Principles of Transplant Surgery

Ruth Mitchell, BA, BSc, BMBSNeurosurgical ResidentRoyal Melbourne HospitalThursday, 25th March 2010

Types of Transplants Autograft

Skin graft, CABG, autologous blood Allograft

Organ or tissue from genetically non-identical members of the same species

Isograft Organ or tissue from genetically identical source

Xenograft/xenotransplantation Organ or tissue from one species to another Porcine heart valves, piscine-primate islet cells

More types of transplants

Split transplants Deceased donor – liver to 2 recipients

(adult and child) Domino transplants

Cystic Fibrosis: heart and lungs from deceased donor to CF patient, heart from CF patient to another recipient

Living donor kidney transplants

History

Which organ was the first to be transplanted?

History of organ transplantation 1905 Cornea 1954 Kidney 1966 Pancreas 1967 Liver 1967 Heart 1981 Heart/lung 1986 double lung

1995 live-donor laparoscopic nephrectomy

1998 live-donor partial pancreas

1998 hand 2005 face transplant 2008 double arm 2008 baby born from

transplanted ovary

Challenges Transplant surgery is easier than

transplant medicine Rejection of transplanted organs is a

bigger challenge than the technical expertise required to perform the surgery

Ethical and cultural issues must be considered

Ischemic time, logistical nightmares

Immunobiology of Rejection Histocompatibility antigens: MHC, in

humans the Human leukocyte antigen or HLA

Clinical stages of rejection Hyperacute rejection – pre-existing antibodies

work in minutes to hours Acute rejection – within 6 months, both cellular

and humoral Chronic rejection – months to years, fibrosis and

scarring (accelerated atherosclerosis, bronchiolitis obliterans, vanishing bile duct syndrome, nephropathy)

Anti-rejection therapy

Corticosteroids Calcineurin inhibitors: tacrolimus,

cyclosporine Antiproliferative agents:

mycophenolate mofetil, azathioprine Monoclonal antibodies: basiliximab,

daclizumab SIDE EFFECTS

Organ donation in Australia

Description of procurement

Thank you!

Questions?