Transplant surgery

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transplantation surgery....history, education, lecture.

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Transplantation surgery:

Transplantation surgery The division of medicine that surgically replaces an organ that is no longer functioning with an organ from a donor that does function . Organs are donated by living and deceased donors in order to save the life of a recipient .

Transplantation surgery:

Transplantation surgery Worldwide, 40,000 organ transplants are performed annually, with very high success rates (90% 1-year graft survival )

Transplantation surgery:

Transplantation surgery Renal transplants were the most common, followed by those of the liver, heart, lung, and others, including dual organ, pancreatic, and intestinal transplantation

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Pioneering Work, Transplantation Surgery surgical technique of transplantation early 1900s by the French surgeon Alexis Carrel, with Charles Guthrie, with the transplantation of arteries or veins. 1912 Nobel Prize in Physiology or Medicine . 1902 Carrel performed transplant experiments on dogs.Surgically successful in moving kidneys, hearts and spleens, first to identify the problem of rejection, which remained insurmountable for decades.

1950: First successful kidney transplant by Dr Richard H. Lawler (Chicago, U.S.A :

1950: First successful kidney transplant by Dr Richard H. Lawler (Chicago, U.S.A

1967: First successful heart transplant by Christian Barnard (Cape Town, South Africa) :

1967: First successful heart transplant by Christian Barnard (Cape Town, South Africa)

1967: First successful liver transplant by Thomas Starzl (Denver, U.S.A.) :

1967 : First successful liver transplant by Thomas Starzl (Denver, U.S.A.)

Transplantation surgery:

Transplantation surgery 1998 : First successful hand transplant by Dr. Jean-Michel Dubernard (Lyon, France ) 2010: First full facial transplant, by Dr Joan Pere Barret and team (Hospital Universitari Vall d'Hebron on July 26, 2010 in Barcelona, Spain.)

Autograft :

Autograft Transplant of tissue to the same person.

Allograft and Allotransplantation :

Allograft and Allotransplantation An Allograft Is A Transplant Of An Organ Or Tissue Between Two Genetically Non-identical Members Of The Same Species

Transplantation surgery:

Transplantation surgery A patient’s own tissue - an autograft – can often be used for a surgical reconstruction procedure. Autograft tissue is the safest and fastest-healing tissue that can be used. However, harvesting autograft tissue creates a second surgical site from which the patient must recover. The additional recovery time can extend a patient’s hospital stay. In addition, the secondary site could be uncomfortable for years after the surgery. Allograft tissue, taken from another person, takes longer to incorporate into the recpient’sr body, but there is no second surgical site to heal. Also, the surgical time and hospital stay may be shorter when allograft tissue is used. Allograft tissue transplants are not rejected by the body as with organ transplants, so that it is not necessary to use drugs to suppress the body’s immune response.

DONORS:

DONORS ORGAN DONORS LIVING BRAIN DEAD .

Living donor :

Living donor In "living donors", the donor remains alive and donates a renewable tissue, cell, or fluid (e.g. blood, skin), or donates an organ or part of an organ in which the remaining organ can regenerate or take on the workload of the rest of the organ (primarily single kidney donation, partial donation of liver, small bowel).

Deceased donor :

Deceased donor Brain dead means the donor must have received an injury (either traumatic or pathological) to the part of the brain that controls heartbeat and breathing Deceased (formerly cadaveric) are donors who have been declared brain-dead and whose organs are kept viable by ventilators or other mechanical mechanisms until they can be excised for transplantation .

Deceased donor:

Deceased donor Cardiac Death Donors (formerly non-heart beating donors) to increase the potential pool of donors as demand for transplants continues to grow. These organs have inferior outcomes to organs from a brain-dead donor; however given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered.

Deceased donor :

Deceased donor "Donation after Cardiac Death" donors are patients who do not meet the brain-dead criteria but, due to the unlikely chance of recovery, have elected via a living will or through family to have support withdrawn. In this procedure, treatment is discontinued (mechanical ventilation is shut off).

COMPENSATED DONATION:

COMPENSATED DONATION Donors Get Money Or Other Compensation In Exchange For Their Organs. This Practice Is Common In Some Parts Of The World, Whether Legal Or Not, And Is One Of The Many Factors Driving Medical Tourism

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United States, The National Organ Transplant Act of 1984 MADE ORGAN SALES ILLEGAL. human kidneys ($15,000) and human livers ($32,000).

Pakistan:

Pakistan 40 percent to 50 percent of the residents of some villages have only one kidney because they have sold the other for a transplant into a wealthy person, probably from another country, Pakistani donors are offered $2,500 for a kidney but receive only about half of that because middlemen take so much . Most Kidney Sellers Say That Selling Their Kidney Was A Mistake

Transplantation Tourism:

Transplantation Tourism One of the driving forces for illegal organ trafficking and for “transplantation tourism” is the price differences for organs and transplant surgeries in different areas of the world .

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The generosity of donors and their families makes organ transplant possible.

Tissue matching for transplants :

Tissue matching for transplants Ensuring that organ donors and recipients have the same antigens on the surface of their cells Tissue matching refers to the matching of donor and recipient tissue types in an organ transplant or tissue graft so that the likelihood of rejection is reduced. The tissue type of an individual depends on certain molecules, called human leukocyte antigens (HLAs ), which are displayed on the cell surface. There are three major HLAs, known as HLA-A, HLA-B and HLA-DR. The antigens are proteins encoded by genes in the major histocompatibility complex on chromosome 6.

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After an organ transplantation, the body will nearly always reject the new organ(s) due to differences in human leukocyte antigen haplotypes between the donor and recipient.

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A lung transplant (or heart and lung transplant) can only be successful if the blood and tissue type of the organ donor and the organ recipient match.

The Indication For Kidney Transplantation:

The Indication For Kidney Transplantation END-STAGE RENAL DISEASE (ESRD), This is defined as a glomerular filtration rate <15ml/min/1.73 sq.m .

Common diseases leading to ESRD :

Common diseases leading to ESRD malignant hypertension infections diabetes mellitus focal segmental glomerulosclerosis genetic causes include polycystic kidney disease a number of inborn errors of metabolism, autoimmune conditions such as lupus. Diabetes is the most common cause of kidney transplantation, accounting for approximately 25% of those in the US.

Kidney Transplantation:

Kidney Transplantation Contraindications include both cardiac and pulmonary insufficiency, as well as hepatic disease.

Kidney Transplantation:

Kidney Transplantation The average lifetime for a donated kidney is ten to fifteen years. When a transplant fails, a patient may opt for a second transplant, and may have to return to dialysis for some intermediary time .

Heart Transplant:

Heart Transplant PATIENTS WITH END-STAGE HEART FAILURE OR SEVERE CORONARY ARTERY DISEASE .

Heart Transplant:

Heart Transplant The first heart transplant in any animal is credited to Vladimer Demikhov . Working in Moscow in 1946, Demikhov switched the hearts between two dogs. The dogs survived the surgery. The first heart transplant in human beings was done in South Africa in 1967 by Dr. Christiaan Barnard; the patient only lived 18 days.

Heart Transplant:

Heart Transplant Norman Shumway is widely regarded as the father of heart transplantation although the world's first adult human heart transplant was performed by Christiaan Barnard in South Africa

A heart transplant may be done to treat: :

A heart transplant may be done to treat: Severe angina Severe heart failure Severe heart defects Life-threatening abnormal heartbeats or rhythms

Heart transplant surgery may NOT be used in patients who: :

Heart transplant surgery may NOT be used in patients who: Are malnourished Are older than age 55 - 60 Have had a severe stroke or dementia Have had cancer Have HIV infection Have infections such as hepatitis that are active Have insulin-dependent diabetes and other organs that aren't working correctly Have kidney, lung, nerve, or liver disease Have no family support and do not follow their treatment Have other diseases that affect the blood vessels of the neck and leg Have pulmonary hypertension (thickening of blood vessels in the lung) Smoke or abuse alcohol or drugs, or have other lifestyle habits that may damage the new heart

Problems after a transplant :

Problems after a transplant Transplant rejection ( hyperacute , acute or chronic ) Infections and sepsis due to the immunosuppressant drugs that are required to decrease risk of rejection

Graft rejection :

Graft rejection Three Types Of Graft Rejection . HYPERACUTE REJECTION, ACUTE REJECTION AND CHRONIC REJECTION. HYPERACUTE REJECTION is caused by preformed anti-donor antibodies. It is characterized by the binding of these antibodies to antigens on vascular endothelial cells. Complement activation is involved and the effect is usually profound. Hyperacute rejection happens within minutes to hours after the transplant procedure . HYPERACUTE REJECTION, B CELL MEDIATED,

Graft rejection :

Graft rejection ACUTE REJECTION is mediated by T cells. It involves direct cytotoxicity and cytokine mediated pathways. Acute rejection is the most common and the primary target of immunosuppressive agents. Acute rejection is usually seen within days or weeks of the transplant.

Graft rejection:

Graft rejection CHRONIC REJECTION is the presence of any sign and symptom of rejection after 1 year. The cause of chronic rejection is still unknown but an acute rejection is a strong predictor of chronic rejections. may happen anytime after the transplant .

Immunosuppression :

Immunosuppression An Act That Reduces The Activation Or Efficacy Of The Immune System. Dr . Joseph Murray of Harvard Medical School and chief plastic surgeon at Children's Hospital Boston from 1972-1985 was awarded the Nobel Prize in Physiology or Medicine in 1990 for his work on immunosuppression

Immunosuppression :

Immunosuppression immunosuppression is performed to prevent the body from rejecting an organ transplant ,

Administration of immunosuppressive drugs is the main method of deliberately induced immunosuppression :

Administration of immunosuppressive drugs is the main method of deliberately induced immunosuppression CORTISONE AZATHIOPRINE was identified in 1959, CYCLOSPORINE in 1970 that allowed for significant expansion of kidney transplantation to less well-matched donor-recipient pairs as well as broad application of liver transplantation, lung transplantation, pancreas transplantation, and heart transplantation .

Immunosuppression :

Immunosuppression RADIATION THERAPY has been used to decrease the strength of the immune system.

Infections due to the immunosuppressant drugs:

Infections due to the immunosuppressant drugs used in people with kidney transplants mucocutaneous areas (41 %), the urinary tract (17%) and the respiratory tract (14 %). The most common infective agents are bacterial (46%), viral (41%), fungal (13%), and protozoan (1 %). Of the viral illnesses , the most common agents are human cytomegalovirus (31.5%), herpes simplex (23.4%), and herpes zoster (23.4 %).

Immunosuppression  Other side effects of medications:

Immunosuppression Other side effects of medications Gastrointestinal Inflammation And Ulceration Of The Stomach And Esophagus, Hirsutism (Excessive Hair Growth In A Male-pattern Distribution), Hair Loss, Obesity, Acne, Diabetes Mellitus Type 2, Hypercholesterolemia, And Osteoporosis. A Patient's Age And Health Condition Before Transplantation Affect The Risk Of Complications. Different Transplant Centers Have Different Success At Managing Complications And Therefore, Complication Rates Are Different From Center To Center

Immunosuppression :

Immunosuppression Post-transplant lymphoproliferative disorder (a form of lymphoma due to the immune suppressants) Imbalances in electrolytes including calcium and phosphate which can lead to bone problems among other things

Immunosuppression :

Immunosuppression Infection is the cause of death in about one third of people with renal transplants, and pneumonias account for 50% of the patient deaths from infection .

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Regenerative medicine may one day allow for laboratory-grown organs, using patient's own cells via stem cells, or healthy cells extracted from the failing organs.

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Coma is Robin Cook's first major published novel, published by Signet Book in 1977

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THANKS arbsurgeon@gmail.com

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