Organ Transplantation 1

Organ transplantation Zhang Shuijun  Professor of surgery The First Affiliated Hospital of Zhengzhou University

Lecturer’s CV Welcome

to china ­­ ­ an ancient and beautiful country. Glad to meet you ­­ my friends My name is Zhang ShuiJun. I graduated from Henan Medical University in 1982. Then I got the degree of the master of medicine in same university in 1989. As a professor of surgery, I work in the department of surgery in the First Affiliated Hospital of the ZhengZhou University.  My major is hepatobilliary and pancreatic surgery, digestive organ transplantation . 

preface Why to learn the cause of transplantology. 1. Transplantation has been a new frontier science, which is one of the three developing trends of surgery in future. 2. The technique of transplantation has been the most effective methods to deal with the end-stage diseases . 3. Medical student have no enough knowledge of transplantation. 4. Few people is engaged in transplantation research.

preface The significance of learning transplantology . 1. To learn new knowledge. Transplantation is a frontier science. It related to surgery 、 anesthesia 、 cryogenics( 低温 学 ) 、 immunology 、 pharmcology 、 pathology 、 gen etics 、 religion 、 ethics( 伦理学 ) etc. Not any traditional medical courses can do it .

preface 2.To know a new method of medicine It is the most effective method for treatment of endstage diseases. Many patients have the second life after transplantation. 3.To widen science thinking To use theory of organ transplantation to think medical problems. To use technique of transplantation to research other medical project.

Preface

Definition 1.Transplantation: A part of the body (cells 、 tissue 、 organs ) is transplanted to the other body of the same or different race in the same or different location of the body by surgical methods. 2.Graft: the cell 、 tissue 、 organ which are transplanted are the graft. 3.Donor: The body who offer the graft is called donor. 4. Recipient or host: The body who accept the graft is called recipient. 5.Implantation : tissue transplantation without vascular anastomosis.

Preface

Classification of organ transplantation 1. By genetics ★ Isotransplantation: transplantation in the same individual or monozygotic twin. ★ Allotransplantation: transplantation in the different individual in the same race. ★ Xenotransplantation.: transplantation in the different species.

Preface 2. By location of transplant ★Orthotopic transplantation . ★Heterotopic transplantation. 3. By technique of transplant ★Anastomosed transplanitation . ★Free transplantation . ★Pedicle transplantation . ★Infused transplantation.

Preface History of transplantation 1. Legends of ancient Chinese document ★In approximately 300BC, a Chinese doctor called Pien Chao( 扁鹊 )who anasthetized two patients with a toxic drink, explored their chests, removed and interchanged their hearts. After operation, the two patients went home recovered. 2. Experimental stage in organ transplantation ★In 1835, Bigger reported a successful corneal allotransplantation between two qazelles( 小羚羊 ) . ★In 1902-1924, Carre and Guthrie performed organ transplantation with the techniques of vascular anastomosis .

Preface 4.The stage of clinical organ transplantation ★In 1936. The first human kidney transplantation was performed for uremia patient ( 尿毒症 ) by Voronov. ★In 1954, Murruy performed the first renal transplantation between monozygotic ( 同卵 ) twin.. ★In 1963 , Starzl performed the first human liver transplantation . ★Hardy performed the first human lung transplantation in 1967. ★Banard performed the first human heart transplantation in 1967.

The presence of organ transplantation 

organ

 kidney

transplantation

No. of cases

survival time

>300,000 cases

>30 years

 liver

transplantation

>70,000 cases

>30 years

 heart

transplantation

>5000 cases

>21 years.

 lung

transplantation

>5,000 cases

>10 years.

transplantation >6,000 cases

>17 years.

 pancreas

Focus of organ transplantation in the future 1. Immunologic tolerance To enlong the survival time of graft. 2. Gene engineering Human can receive the organs of animals. 3. Organ clooning To resolve the shortage of grafts.

Selection of donor 1.No infective diseases. 2.No malignant tumor. 3.No injure of the graft . 4.The presence of ABO blood group compatibility. 5.Age: depending on graft.

Selection of recipient 1. The failure of the organ function: no efficient treatment to cure it. 2. No infective diseases 3. To be able to tolerate the operation. 4. No malignant tumor except organs which will be removed. 5. Age: depending on different diseases. 6. Patients and his relatives agree to operation

Immunologic selection between recipient and donor 1.Test of ABO blood group compatibillty. 2.Test of a cross-matching of lymphocytes ( 淋巴毒 交叉试验 ) 。 3. Test of HLA histocompatibillty.

Harvest of organ  1.

From living related donor

 2.

From brain-death donor.

 3.

From non-heart-beating donor

Organ preservation 1. Principle To keep hypothemia To prevent cell edema( 水肿 ) To improve cellular biochemical environment. 2. Preservative solution Hartmann’s solution HCA solution UW solution 3. Methods of preservation Simple cold storage Continuous machine perfusion