1 1 Solid Organ Transplantation Daniel Maluf, MD Assistant Professor of Surgery VCU School of Medicine 2 Basic Immunology 3 Basic Immunology 4 Basic Immunology 5 History of organ transplantation First successful heart transplant Dr. Norman Shumway, Stanford University Hospital, Stanford, CA 1968 First isolated pancreas transplant Dr. Richard Lillehei, University of Minnesota, Minneapolis, MN 1968 First successful liver transplant* Dr. Thomas Starzl, University of Colorado Health Sciences Center, Denver, CO 1967 First successful pancreas/kidney transplant Drs. Richard Lillehei, William Kelly, University of Minnesota, Minneapolis, MN 1966 First successful kidney transplant* Dr. Joseph E. Murray, Brigham & Women's Hospital, Boston, MA 1954 6 History of organ transplantation *Transplant was the first of its kind in the world First successful living-related lung transplant Dr. Vaughn A. Starnes, Stanford University Medical Center, Stanford, CA 1990 First successful living-related liver transplant Dr. Christoph Broelsch, University of Chicago Medical Center, Chicago, IL 1989 First successful double lung transplant* Dr. Joel Cooper, Toronto Lung Transplant Group, Toronto General Hospital, Toronto Canada 1986 First successful single lung transplant* Dr. Joel Cooper, Toronto Lung Transplant Group, Toronto General Hospital, Toronto Canada 1983 First successful heart-lung transplant Dr. Bruce Reitz, Stanford University Hospital, Stanford, CA 1981
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Basic Immunology Solid Organ Transplantation...Solid Organ Transplantation Daniel Maluf, MD Assistant Professor of Surgery VCU School of Medicine 2 Basic Immunology 3 Basic Immunology
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Solid Organ Transplantation
Daniel Maluf, MDAssistant Professor of SurgeryVCU School of Medicine
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Basic Immunology
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Basic Immunology
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Basic Immunology
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History of organ transplantation
First successful heart transplantDr. Norman Shumway, Stanford University Hospital, Stanford, CA
1968
First isolated pancreas transplantDr. Richard Lillehei, University of Minnesota, Minneapolis, MN
1968
First successful liver transplant*Dr. Thomas Starzl, University of Colorado Health Sciences Center, Denver, CO
1967
First successful pancreas/kidney transplantDrs. Richard Lillehei, William Kelly, University of Minnesota, Minneapolis, MN
1966
First successful kidney transplant*Dr. Joseph E. Murray, Brigham & Women's Hospital, Boston, MA
1954
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History of organ transplantation
*Transplant was the first of its kind in the world
First successful living-related lung transplantDr. Vaughn A. Starnes, Stanford University Medical Center, Stanford, CA
1990
First successful living-related liver transplantDr. Christoph Broelsch, University of Chicago Medical Center, Chicago, IL
1989
First successful double lung transplant*Dr. Joel Cooper, Toronto Lung Transplant Group, Toronto General Hospital, Toronto Canada
1986
First successful single lung transplant*Dr. Joel Cooper, Toronto Lung Transplant Group, Toronto General Hospital, Toronto Canada
1983
First successful heart-lung transplantDr. Bruce Reitz, Stanford University Hospital, Stanford, CA
1981
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Cadaveric Donors, Cadaveric Transplants,and Number on Waiting List
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Source: Donors from OPTN data as of 9/5/00; transplants from Scientific Registry data as of 9/5/00; snapshot of OPTN waiting list on the last day of each year.
• Retransplant/Graft Failure • Diabetes Mellitus – Type I• Diabetes Mellitus – Type II Diabetes
– Chronic Pancreatitis – Cystic Fibrosis
– Pancreas after kidney• DM
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Pancreas Transplantation
Arterial inflow provided by ‘y graft’Splenic attachment preserved to decrease graft hyperperfusionSpleen is removed and exocrine secretions drained via duodeno-ileostomy or duodeno-cystostomy
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Kidney-Pancreas Transplantation
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Kidney-Pancreas Transplantation
Success rates– Patient Survival (1995-1999)
MCV National• 30 day 100% 98.4%• 1 year 95.6% 94.5%• 5 years 83.8% 90%
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Kidney-Pancreas Transplantation: success rates
82.5%82.5%90.2%75.7%5 years
91.4%91.4%95.7%82.6%1 year
96.2%95.8%97.9%90%30 day
KidneyPancreasKidneyPancreas
NationalMCV
Graft Survival (1995 – 1999)
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Kidney-Pancreas Transplantation
1997 National Wait Time - 335 days 2000 MCVH Wait Time - 238 days 2000 MCV Length of Stay- 9 days
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Kidney-Pancreas Transplantation
Etiology of early renal graft dysfunction– Donor issues
Etiology of early renal graft dysfunction– Immunologic issues
• ABO incompatibility• high PRA• african-american descent• hyperacute rejection (preformed antibodies)• accelerated rejection (second set exposure)• Acute and chronic rejection
– Drug toxicity
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Kidney-Pancreas Transplantation
Early complications– Vascular thrombosis
• venous/ arterial– Ureteral issues
• leakage/stenosis– Lymphocele– Incisional issues
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Kidney-Pancreas Transplantation
Contraindications– Active Infection– Cancer w/in 5 years– Morbid Obesity/Type II diabetes– Active Substance Abuse– Severe Coronary Artery or Peripheral
Vascular Disease– Medical Non-Compliance– age >50 years
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Liver Transplantation
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Liver TransplantationSeverity, Signs and Symptoms
• quality of life issues– recurrent cholangitis, intractable ascites or
pruritis, severe lethargy or bone disease• severe hepatic dysfunction & complications