock, California, October 1997. 44. Liver Transplantation. Presented to MedPartners/Tenet Group, Cerritos, California, November 1997. 45. Controversies in Liver Transplantation and Liver Surgery. Presented at the Southern California Society of Gastroenterology (21st Post AGA-DDW Review), Rancho Mirage, California, July 1998. 46. Bloodless Hepatobiliary and Liver Transplant Surgery: An Overview, Fourth National Seminar Bloodless Medicine & Surgery, “Exploring New Frontiers in Medicine”, Hyatt Regency, Chicago, Illinois, Creighton University, October 1998. 47. Living Related Liver Transplant. Nurses Grand Rounds, USC University Hospital, Los Angeles, California, November 1998. 48. *Shirazi SK, Jabbour N, Selby RR. Surgical management of complicated hepatic hydatid disease. Poster session, The Southwestern Surgical Congress, San Antonio, Texas, April 19-22, 1998. 49. Long-term Care of the Transplanted Liver. Liver Disease 2000: A Symposium for Nurses, USC University Hospital, Los Angeles, California, February 2000. 50. Transplantation in the Future. Liver Disease 2000: A Symposium for Nurses, USC University Hospital, Los Angeles, California, February 2000 51. Liver Transplant. Symposium: New Trends in the Treatment of Hepatitis C Virus, Academia Nacional de Medicina de Mexico, A.C., Mexico, DF, April 8, 2000. 52. Hepatic Resection for Colorectal Metastases, Colorectal Staff Conference, Department of
  • 186. Surgery, LAC+USC Medical Center, Los Angeles, California, July 18, 2000. 53. Treatment of Gastrointestinal Cancer II, 8th Annual Care of the Elderly Conference, University of Alaska Southeast, Sitka, Alaska, September 22-23, 2000. Postgraduate Lectures 1. Liver and Multivisceral Transplantation, Norris Cancer Hospital, Los Angeles, CA, October 1995. 2. Transplantation for Tumor, LAC+USC Medical Center, Los Angeles, CA, October 1995. 3. Liver Transplantation, Rancho Los Amigos, Downey, CA, November 1995. 4. Liver Resections, USC University Hospital, Los Angeles, CA, December 1995. 5. Liver Transplantation, Suburban Medical Center, Paramount, CA, February 1996. 6. Liver Transplantation, Santa Marta Hospital, Los Angeles, CA, March 1996. 7. Innovations, Research & Future Directions in Transplantation, Century City Hospital, Los Angeles, CA, April 1996. 8. Current Trends in Liver Transplantation, St. Francis Medical Center, Los Angeles, CA, April 1996. 9. New Trends in Liver Transplantation, Pacifica Hospital, Sun Valley, CA, April 1996. 10. Laparoscopic Cholecystectomy Injuries, Kaiser Hospital, Riverside, CA, May 1996. 11. Hepatoma and Cholangiocarcinoma, Long Beach Community Hospital, Long Beach, CA, May 1996. 12. Liver Transplantation: Techniques and Results, Daniel Freeman Hospitals, Inc., Inglewood, CA, June 1996. 13. Liver Transplantation, Encino-Tarzana Medical Center, Tarzana, CA, June 1996. 14. Liver Transplantation, Redding Medical Center, Redding, CA, July 1996. 15. Liver Transplantation, Update in Medicine/USC, San Diego Marriott Valley, San Diego, CA, September 1996. 16. Hepatic Resection for Primary & Metastatic Tumors, Parkview Community Hospital Medical Center, Riverside, CA, October 1996. 17. Liver Transplantation, Huntington Memorial Hospital, Pasadena, CA, January 1997. 18. Current Issues in Organ Donation and Transplantation, County of Los Angeles,
  • 187. Department of Coroner, Los Angeles, CA, February 1997. 19. End-Stage Liver Disease/Transplantation, Anaheim Memorial Medical Center, Anaheim, CA, March 1997. 20. Complex Liver Disease, St. Jude Medical Center, Fullerton, CA, March 1997. 21. Liver Transplantation, Pomona Valley Hospital Medical Center, Pomona, CA, June 1997. 22. Radiography and Management of Benign Hepatic Lesions, LAC+USC Medical Center, Department of Surgery, Los Angeles, CA, July 1997. 23. Laparoscopic Cholecystectomy Injuries, Parkview Community Hospital Medical Center, Riverside, CA, September 1997. 24. Hepatic Resection for Primary and Metastatic Tumors, Eisenhower Medical Center, Rancho Mirage, CA, October 1997. 25. Liver Resection and Liver Transplantation is Possible Without The Use of Blood, 3rd Transfusion-Free Medicine & Surgery Conference, Good Samaritan Hospital, Los Angeles, CA, September 1998. 26. End Stage Liver Disease, Ventura County Medical Center, Ventura, CA, September 1998. 27. What’s New in Liver Transplant Living Related Transplant, The USC Experience, Childrens Hospital Los Angeles Grand Rounds, Los Angeles, CA, February 1999 28. Transplantation for Hepatocellular Cancer and Resection, USC/Norris Comprehensive Cancer and Hospital, Cancer Center Grand Rounds, Los Angeles, CA, May 1999. 29. Viral Hepatitis: Virology to Transplantation, Childrens Hospital Los Angeles, Department of Pathology and Laboratory Medicine, Los Angeles, CA, June 1999. 30. Liver Transplantation, USC School of Pharmacy, Health Sciences Campus, Los Angeles, CA, June 1999. 31. Bleeding Curiosities of the Mesenteric Circulation, Kern Medical Center, Bakersfield, CA, June 1999. 32. Living Related Liver and Kidney Transplantation, 42nd USC Annual Postgraduate Refresher Course, Kapalua Hotel, Maui, Hawaii, August 1999. 33. Living Related Liver and Kidney Transplantation, St. Joseph Heritage, Fullerton, CA, August 1999. 34. Laparoscopic Living Related Kidney Transplantation, Anaheim Memorial Medical
  • 188. Center, Anaheim, CA, October 1999. 35. Living Related Liver & Kidney Transplantation, Century City Hospital, Los Angeles, CA, October 1999. 36. Surgical Management of Pancreatic Problems, UC Irvine Medical Center, Irvine, CA, March 2000. 37. Liver Transplantation Today, 2000 Post Graduate Assembly, Saint John’s Hospital and Health Center, Santa Monica, CA, September 2000. 38. New Approaches to Liver Transplantation, Symposium: Liver Disease Update 2000, Meyer Auditorium, USC, November 2000. 39. Acute Pancreatitis, Daniel Freeman Marina Hospital, Marina Del Rey, CA, January 2001 Return to Faculty and Staff USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 189. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney (Under construction) Transplant Kidney-Pancreas Transplant Pancreas Transplant Information for Patients Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 190. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor q XIX International Congress of The Laparoscopic Transplant Transplantation Society Conventional Kidney http://www.transplantation2002.com/ Transplant August 18 - 23, 2002 Kidney-Pancreas Transplant Buenos Aires, Argentina Pancreas Transplant Information: PDF Flyer, 377kb Information for Patients Transplant Patient Guide q National Kidney Foundation's Professional About the USC Councils Conference University Hospital October 11 - 14, 2001 Financial Considerations San Francisco, CA Kidney Glossary (800) 622-9010 Features What's New q Association of Organ Procurement Kidney Research Organizers Annual Meeting and Development June 20, 2001 - June 22, 2001 Calendar of Events Minneapolis, MN (USA) Kidney Newsletter More information: Downloads USA tel: +1 703 573 2976 General Information e-mail: aopo@erols.com Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 191. XIX INTERNATIONAL CONGRESS OF THE TRANSPLANTATION SOCIETY AUGUST 18 - 23, 2002 · BUENOS AIRES, ARGENTINA Buenos Aires Sheraton Hotel & Convention Center KEY DATES January 20, 2002 Abstracts Submission Deadline Early Registration Deadline May 15, 2002 Standard Registration Deadline August 18 - 23, 2002 Congress CONGRESS SECRETARIAT ana juan congresos Tel: 54-11-4381-1777 / 4382-1874 Sarmiento 1562 4º “F” Fax: 54-11-4382-6703 (C1042ABD) Buenos Aires E-mail: info@transplantation2002.com Argentina Web site: www.transplantation2002.com SCIENTIFIC PROGRAMME The Scientific Programme will include Plenary Sessions, State-of-the-Art Symposia, Oral Abstract Presentations and Poster Sessions. Abstract Categories are as follows: 1. Immunobiology 15. Clinical pancreas and islets transplantation 2. Histocompatibity and Immunogenetics 16. Pediatric transplantation 3. Experimental Transplantation 17. Bone marrow transplantation 4. Xenotransplantation 18. Tissue transplantation. Composite tissue 5. Organ Procurement transplantation. Bone transplantation 6. Preservation 19. Cell transplantation 7. Donation 20. Infections 8. Experimental immunosuppression 21. Malignancies 9. Clinical immunosuppression 22. Bioartificial Devices 10. Clinical kidney transplantation 23. Quality of Life 11. Clinical liver transplantation 24. Economics and Legal Aspects 12. Clinical heart transplantation 25. Ethics 13. Clinical lung transplantation 26. Pathology in solid organ transplantation 14. Clinical intestine and multivisceral 27. Miscellaneous transplantation MAIN ANNOUNCEMENT EXHIBIT To make sure you receive the Main Announcement An exhibit will be organised at the Sheraton Hotel & and Call for Abstracts, please send an email or fax Convention Center in conjunction with the your request to the Congress Secretariat. All details Congress. It will display pharmaceutical and concerning call for abstract, registration, scientific products, technical equipment, scientific accommodation, social events and tours are books and journals related to transplantation. included in the Main Announcement available from September 2001.
  • 192. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor (Under construction) Laparoscopic Transplant Conventional Kidney Transplant Kidney-Pancreas Transplant Pancreas Transplant Information for Patients Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 193. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor q Flyer: XIX International Congress of The Transplantation Laparoscopic Transplant Society Conventional Kidney PDF file, 377kb Transplant August 18 - 23, 2002 Kidney-Pancreas Transplant Buenos Aires, Argentina Pancreas Transplant http://www.transplantation2002.com/ Information for Patients Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 194. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Transplant Surgery Cardiovascular Surgery Conventional Kidney Rick Selby, M.D., Surgical Vaughn Starnes, M.D. Transplant Director Radiology Kidney-Pancreas Transplant Nicolas Jabbour, M.D., Sue E. Hanks, M.D. Pancreas Transplant Associate Director Michael D. Katz, M.D. Yuri Genyk, M.D. Philip W. Ralls, M.D. Information for Patients Rod Mateo, M.D. Transplant Patient Guide Linda Sher, MD Pulmonary and Critical Care About the USC Khalid Chan, M.D. University Hospital Transplant Medicine Financial Considerations Mohammed El-Shahawy, M.D. Cardiology Shelly Shapiro, M.D. Kidney Glossary Medical Director Oncology Features Transplant Urology What's New John R. Daniels, M.D. Matt Dunn MD Kidney Research John Stein MD Tissue Typing Laboratory and Development Yuichi Iwaki, M.D., PhD Calendar of Events Nephrology Jim Cicciarelli, PhD Mohammed El-Shahawy, M.D. Kidney Newsletter Vito Campesi, M.D. Infectious Disease Downloads Elaine Kaptein, M.D. Jan Geiseler, M.D. Hosameldin Madkour, M.D. General Information Saeid Nosrati, M.D. Psychiatry Faculty and Staff Miroslaw Smogorzewski, M.D. Thomas Krulisky, M.D. Contact Information Web Links Endocrinology Gastroenterology Jorge Mestman M.D. Site Map Francisco Durazo, M.D. Peter Butler M.D. Search this site Vikram Kamdar M.D. Pathology Peter Singer M.D. Stebbins B. Chandor, M.D. Gary C. Kanel, M.D. Transplant Coordinators Submit Marlene Abe, RN, BS, CPTC USC Care Medical Group Karen Ochenkoski, RN, CNN, Jeffry L. Huffman, M.D., MHA CCTC Program Case Manager Colleen Rooney, RN, BSN, James Magliglig, RN PHN Barbara Simmons, RN Outreach Educational Dietary Liaison Sonia LePhlegm, RD, CDE Barbara Schulman, RN Database Coordinator Administrative Director Matthew Buffington Brad Selby Administrative Staff Social Services
  • 195. Felipe Amaya, MSW Christina Olmeda Financial Services Kathy Villanueva Anesthesiology Steven Haddy, M.D. Aruna R. Patil, M.D. Earl M. Strum, M.D. Neurology Norman J. Kachuck, M.D. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 196. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Nicolas Conventional Kidney Jabbour, M.D. Transplant Associate Director Kidney-Pancreas Transplant Kidney Transplant Pancreas Transplant Program Information for Patients Phone: (323) 442-5908 Transplant Patient Guide Fax: (323) 442-5721 About the USC E-mail: University Hospital usckidney@surgery.hsc.usc.edu Financial Considerations Kidney Glossary Dr. Jabbour joined the abdominal organ Features transplant team at USC What's New University Hospital in Kidney Research October 1995. He is and Development Associate Director of Hepatobiliary/Pancreas Calendar of Events Surgery and Abdominal Kidney Newsletter Organ Transplantation at Downloads USC University Hospital and the Los Angeles General Information County+USC Medical Center. Dr. Jabbour is also the Assistant Faculty and Staff Director of the pediatric liver transplant program at Children's Hospital Contact Information Los Angeles. Web Links Site Map Dr. Jabbour completed his training in abdominal organ transplantation at the University of Pittsburgh Transplantation Institute. His experience Search this site includes transplantation of the kidneys, liver, pancreas and small bowel in adult and pediatric patients as well as caring for hundreds of pre- and post-transplant patients, participating in the clinical trials for Submit FK 506. As both a fellow and an Assistant Professor of Surgery under Dr. Starzl, Dr. Jabbour intimately experienced many of the recent advances in abdominal organ transplantation. This included his appointments to the multivisceral and small bowel transplantation teams, which performed more than 40 of these highly advanced and complex procedures. Name: Nicolas Jabbour, M.D. Title: Assistant Professor of Surgery Division of Hepatobiliary/Pancreas Surgery and Liver Transplantation Associate Director, Liver Transplantation Service
  • 197. Date of Employment: 10/27/95 Board Certification: Surgery - Certified 1992 Surgery Critical Care - Certified 1993 Specialty: Abdominal Organ Transplantation and Liver Resection Post-Residency Training: Abdominal Organ and Multivisceral Transplantation University of Pittsburgh Medical Center, 1991-93 Abdominal Organ and Multivisceral Transplantation Children's Hospital of Pittsburgh, 1991-93 Return to Faculty and Staff USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 198. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Address: USC Kidney Transplant Program Laparoscopic Transplant 1510 San Pablo Street Conventional Kidney Suite 430 Transplant Los Angeles CA 90033-4612 Kidney-Pancreas Transplant Telephone: (323) 442-5908 Pancreas Transplant Fax: (323) 442-5721 Information for Patients Transplant Patient Guide E-mail: usckidney@surgery.hsc.usc.edu About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit This is a printable map. For freeway directions, please scroll down this page. For door-to-door directions, please visit MAPQUEST. Freeway Directions From 10 Eastbound: Exit at Soto and Turn left. Left on Alcazar. Left on San Pablo. From 10 Westbound: Exit at Soto and turn right. Left on Alcazar. Left on San Pablo. From 5 Southbound: Exit at Mission and turn left. Right on Zonal. Left on San Pablo. From 5 Northbound: Transition to 10 Eastbound. Exit Soto and turn left. Left on Alcazar. Left on San Pablo. From 101 Southbound: Transition to 10 Eastbound. Exit State/Soto. Proceed across State onto onramp, and bear right to exit at Soto. Left on Alcazar. Left on San Pablo. From 710 North or Southbound: Transition to 10 Westbound. Exit at Soto and turn right. Left on Alcazar. Left on San Pablo.
  • 199. From Huntington Drive (Pasadena, West San Gabriel Valley): Follow Huntington Drive westbound until it divides into Mission and Soto. Bear left onto Soto and proceed to Alcazar. Turn right. Left on San Pablo. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 200. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Organ Transplant and Donation Laparoscopic Transplant q XIX International Congress of The Transplantation Society Conventional Kidney q Children's Organ Transplant Association, Inc. Transplant q United Network for Organ Sharing (UNOS) Kidney-Pancreas Transplant Pancreas Transplant q National Transplant Assistance Fund Information for Patients q Japan Network for Organ Sharing Transplant Patient Guide q Hong Kong Medical Association Organ Donation Register About the USC q British Organ Donor Society University Hospital Financial Considerations q British Organ Donor Society - Links Kidney Glossary q American Share Foundation Features q California Transplant Donor Network What's New q TransWeb - Transplantation and Donation Kidney Research and Development q Partnership for Organ Donation Calendar of Events q CenterSpan Kidney Newsletter Downloads Educational Institutions General Information q Virtual Hospital Faculty and Staff q Yale Gopher Menu - Transplantation Information Contact Information Web Links Government and National Organizations Site Map q U.S. Department of Health and Human Services Search this site q Health Resources and Services Administration q National Kidney Foundation Submit q The PBC Foundation (Primary Biliary Cirrhosis) Search Engines and Indexes q MedExplorer Search Engine q HospitalWeb - USA Hospitals on the World Wide Web q Yahoo - Health Links Commercial Organizations q Tenet Healthcare Corporation q Bloodless Medicine and Surgery Network
  • 201. q RENALNET USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 202. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Home Page Laparoscopic Transplant Conventional Kidney Areas of Expertise Transplant q Bloodless Kidney Transplant Kidney-Pancreas Transplant q Live Donor Laparoscopic Transplant Pancreas Transplant q Conventional Kidney Transplant Information for Patients Transplant Patient Guide q Kidney-Pancreas Transplant About the USC q Pancreas Transplant University Hospital Financial Considerations Information for Patients Kidney Glossary q Transplant Patient Guide Features q A Patient's Guide to Kidney Transplant Surgery What's New q A Guide to Medications Kidney Research q Kidney Transplant Team and Development Calendar of Events q The Organ Donation Process Kidney Newsletter q About the USC University Hospital Downloads q Financial Considerations General Information q Kidney Glossary Faculty and Staff Contact Information Features Web Links q What's New Site Map q L.A. Mom Has Dual Organ Transplant Search this site q Kidney Research and Development q Calendar of Events Submit q Kidney Newsletter q Downloads General Information q Faculty and Staff q Rick Selby, M.D., Surgical Director q Yuri Genyk, M.D. q Nicolas Jabbour, M.D. q Rod Mateo, M.D. q Mohammed El-Shahawy, M.D. Medical Director
  • 203. q Marlene Abe, RN, BSN, CCPC q Jennifer Moser, RN, BSN, CCTC q Contact Information q Web Links q Site Map USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 204. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Yuri Genyk, Laparoscopic Transplant Conventional Kidney M.D. Transplant Surgical Director Kidney-Pancreas Transplant Kidney Transplant Program Pancreas Transplant Information for Patients Phone: (323) 442-5908 Transplant Patient Guide Fax: (323) 442-5721 About the USC E-mail: usckidney@surgery.hsc.usc.edu University Hospital Financial Considerations Dr. Genyk is an Kidney Glossary Assistant Professor of Surgery at the USC Features School of Medicine and What's New the Division of Kidney Research Transplantation and and Development Hepatobiliary and Calendar of Events Pancreatic Surgery. Kidney Newsletter Additionally, he is an attending surgeon at Downloads Children's Hospital of General Information Los Angeles. Faculty and Staff Dr. Genyk graduated with honors from Ivano-Frankivk's Medical Contact Information Institute in Ukraine. He received his postgraduate medical and Web Links research training at Baylor University Medical Center in Dallas, Texas, Site Map University of Alabama Birmingham Medical Center and Mount Sinai Medical Center in New York City. He has considerable expertise in Search this site living-related donor liver transplantation, pediatric liver transplantation, laparoscopic donor nephrectomy for kidney transplantation, pancreas transplantation as well as general hepatobiliary and pancreatic Submit surgery. Shortly after joining the USC faculty, the USC Liver Transplant Team pioneered living-related donor liver transplantation at Children's Hospital of Los Angeles. Dr. Genyk is board certified in general surgery and ASTS certified in transplant surgery. His research interests include innovations in live donor kidney and liver transplantation, minimally invasive surgery for renal, hepatobiliary and pancreatic diseases, xenotransplantation and immunological tolerance in transplantation. Name: Yuri Genyk, M.D. Title: Assistant Professor of Surgery
  • 205. Date of Employment: 9/1/98 Board Certification: Surgery - Certified 1997 Specialty: Abdominal Organ Transplantation and Liver Resection Post-Residency Training: Abdominal Organ and Multivisceral Transplantation Mount Sinai Medical Center, New York 1996-1998 Return to Faculty and Staff USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 206. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Rod Mateo, Laparoscopic Transplant Conventional Kidney M.D. Transplant Assistant Professor Kidney Transplant Kidney-Pancreas Transplant Program Pancreas Transplant Phone: (323) 442-5908 Information for Patients Fax: (323) 442-5721 Transplant Patient Guide E-mail: About the USC usckidney@surgery.hsc.usc.edu University Hospital Financial Considerations Dr. Mateo is an assistant Kidney Glossary professor of surgery at the USC School of Features Medicine and the What's New Division of Hepatobiliary Kidney Research and Pancreas Surgery at and Development USC University Hospital. Calendar of Events He is also Assistant Unit Chief for the Kidney Newsletter Hepatobiliary Division at Downloads the Los Angeles County General Information Hospital. Faculty and Staff Dr. Mateo completed his general surgery residency and his Contact Information Multi-Organ Transplantation Fellowship at the University of Pittsburgh Web Links Medical Center, where he was involved with the surgical care of adult Site Map and pediatric liver, kidney, pancreas and small bowel transplant patients. He is board certified in general surgery and has done a Search this site surgical care fellowship. His research interests include the use of molecular biology in the study Submit of Hepatitis C in transplantation. He has studied the role of Hepatocyte Growth Factor in liver transplantation, and is currently involved in the design and implementation of databases for non-transplant hepatic, biliary tract and pancreatic patients. Return to Faculty and Staff
  • 207. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 208. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Mohamed A. Laparoscopic Transplant Conventional Kidney El-Shahawy, M.D., Transplant M.H.A. Kidney-Pancreas Transplant Medical Director Pancreas Transplant Kidney Transplant Program Information for Patients Phone: (323) 442-5568 Transplant Patient Guide Fax: (323) 442-5721 About the USC E-mail: University Hospital usckidney@surgery.hsc.usc.edu Financial Considerations Dr. El-Shahawy is an associate Kidney Glossary professor of medicine at the USC Features School of Medicine, as well as What's New medical director of the Kidney Kidney Research Transplant Program and vice chief of medicine at USC and Development University Hospital. Calendar of Events Kidney Newsletter Dr. El-Shahawy did his residency Downloads in internal medicine at St. Mary's Hospital-Yale University School of Medicine. He completed a fellowship in nephrology and General Information transplantation at the University of Pittsburgh in Pennsylvania and a Faculty and Staff fellowship in nephrology at Los Angeles County+USC Medical Center. Contact Information Dr. El-Shahawy joined the USC School of Medicine faculty in 1989 Web Links and began research in multiple areas including renal transplantation, Site Map acute renal failure, and hepatitis C virus infection in patients Search this site undergoing dialysis or kidney transplantation. Dr. El-Shahawy also developed the USC Acute Renal Failure Registry, a computerized database of patients with acute renal failure at LAC+USC Medical Center and USC University Hospital. Submit He is board-certified in internal medicine and nephrology and is a UNOS-certified transplant nephrologist. Dr. El-Shahawy is an honors graduate of the Masters in Health Administration program at the USC School of Policy Planning and Development, and a member of the Phi Kappa Phi society. Return to Faculty and Staff
  • 209. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 210. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Marlene Abe, RN, BS, CPTC Laparoscopic Transplant Clinical Transplant Coordinator Conventional Kidney Kidney Transplant Program Transplant Kidney-Pancreas Transplant Phone: (323) 442-5908 Pancreas Transplant Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu Information for Patients Transplant Patient Guide Board Certification About the USC Certified Procurement Transplant Coordinator - 1988 University Hospital Ms. Abe's background includes a B.S. in Biological Sciences from the Financial Considerations University of Southern California and a Diploma in Nursing from the Kidney Glossary Los Angeles County School of Nursing. Ms. Abe has 13 years of organ procurement and organ allocation experience, and certification Features from NATCO as a Certified Procurement Transplant Coordinator. Ms. What's New Abe joined the USC Abdominal Organ Transplant Team in 1999. Kidney Research and Development Ms. Abe works with Dr. Selby and his team to oversee the clinical Calendar of Events activities of the USC kidney transplant program. She is responsible for Kidney Newsletter developing clinical protocols for pre- and post-transplant patients and for direct patient care. Downloads General Information Faculty and Staff Return to Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 211. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Jennifer Moser, RN, CCTC Laparoscopic Transplant Clinical Transplant Coordinator Conventional Kidney Kidney Transplant Program Transplant Kidney-Pancreas Transplant Phone: (323) 442-5908 Pancreas Transplant Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu Information for Patients Transplant Patient Guide Board Certification About the USC Certified Clinical Transplant Coordinator - 1994 University Hospital Ms. Moser's background includes a BSN from Duquesne University in Financial Considerations Pittsburgh and certification from NATCO as a Certified Clinical Kidney Glossary Transplant Coordinator. Ms. Moser joined the USC Abdominal Organ Transplant Team in 1995 as the Senior Transplant coordinator, Features bringing with her 15 years of transplant experience. What's New Kidney Research Ms. Moser works with Dr. Selby and his team to oversee the clinical and Development activities of the USC Abdominal Organ Transplant Program. She is Calendar of Events responsible for developing clinical protocols for pre- and Kidney Newsletter post-transplant patients and for direct patient care. Downloads General Information Faculty and Staff Return to Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 212. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Karen Ochenkoski, RN, CNN, CCTC Laparoscopic Transplant Clinical Transplant Coordinator Conventional Kidney Kidney Transplant Program Transplant Kidney-Pancreas Transplant Phone: (323) 442-5908 Pancreas Transplant Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu Information for Patients Transplant Patient Guide Board Certification About the USC Certified Clinical Transplant Coordinator - 1998 University Hospital Certified Nephrology Nurse- 1991 Financial Considerations Ms. Ochenkoski's background includes A.D. in Nursing from the Kidney Glossary University of Cincinnati in Cincinnati, Ohio. Ms. Ochenkoski has 7 years of experience in both acute and chronic dialysis. She is certified Features in Nephrology and is currently a member of ANNA. In addition, she What's New has 9 years of experience as a clinical transplant coordinator and Kidney Research received her certification from NATCO. Ms. Ochenkoski joined the and Development USC Abdominal Organ Transplant Team in 2001. Calendar of Events Ms. Ochenkoski works with Dr. Selby and his team to develop clinical Kidney Newsletter protocols for pre and post transplant patients and is also responsible Downloads for direct patient care. General Information Faculty and Staff Contact Information Return to Faculty and Staff Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  • 213. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Colleen Rooney, RN, BSN, PHN Laparoscopic Transplant Clinical Transplant Coordinator Conventional Kidney Kidney Transplant Program Transplant Kidney-Pancreas Transplant Phone: (323) 442-5908 Pancreas Transplant Fax: (323) 442-5721 E-mail: crooney@surgery.usc.edu Information for Patients Transplant Patient Guide Education About the USC Bachelor of Arts University Hospital Bachelor of Science in Nursing Financial Considerations Board Certification Kidney Glossary California Registered Nurse NATCO member Features What's New Ms. Rooney is a multilingual (English, Spanish, Portuguese) graduate Kidney Research from the University of Minnesota. She began her career at UCLA as a and Development Clinical Nurse II, providing care for a variety of medical and surgical Calendar of Events patients, specializing in kidney transplants. Since leaving UCLA, Ms. Rooney came to USC as a Kidney Transplant Coordinator. Her Kidney Newsletter language skills have been instrumental in facilitating the pre-op and Downloads post-op organ transplant process for the multi-cultural transplant General Information patients at USC. Faculty and Staff Contact Information Web Links Return to Faculty and Staff Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu

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