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A Concise Presentation By
Mr. Deepak Sarangi, M.Pharm
ORGAN TRANSPLANTATION
Introduction History of transplant Types of transplants Major organs and tissues transplanted Types of donors Timeline of successful transplants Heart transplant procedure Transplant rejection Immunosuppressive drugs Cost of transplants Conclusion References
CONTENTS
DEFINITION : An organ transplant is a surgical operation in which
a failure or damaged organ in human body is removed and replaced with a functioning one. The donated organ may be from a deceased donor, a living donor or an animal.
Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, intestine and thymus.
Tissues include bones, tendons, cornea, skin, heart valves, nerves and veins.
Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and then the heart.
INTRODUCTION
SIR PETER MEDAWAR:Father of transplantation workedon graft rejection and acquired immune tolerance in 1944 showed that skin allograft between two mice are rejected.
HISTORY
ALEXIS CARREL:The noble prize in physiology or medicine 1912 was awarded to Alexis carrel in recognition ofhis work on vascular suture and the transplantation of blood vessels and organs.
BRUCE REITZ:On march 9th 1981 the first successful heart lung transplanttook place at stanford university hospital. The surgeon, Bruce reitz, credited the patients recovery to cyclosporine-A.
DR.EDUARD ZIRM:The first successful human Corneal transplant, a keratoplastic operation was performed by Eduard zirm in Austria 1905.
Autograft Allograft Isograft Xenograft Split transplant Domino transplant
TYPES OF TRANSPLANTS
Autograft is a transplant of tissue from one to oneself. Sometimes this is done with surplus tissue, or tissue that can regenerate, or tissues more desperately needed elsewhere (examples include skin grafts, for CABG, etc.) sometimes this is done to remove the tissue and then treat it or the person before returning it.
AUTOGRAFT
An allograft is transplant of an organ or tissue between two genetically non identical members of the same species. Most human tissue and organ transplants are allografts.
ALLOGRAFT
A sub set of allografts in which organs or tissues are transplanted from a donor to a genetically identical recipient(such as an identical twin). Isografts are differentiated from other types of transplants because while they are anatomically identical to allografts, they do not trigger an immune response.
ISOGRAFT
A transplant of organs or tissue from one species to another. Xenograft is often an extremely dangerous type of transplant because of increased risk of non-compatibility, rejection, and disease carried in the tissue. Examples include porcine heart valves, which are quite common and successful. The latter’s research study directed for potential human use if successful.
XENOGRAFT
Sometimes, a deceased-donor organ, usually a liver, may be divided between two recipients, especially an adult and a child. This is not usually a preferred option because the transplantation of a whole organ is more successful.
SPLIT TRANSPLANTS
This operation is usually performed for cystic fibrosis as both lungs need to be replaced and it is a technically easier operation to replace the heart and lungs. As the recipient’s native heart is usually healthy, this can then itself be transplanted into someone needing a heart transplant.
DOMINO TRANSPLANTS
CHEST: Heart (deceased-donor only) Lung (deceased-donor and living-donor) Heart/Lung (deceased-donor and domino transplant)ABDOMEN: Kidney (deceased-donor and living-donor) Liver (deceased-donor and living-donor) Pancreas (deceased-donor only) Intestine (deceased-donor and living-donor) Stomach (deceased-donor only) Testis (deceased-donor and living-donor)
MAJOR ORGANS AND TISSUES TRANSPLANTED
TISSUES,CELLS AND FLUIDS: Hand (deceased-donor only) Cornea (deceased-donor only) Skin (deceased-donor, living-donor and autograft) Islets of langerhans (deceased-donor and living-
donor) Bone marrow (living-donor and autograft) Heart valves (deceased-donor, living-donor and
xenograft) Bone (deceased-donor, living-donor and autograft)
LIVING DONOR: In living donors, the donor remains alive and
donates a renewable tissue, cell or fluid(ex: skin, blood) or donates an organ(primarily single kidney donation, partial donation of liver, lung lobe).
DECEASED DONOR: Deceased donors are people who have been
declared brain-dead and whose organs are kept viable by ventilators or other mechanical mechanism until they can be excised for transplantation.
TYPES OF DONORS
1908- First transplant of a knee 1909- First recorded kidney transplant, animal to human 1936- First human-to-human kidney transplant 1953- First successful surgery using heart-lung bypass 1954- First successful kidney transplant 1963- First successful lung transplant 1967- First successful liver transplant 1968- First successful heart transplant in the U.S 1973- First successful bone marrow transplant 1998- First successful hand transplant
TIMELINE OF SUCCESSFUL TRANSPLANTS
When an organ that meets your requirements is located, the transplant doctors will be checking the donor organ while you are being evaluated and started on medications in preparation for transplantation.
If the donated organ is good, you will then be taken to the operating room, put to sleep with an anesthetic, and one of the transplant surgeons will begin the process of preparing the chest cavity for removal of your heart.
HEART TRANSPLANT PROCEDURE
The surgeon will begin by exposing the chestcavity through a cut in the ribcage.The surgeon will then open the pericardium(a membrane that covers the entire heart)in order to remove your diseased heart.The back part of your own left atrium will be left in place, but the rest of the heart will be removed.
Your new heart will be carefully trimmed and sewn to fit the remaining parts of your old heart. This transplant method is called an "Orthotopic procedure".This is the mostcommon method used to transplant hearts.
You will be given medications both before andduring the operation to prevent you from rejecting the new heart. After the operation, You will be taken to a special unit and hospitalfloor for recovery. You will stay in the hospital until your doctor believes you are ready to gohome. How long you stay in the hospital will depend on the following factors:
•Your health•How well the new heart is working•Your ability to learn to take care of your new heart transplant
TRANSPLANT REJECTION Hyperacute Occurs minutes to hours after
transplantation No treatment (organ must be
removed) Acute Occurs days (one week) to month
after transplantation T- cytotoxic lymphocytes attack to
the transplanted organ Chronic Occurs over months to years Most common in lung transplants
SOME COMMON SIGNS AND SYMPTOMS
Pain at the site of the transplant
Feeling ill Flu-like symptoms Fever Weight change Swelling Decreased urine output
TRANSPLANT REJECTION
Corticosteroids Prednisolone Hydrocortisone Calcineurin inhibitors Cyclosporin Tacrolimus Anti-proliferative Azathioprine Mycophenolic acid mTOR inhibitors Sirolimus Everolimus
IMMUNOSUPPRESSIVE DRUGS
Bone Marrow (autograft): $360,000 Bone Marrow (allograft): $800,000 Cornea: $25,000 Heart: $1 million Intestine: $1.2 million Kidney: $260,000 Liver: $575,000 Lung: $550,000 Double Lung: $800,000 Pancreas: $290,000 Heart/Lung: $1.2 million Kidney/Pancreas: $475,000 Kidney/Heart: $1.3 million Liver/Kidney: $1 million
COST OF TRANSPLANTS(ANNUAL EXPENSES)
Organ transplant is a successive therapeutic option for treatment of end stage organ disease. Success depends on improved surgical techniques, immunosuppression, organ preservation and follow-up.
CONCLUSION
Manara, A. R.; Murphy, P. G.; O'Callaghan, G. (2011). "Donation after circulatory death". British Journal of Anaesthesia 108: 108–121.
Frohn C, Fricke L, Puchta JC, Kirchner H (February 2001). The effect of HLA-C matching on acute renal transplant rejection, Nephrol. Dial. Transplant. 16 (2): 355–60.
Yacoub, M. H.; Banner, N. R.; Khaghani, A.; Fitzgerald, M.; Madden, B.; Tsang, V.; Radley-Smith, R.; Hodson, M. (1990). "Heart-lung transplantation for cystic fibrosis and subsequent domino heart transplantation". The Journal of heart transplantation 9 (5): 459–466.
West, L. J., Pollock- Barziv, S. M., Dipchand, A. I., Lee, K.-J. J., Cardella, C. J., Benson, L. N.; et al. (2001). "ABO-incompatible (ABOi) heart transplantation in infants". New England Journal of Medicine 344 (11): 793–800.
REFERENCES
Fan X, Ang A, Pollock-Barziv SM, Dipchand AI, Ruiz P, Wilson G, Platt JL, West LJ (2004). "Donor-specific B-cell tolerance after ABO-incompatible infant heart transplantation". Nature Medicine 10 (11): 1227–1233.
Horisberger B, Jeannet M, De Weck A, Frei PC, Grob P, Thiel G (October 1970). "A cooperative kidney typing and exchange program". Helvetica Medica Acta 35 (4): 239–47.
