Primary non functioning graft

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Primary non function of a transplant is the most catastrophic outcome in kidney transplantation.

Text of Primary non functioning graft

  • 1. Mr. Adil El Tayar FRCS, FEuBTS Consultant Transplant Surgeon Ibn Sina Hospital

2. Transplantation Transplantation is the transfer (engraftment) of human cells, tissues or organs from a donor to a recipient with the aim of restoring function(s) in the body 3. Types of grafts Auto graftNo immunogenicbarrier. Isograft Genetically identical monozygotic twins and inbred strains. Allograft Genetically non identical individuals Xenograft Across species barrier 4. GRAFT Function PNF means total and irreversible loss of function after transplantation. P dysfunction G means irreversible but partial impairment of function DGF means the organ fails to function at first but start to function later. 5. Alex Carrel in 1901 Alex Carrel in 1901 wrote I have startedresearch into the procedure of vascular anastomosis in order to be able to transplant certain organs..... 6. Alex Carrel technique He defined the two factors essential to the success of this anastomosis: a meticulous surgical technique protection against the risk of infection. 7. First hand transplant:by Professor Jean-Michel Dubernard in Lyon. In 1998 8. They made the mistake of picking the wrong patient. 9. Mrs. Renard and her son Marius 10. Causes of PNF 1. 2. 3. 1. 2. 3. Xenotransplantation ABO incompatibility Sensitized patients Non heart beating kidney donation Ischemia time Warm Ischemia Cold Ischemia Re-warm Ischemia Perfusion fluid Surgical complications Renal artery thrombosis Venous thrombosis Urological obstruction Drugs Toxicity Recurrent of primary disease 11. Xenotransplantation Transplantation across species barrier Discordant when there is a preformedanti bodies similar to Blood grouping ( pig to man) Concordant when there is no preformed antibodies ( baboon to man) 12. Mathieu Jaboulay 1906 First Xenotransplantation ( Leftkidney from a pig into the cubital fossa of woman with nephrotic syndrome) 13. Hyper acute Rejection Xenotransplantation ABO incompatible Pre formed Anti HLA antibodies 14. Cortical necrosis a histopathological feature of severe vascular rejection 15. C4d positive immunohistological marker of humoral rejection 16. Avoid Hyper acute rejection Blood group compatible Initial cross match Final cross match DSA DesensitizationCDC test Flow cytometry 17. Yu Yu Voronoy 1933 The first human kidney allograft,carried out in Kiev in 1933 using the thigh location 18. Non-heart beating kidney donation Categories of non heart beatingdonors: 1. Dead on arrival 2. Unsuccessful resuscitation 3. Awaiting cardiac arrest. 4. Cardiac arrest during or after brain stem diagnosis 19. Strategies of Organ Preservation To maintain survival capacity over the necessary timeand to ensure rapid resumption of function after transplantation: 1. Simulate as exactly as possible the physiological environment of the organ during the extracorporeal phase. 2. Use of hypothermia and pharmacological inhibition to slow down metabolic process in the ischemic /anoxic organ 20. Renal vein thrombosis 21. Transplant Clinical and Business Multidisciplinary Team Transplant SurgeonPublic Relatio Information n TechnologyTransplant AnaesthesiaTransplant Physician Transplant AdministrationPatient Registration Financial CoordinationOPO Relatio nTransplant PatientTransplant CoordinatorTransplant Sister Social Worker Ward Manager Impatient UnitCost Reporting Transplant Dietation Data ManagementTransplant PharmacistRoutine LaboratoryHLA Laboratory