Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
PRINCIPLES
INVOLVED IN ORGAN
TRANSPLANT
DR BASHIR YUNUS
SURGERY DEPT.
AKTH
19/1/15
1/19/2015bbinyunus2002@gmail.com 1
OUTLINE
O INTRODUCTION
O Definition of terms
O Transplant immunology
O Graft rejection
O PRINCIPLES
O Pre-operatives
O Int...
INTRODUCTION
DEFINITION OF TERMS
• An organ transplant is a surgical procedure in which a failing
organ is replaced by a f...
INTRODUCTION
• TRANSPLANT IMMUNOLOGY
The immune system recognizes graft from someone else as foreign and
triggers response...
Cell-mediated immune response
Defend against intracellular pathogens/rejection
Active
Cytotoxic T cells
Memory
Cytotoxic T...
Cytotoxic T cell
Perforin
Granzymes
TCRCD8
Class I MHC
molecule
Target
cell
Peptide
antigen
Pore
Released cytotoxic T cell...
B-LYMPHOCYTES
• Mediators of humeral immunity by antibody production.
• There activation is aided by cytokine and the T-he...
Key
Stimulates
Gives rise to
+
Memory
Helper T cells
Antigen-
presenting cell
Helper T cell
Engulfed by
Antigen (1st expos...
• ANTIGEN PRESENTING CELLS(APC)
• They capture antigens and display to lymphocytes e.g.
Macrophages, dendritic cells and f...
APC
1/19/2015bbinyunus2002@gmail.com
10
TRANSPLANT ANTIGENS
Human leucocytes antigen(HLA);
O a group of highly polymorphic cell surface
molecules
O They act as an...
MHC;
O Major histocompatibility complex. They
are clusters of genes on the short arm of
chromosome 6 expressed on the cell...
GRAFT REJECTION;
Rejection of transplanted organs is a bigger
challenge than the technical expertise
required to perform t...
Hyperacute rejection
O Immediate graft destruction due to ABO
or preformed anti- HLA antibodies.
O Characterized by intrav...
Acute rejection
O Usually occurs during the first 6month
O May be cell mediated (T-cell), antibody
mediated or both
O Char...
CHRONIC REJECTION
O it occurs after 6month
O Most common cause of graft failure
O Antibodies play important role
O Non- im...
PRINCIPLES
1. PRE-OPERATIVE
O Patient selection and Evaluation
O Counseling
O Informed consent
O optimization
1/19/2015bbi...
PATIENT SELECTION AND EVALUATION
RECIPIENT
O Patient who met the indication for transplant –
ORGAN FAILURE
O Clinical eval...
Patient selection
O DONOR
a) Cadaveric
O Individuals with severe brain injury
resulting in brain death-Brain death is
defi...
Other criteria;
O Normothermic patient.
O No respiratory effort by the patient.
O The heart is still beating.
O No depress...
b. Living donor;
a living donor should be healthy
Living unrelated donor or
Living related donor.
O Improved graft surviva...
O Contra-indications for living donor ;
O Mental disease
O Disease organ
O Morbidity and mortality risk
O ABO incompatibil...
Evaluation; to assess for suitability
O CLINCAL; history of risk factors for infection,
malignancy in the past 5 years. Pr...
FACTORS DETERMING ORGAN
FUNCTION AFTER TRANSPLANT
DONOR CHARACTERISTICS
O ■ Extremes of age
O ■ Presence of pre-existing d...
Tissue typing
O The tissue typing laboratory carries out 3
tasks
O To determine the HLA type of blood for
both donor and r...
O Positive cross matching;
O Recipient antibodies attacks donor’s.
O Not suitable for transplant
O Negative cross matching...
PRE-OPERATIVE
O Patient selection and Evaluation
O Counseling
O Informed consent
O optimization
1/19/2015bbinyunus2002@gma...
COUNSELING
O May involve professional counselors/
psychotherapist
O Aimed at preventing / minimizing possible
complication...
INFORMED CONSENT
O Living Donor ;
O Education
O Willingly not for any financial reason or
under duress
O Most undergo exte...
O DECEASE DONOR
O Some Factors influencing refusal to consent by
relatives;
O non-acceptance of brain death.
O Superstitio...
INFORMED CONSENT
O RECIPIENT
O Nature of disease and the need for
transplant
O Outcome and complications
O Need for compli...
OPTIMIZATION OF RECIPIENT
Correction of derangements, getting patient ready for
surgery
O Correction of anaemia
O Uremia
O...
PRINCIPLES
INTRA-OPERATIVE
Organ procurement and preservation
Living donors
a. Strict asepsis and hemostasis
b. Adequate e...
1/19/2015bbinyunus2002@gmail.com
34
g. Organ packaging
1/19/2015bbinyunus2002@gmail.com 35
Deceased donor
1/19/2015bbinyunus2002@gmail.com 36
NONHEART-BEATING KIDNEY DONATION
Initiation of preservation in situ- for
DCD donors- donation after circulatory
death dono...
h. Transplantation/vascular
reconstruction
Warm ischemic time ; time an organ
remains at body temperature between which
th...
Maximum and optimal cold storage times
(approximate)a
O Organ Optimal (hours ) Safe
maximum(hours)
O Kidney < 24 48
O Live...
PRINCIPLES
O Post-operative
O Post-operative assessment
O Clinical –vital signs; fever, tarchychadia, hypertension, pain a...
IMMUNOSUPPRESSION
O The principles are the same for type of
organ transplant; maximize graft
protection and minimize side ...
AGENT MODE OF ACTION SIDE FFECT
CALCINEURINE
INHIBITORS
Cyclosporine
tacrolimus
Block IL-2 gene
transcription
Nephrotoxici...
AGENT MODE OF ACTION SIDE EFFECT
ANTIBODY THERAPIES
a. OKT3 monoclonal
antibody
b. Anti-CD25 monoclonal
antibody
c. Polycl...
REGIMENS
O Immunosuppressive agents are given as
O Induction; early post-op period
O Maintanance ; given for life
O Rescue...
O Maintenance ;
O mTOR- inhibitors (esp in kidney transplant
because they provide a noo-nephrotoxic
alternative to CNI)
O ...
COMPLICATIONS OF
IMMUNOSUPPRESSION
O INFECTIONS; high risk of opportunistic
infections
O Bacterial; common during first mo...
O Viral ; highest in the first six month
 CMV infection; may presents as
pnuemonia, gastrointestinal disease,
hepatitis, ...
O MALIGNANCY
 Post transplant lymphoprolipherative
disease (PTLPD); seen 1-3% of kidney
transplant with 50% mortality
 S...
KIDNEY TRANSPLANT
O Indications
O End-stage renal disease
Causes
O glomerulonephritis;
O diabetic nephropathy;
O hypertens...
Exclusion criteria for living donor
O
1/19/2015bbinyunus2002@gmail.com 50
OPERATIVES
O DONOR NEPHRECTOMY
O DONOR BENCH SURGERY
O TRANSPLANTATION
1/19/2015bbinyunus2002@gmail.com 51
1/19/2015bbinyunus2002@gmail.com 52
O Donor Nephrectomy
O Open or laparoscopic
O Open donor nephrectomy is the gold standard
O Open donor nephrectomy is via t...
Donor Kidney Bench Surgery
O The kidney is perfused with ice-cold
preservative
O Iced saline is mashed into a slush and
ki...
THE TRANSPLANT
O Right donor kidney to left recipient site
and vice versa
O Gibson’s incision; Curvilinear incision 2
cm a...
1/19/2015bbinyunus2002@gmail.com 56
COMPLICATIONS
O TECHNICAL
O Vascular hemorrhage; Vascular thrombosis 10-
20%, within 2-3 days→ technical, 2/12→rejection,
...
Outcome
O Patient survival after deceased donor
renal transplantation is >90% at 1 year
and > 80% at 5 years.
O Graft surv...
ETHICAL CONSIDERATION
INTERNATIONAL PERSPECTIVES ON
THE ETHICS AND REGULATION OF
HUMAN CELL AND TISSUE
TRANSPLANTATION
O C...
Future trend
O Genetic engineering –cloning
O Newer specific immuno-suppresive
therapy
1/19/2015bbinyunus2002@gmail.com 60
CONCLUSION
O Organ transplant is a successive
therapeutic option for treatment of end-
stage organ disease. Success depend...
REFERENCES
O Bailey and Love’s “Short Practice of Surgery”
26th edition CRC press Taylor and Francis group.
2013
O E.A Bad...
Upcoming SlideShare
Loading in …5
×
Upcoming SlideShare
Organ transplant ppt
Next
Download to read offline and view in fullscreen.

104

Share

Download to read offline

Principles of organ transplant

Download to read offline

organ transplantation. immunology, pre-op, intra and post operative principles

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Principles of organ transplant

  1. 1. PRINCIPLES INVOLVED IN ORGAN TRANSPLANT DR BASHIR YUNUS SURGERY DEPT. AKTH 19/1/15 1/19/2015bbinyunus2002@gmail.com 1
  2. 2. OUTLINE O INTRODUCTION O Definition of terms O Transplant immunology O Graft rejection O PRINCIPLES O Pre-operatives O Intra-operatives O Post-operative O COMPLICATIONS O RENAL TRANSPLATATION O ETHICAL CONSIDERATIONS O CONCLUSION O REFERENCES 1/19/2015bbinyunus2002@gmail.com 2
  3. 3. INTRODUCTION DEFINITION OF TERMS • An organ transplant is a surgical procedure in which a failing organ is replaced by a functioning one from a donor with a compatible tissue type. • Autograft • Allograft • Isograft • Xenograft • Orthotopic graft • Heterotopic graft 1/19/2015bbinyunus2002@gmail.com 3
  4. 4. INTRODUCTION • TRANSPLANT IMMUNOLOGY The immune system recognizes graft from someone else as foreign and triggers response via immune cells or substances they produce - cytokines and antibodies • Responses are via; recognition, amplification and memory • CELL; • Lymphocytes; T-lymphocyte, B-lymphocyte, N-killer cells • Antigen presenting cells(APC); macrophages, dendritic cells • The Effector Cells; Neutrophils , macrophages and T-lymphocytes • T-LYMPHOCYTES • Mediator of cell mediated immunity • They recognizes MHC antigen on transplant tissues • Cytotoxic T-cells produces cytotoxic factors (perforins, granzymes) implicated in transplant rejection 1/19/2015bbinyunus2002@gmail.com 4
  5. 5. Cell-mediated immune response Defend against intracellular pathogens/rejection Active Cytotoxic T cells Memory Cytotoxic T cells Memory Helper T cells Antigen- presenting cell Antigen (2nd exposure) Helper T cell Engulfed by Antigen (1st exposure) Cytotoxic T cell Key Stimulates Gives rise to + + + + + + + 1/19/2015bbinyunus2002@gmail.com 5
  6. 6. Cytotoxic T cell Perforin Granzymes TCRCD8 Class I MHC molecule Target cell Peptide antigen Pore Released cytotoxic T cell Dying target cell 1/19/2015bbinyunus2002@gmail.com 6
  7. 7. B-LYMPHOCYTES • Mediators of humeral immunity by antibody production. • There activation is aided by cytokine and the T-helper cells • Clonal selection generates plasma secreting antibodies. • There are 5 major classes of antibodies or immunoglobulin; IgG, IgM, IgA, IgE and IgD the 1st 3 are involve in graft rejection N-KILLER CELLS • Cells of innate immunity, capable of killing foreign targets without prior sensitisation 1/19/2015bbinyunus2002@gmail.com 7
  8. 8. Key Stimulates Gives rise to + Memory Helper T cells Antigen- presenting cell Helper T cell Engulfed by Antigen (1st exposure) + + + + + + Defend against extracellular pathogens/Transplant rejection Memory B cells Antigen (2nd exposure) Plasma cells B cell Secreted antibodies Humoral (antibody-mediated) immune response 1/19/2015bbinyunus2002@gmail.com 8
  9. 9. • ANTIGEN PRESENTING CELLS(APC) • They capture antigens and display to lymphocytes e.g. Macrophages, dendritic cells and follicular dendritic cells. • Dendritic cells; initiate T-cells response • Macrophages; Initiate effector phase of cell mediated immunity • Follicular dendritic cells; display antigens to B-lymphocytes in humeral response. • EFFECTOR CELLS • They eliminate antigens by phagocytosis • E.g neutrophils, macrophage and T-lymphocytes 1/19/2015bbinyunus2002@gmail.com 9
  10. 10. APC 1/19/2015bbinyunus2002@gmail.com 10
  11. 11. TRANSPLANT ANTIGENS Human leucocytes antigen(HLA); O a group of highly polymorphic cell surface molecules O They act as antigen recognition unit on T- lymphocytes and are the major trigger for graft rejection O Types; class1 –A,B,C present in all nucleated cells, class2 – HLA- DR,DP,DQ present only on APC O Class 2- HLA-DR are most important in rejection O CD8+ and CD4+ recognize class 1 and 2 receptors respectively 1/19/2015bbinyunus2002@gmail.com 11
  12. 12. MHC; O Major histocompatibility complex. They are clusters of genes on the short arm of chromosome 6 expressed on the cell surface as HLA i.e. genes that encode HLA. ABO O These blood group antigen are expressed not only on red blood cells but by most cell types as well. O Incompatibility leads to hyperacute rejection 1/19/2015bbinyunus2002@gmail.com 12
  13. 13. GRAFT REJECTION; Rejection of transplanted organs is a bigger challenge than the technical expertise required to perform the surgery. It results mainly from HLA and ABO incompatibility. O Hyperacute O Acute O Chronic 1/19/2015bbinyunus2002@gmail.com 13
  14. 14. Hyperacute rejection O Immediate graft destruction due to ABO or preformed anti- HLA antibodies. O Characterized by intravenous thrombosis and interstitial hemorrhage. O Risk factors are previous failed transplant and blood transfusions O Kidney transplant is vulnerable to hyperacute rejection 1/19/2015bbinyunus2002@gmail.com 14
  15. 15. Acute rejection O Usually occurs during the first 6month O May be cell mediated (T-cell), antibody mediated or both O Characterized by cellular infiltration of the graft(cytotoxic, B- cells, NK cells and macrophages ) 1/19/2015bbinyunus2002@gmail.com 15
  16. 16. CHRONIC REJECTION O it occurs after 6month O Most common cause of graft failure O Antibodies play important role O Non- immunological factors contribute to the pathogenesis O Characterized by myointimal proliferation in graft arteries leading to ischemia and fibrosis 1/19/2015bbinyunus2002@gmail.com 16
  17. 17. PRINCIPLES 1. PRE-OPERATIVE O Patient selection and Evaluation O Counseling O Informed consent O optimization 1/19/2015bbinyunus2002@gmail.com 17
  18. 18. PATIENT SELECTION AND EVALUATION RECIPIENT O Patient who met the indication for transplant – ORGAN FAILURE O Clinical evaluation; history and physical examination to rule out other diseases and co- morbidities O Immunological evaluation O Serology; HIV, Hepatitis, CMV, VDRL O Tissue typing & cross matching O Blood group O Infection screening – septic work-up, mantoux O Others ; FBC, clotting profile, FBS, ECG, U/Ecr, tumour markers, stool microscopy 1/19/2015bbinyunus2002@gmail.com 18
  19. 19. Patient selection O DONOR a) Cadaveric O Individuals with severe brain injury resulting in brain death-Brain death is defined as “complete irreversible cessation of all brain functions”. 1/19/2015bbinyunus2002@gmail.com 19
  20. 20. Other criteria; O Normothermic patient. O No respiratory effort by the patient. O The heart is still beating. O No depressant drugs intake should be there while evaluating the patient. O Individual should not have any sepsis, cancer (except brain tumour). O Not a HIV or hepatitis individual. 1/19/2015bbinyunus2002@gmail.com 20
  21. 21. b. Living donor; a living donor should be healthy Living unrelated donor or Living related donor. O Improved graft survival O Less recipient morbidity O Early function and easier to manage O Avoidance long waiting time for transplant O Less aggressive immunosuppressive regimen 1/19/2015bbinyunus2002@gmail.com 21
  22. 22. O Contra-indications for living donor ; O Mental disease O Disease organ O Morbidity and mortality risk O ABO incompatibility O Crossmatching incompatibility O Transmissible disease 1/19/2015bbinyunus2002@gmail.com 22
  23. 23. Evaluation; to assess for suitability O CLINCAL; history of risk factors for infection, malignancy in the past 5 years. Presence of co-morbidities O ABO typing. O Serology tests. O Infection and malignant screening O CT-Angiogram; O Intravenous urography. O HLA typing. 1/19/2015bbinyunus2002@gmail.com 23
  24. 24. FACTORS DETERMING ORGAN FUNCTION AFTER TRANSPLANT DONOR CHARACTERISTICS O ■ Extremes of age O ■ Presence of pre-existing disease in the transplanted organ O ■ Haemodynamic and metabolic instability PROCUREMENT-RELATED FACTORS O ■ Warm ischaemic time O ■ Type of preservation solution O ■ Cold ischaemic time RECIPIENT-RELATED FACTORS O ■ Technical factors relating to implantation O ■ Haemodynamic and metabolic stability O ■ Immunological factors O ■ Presence of drugs that impair transplant function 1/19/2015bbinyunus2002@gmail.com 24
  25. 25. Tissue typing O The tissue typing laboratory carries out 3 tasks O To determine the HLA type of blood for both donor and recipient by PCR. O Lymphocyte crosshatching to exclude circulating antibodies in recipient against HLA expressed by donor. O HLA antibody screening and specificity in recipient before and after transplant to guide immunosuppressive therapy 1/19/2015bbinyunus2002@gmail.com 25
  26. 26. O Positive cross matching; O Recipient antibodies attacks donor’s. O Not suitable for transplant O Negative cross matching; O Recipient antibodies donot attack donor O Suitable for transplant O Methods; O Microcytotoxic assay, mixed lymphocytes, flow cytometory, DNA analysis. 1/19/2015bbinyunus2002@gmail.com 26
  27. 27. PRE-OPERATIVE O Patient selection and Evaluation O Counseling O Informed consent O optimization 1/19/2015bbinyunus2002@gmail.com 27
  28. 28. COUNSELING O May involve professional counselors/ psychotherapist O Aimed at preventing / minimizing possible complication O Need for adherance to post-op maintenance medications O Regular follow-up thorough evaluation O life style modification; smoking, alcohol, sedentary life style, junks, excessive salt ingestion. 1/19/2015bbinyunus2002@gmail.com 28
  29. 29. INFORMED CONSENT O Living Donor ; O Education O Willingly not for any financial reason or under duress O Most undergo extensive screening – medical phycological O Involve family O Surgery and anaesthetic complications complications outline to patients 1/19/2015bbinyunus2002@gmail.com 29
  30. 30. O DECEASE DONOR O Some Factors influencing refusal to consent by relatives; O non-acceptance of brain death. O Superstitions relating to being reborn with a missing organ O A delay in funeral O Lack of consensus within family members O Fear of social criticism O Dissatisfaction with the hospital staff O Religious believes 1/19/2015bbinyunus2002@gmail.com 30
  31. 31. INFORMED CONSENT O RECIPIENT O Nature of disease and the need for transplant O Outcome and complications O Need for compliance to immunosuppressive therapy O Other available options 1/19/2015bbinyunus2002@gmail.com 31
  32. 32. OPTIMIZATION OF RECIPIENT Correction of derangements, getting patient ready for surgery O Correction of anaemia O Uremia O Dehydration O Treatment of infection O Treatment of malaria O Deworming of patient O Central line O Urethral catheter O Loading dose immunosuppression 12hr pre-op O Prophylactic antibiotics 1/19/2015bbinyunus2002@gmail.com 32
  33. 33. PRINCIPLES INTRA-OPERATIVE Organ procurement and preservation Living donors a. Strict asepsis and hemostasis b. Adequate exposure c. Control of the vessels above and below the organs to be removed is done- cross clamping d. Removal of the organ 1/19/2015bbinyunus2002@gmail.com 33
  34. 34. 1/19/2015bbinyunus2002@gmail.com 34
  35. 35. g. Organ packaging 1/19/2015bbinyunus2002@gmail.com 35
  36. 36. Deceased donor 1/19/2015bbinyunus2002@gmail.com 36
  37. 37. NONHEART-BEATING KIDNEY DONATION Initiation of preservation in situ- for DCD donors- donation after circulatory death donors 1/19/2015bbinyunus2002@gmail.com 37
  38. 38. h. Transplantation/vascular reconstruction Warm ischemic time ; time an organ remains at body temperature between which the blood supply is cut off before cold perfusion. (within 30min) Cold ischemic time ; the time between the chilling of the organ, after blood supply has been cut off and the time it is warmed by reconnection 1/19/2015bbinyunus2002@gmail.com 38
  39. 39. Maximum and optimal cold storage times (approximate)a O Organ Optimal (hours ) Safe maximum(hours) O Kidney < 24 48 O Liver < 12 24 O Pancreas < 10 24 O Small intestine < 4 8 O Heart < 3 6 O Lung < 3 8 Assuming zero warm ischaemic time and organs obtained from a non-marginal 1/19/2015bbinyunus2002@gmail.com 39
  40. 40. PRINCIPLES O Post-operative O Post-operative assessment O Clinical –vital signs; fever, tarchychadia, hypertension, pain at site of transplant, pedal oedema (compession of external iliac vein), decrease urine volume- features of hyperacute rejection O Investigations ;  U/Ecr  USS- increase in size, pelvicalyceal dilation  Biopsy; mononuclear infiltrates, fibrinoid necrosis, interstitial haemorrhage.  Others O Maintenance immunosuppression O DVT prophylaxis O Treatment of infection O Regular follow up 1/19/2015bbinyunus2002@gmail.com 40
  41. 41. IMMUNOSUPPRESSION O The principles are the same for type of organ transplant; maximize graft protection and minimize side effect. O The agents used to prevent rejection act predominantly on T cells. O The need for immunosuppression is highest in the first 3 month but indefinite treatment is needed O It increase the risk of infection and malignancy. 1/19/2015bbinyunus2002@gmail.com 41
  42. 42. AGENT MODE OF ACTION SIDE FFECT CALCINEURINE INHIBITORS Cyclosporine tacrolimus Block IL-2 gene transcription Nephrotoxicity, hypertension, dyslipidaemia, hirsutism, gingival hyperplasia, neurotoxicity and diabetes AZATHIOPRINE Prevents lymphocyte proliferation Leucopenia, thrombocytopenia, hepatotoxicity, gastrointestinal symptoms MYCOPHENOLIC ACID DERIVATIVES eg MMF – mycofenolate mofetil Prevents lymphocyte proliferation Leucopenia, thrombocytopenia, gastrointestinal symptoms CORTICOSTEROIDS Widespread anti- inflammatory effects Hypertension, dyslipidaemia, diabetes, osteoporosis, avascular necrosis, cushingoid appearance mTOR-inhibitors Sirolimus, everolimus Blocks IL-2 receptor signal transduction Thrombocytopenia, dyslipidaemia, 1/19/2015bbinyunus2002@gmail.com 42
  43. 43. AGENT MODE OF ACTION SIDE EFFECT ANTIBODY THERAPIES a. OKT3 monoclonal antibody b. Anti-CD25 monoclonal antibody c. Polyclonal antibody [antilymphocyte globulin (ALG) or anti- lymphocyte serum (ALS)] Depletion and blockade of T Cells Targets activated T cells Depletion and blockade of lymphocytes a. Cytokine release syndrome, pulmonary oedema, leucopenia b. None described c. Leucopenia, thrombocytopenia 1/19/2015bbinyunus2002@gmail.com 43
  44. 44. REGIMENS O Immunosuppressive agents are given as O Induction; early post-op period O Maintanance ; given for life O Rescue agents ; to reverse acute rejection O Induction regimen (most currently used )  CNI + anti CD 25 monoclonal antibody  Triple therapy ; CNI, antiproliferative agent (MMF) and steroids  Dual therapy ; CNI + MMF or steroids  Polyclonal antibody (ALG/ALS) 1/19/2015bbinyunus2002@gmail.com 44
  45. 45. O Maintenance ; O mTOR- inhibitors (esp in kidney transplant because they provide a noo-nephrotoxic alternative to CNI) O Multidrug therapy ; steroids, antiproliferatives, CNIs, lymphocytes sequestration –FTY720 O Acute rejection; O Polyclonal antibody combine with induction regimen- quadruple therapy. 1/19/2015bbinyunus2002@gmail.com 45
  46. 46. COMPLICATIONS OF IMMUNOSUPPRESSION O INFECTIONS; high risk of opportunistic infections O Bacterial; common during first month after transplantation / before recovery from surgery  Community acquired infections  Wound infection  UTI (catheter related)  Tuberculosis 1/19/2015bbinyunus2002@gmail.com 46
  47. 47. O Viral ; highest in the first six month  CMV infection; may presents as pnuemonia, gastrointestinal disease, hepatitis, retinitis, encephalitis  Herpes simplex virus (HSV) ; mucocuteneous lesions sometimes around the genitalia  BK-virus; graft dysfunction  Herpes zoster infection; chicken pox O Fungal ; pneumocystic jiroveci(carinii), candidiasis, aspergillosis O Parasitic; strongiloides, leimaniasis, toxoplasmosis 1/19/2015bbinyunus2002@gmail.com 47
  48. 48. O MALIGNANCY  Post transplant lymphoprolipherative disease (PTLPD); seen 1-3% of kidney transplant with 50% mortality  Squamous cell ca of the skin  Basal cell ca and malignant melanoma are higher in transplant patient than the genral population  50% of transplant patient would develop skin malignancy in 20years  Kaposi sarcoma; 300 fold increased risk 1/19/2015bbinyunus2002@gmail.com 48
  49. 49. KIDNEY TRANSPLANT O Indications O End-stage renal disease Causes O glomerulonephritis; O diabetic nephropathy; O hypertensive nephrosclerosis; O renal vascular disease; O polycystic disease; O pyelonephritis; O obstructive uropathy; O systemic lupus erythematosus; O analgesic nephropathy; O metabolic disease (oxalosis, amyloid). 1/19/2015bbinyunus2002@gmail.com 49
  50. 50. Exclusion criteria for living donor O 1/19/2015bbinyunus2002@gmail.com 50
  51. 51. OPERATIVES O DONOR NEPHRECTOMY O DONOR BENCH SURGERY O TRANSPLANTATION 1/19/2015bbinyunus2002@gmail.com 51
  52. 52. 1/19/2015bbinyunus2002@gmail.com 52
  53. 53. O Donor Nephrectomy O Open or laparoscopic O Open donor nephrectomy is the gold standard O Open donor nephrectomy is via the 12th rib incision, and in fat patient 10th rib or hypogastrium O Extraperitoneal : avoid devascularizing ureter, sharp dissection, avoid diathermy near vessels O Renal vasculature dissect flush to IVC/Aorta O Ligate lumbar veins posteriorly ± gonadal vein 1/19/2015bbinyunus2002@gmail.com 53
  54. 54. Donor Kidney Bench Surgery O The kidney is perfused with ice-cold preservative O Iced saline is mashed into a slush and kidney immersed O Extra veins ligated, accessory artery(ies) anastamosed together O Kidney now ready for transplanting 1/19/2015bbinyunus2002@gmail.com 54
  55. 55. THE TRANSPLANT O Right donor kidney to left recipient site and vice versa O Gibson’s incision; Curvilinear incision 2 cm above the inguinal ligament, from midline to just above the anterior Sup. Iliac Spine O End to side venous anastamosis 5/0 prolene O End to end arterial anastamosis 5/0 prolene O Implant ureter to bladder 1/19/2015bbinyunus2002@gmail.com 55
  56. 56. 1/19/2015bbinyunus2002@gmail.com 56
  57. 57. COMPLICATIONS O TECHNICAL O Vascular hemorrhage; Vascular thrombosis 10- 20%, within 2-3 days→ technical, 2/12→rejection, most are lost: ↓urine output, ↑creat O Urological ; infection, fistula, obstruction O Wound infection O RENAL O Acute tubula necrosis O Cortical necrosis O Lymphocele O Graft rupture O Recurrent glomerulo-nephritis 1/19/2015bbinyunus2002@gmail.com 57
  58. 58. Outcome O Patient survival after deceased donor renal transplantation is >90% at 1 year and > 80% at 5 years. O Graft survival is around90% at 1 year and 75% at 5 years. Graft survival after a second transplant is only marginally worse than after a first graft. O After living-related kidney transplantation, overall graft survival is around 95% at 1 year and 85% at 5 years. 1/19/2015bbinyunus2002@gmail.com 58
  59. 59. ETHICAL CONSIDERATION INTERNATIONAL PERSPECTIVES ON THE ETHICS AND REGULATION OF HUMAN CELL AND TISSUE TRANSPLANTATION O Consent for removal of human cells and tissues O Confidentiality of donor data O Unpaid donation O Fair procurement of cells and tissues O Stewardship for donated cells and tissues O Quality and safety of HC/HT procurement and processing O Fair distribution of processed cells and tissues O Consent for HC/HT transplantation 1/19/2015bbinyunus2002@gmail.com 59
  60. 60. Future trend O Genetic engineering –cloning O Newer specific immuno-suppresive therapy 1/19/2015bbinyunus2002@gmail.com 60
  61. 61. CONCLUSION O Organ transplant is a successive therapeutic option for treatment of end- stage organ disease. Success depends on improved surgical technique, immunosuppression, organ preservation and follow-up . 1/19/2015bbinyunus2002@gmail.com 61
  62. 62. REFERENCES O Bailey and Love’s “Short Practice of Surgery” 26th edition CRC press Taylor and Francis group. 2013 O E.A Badoe et al, “Principles and Practice of surgery including pathology in the tropics” 4th edition, Assembly of God Literature Center ltd, 2009 O M.A.R Al-Fallouji; “Postgraduate Surgery the candidate guide”. 2nd Edition. Rced Educational and Professional Pub. Ltd 1998 O Sabiston texbook of surgery. 18th edition.2007 O Andrew C et al “Operative urology at the cleveland clinic” 2nd edition. 2006. 1/19/2015bbinyunus2002@gmail.com 62
  • RahulMondal15

    Sep. 13, 2021
  • AnkitaThakur4865

    Sep. 3, 2021
  • AnuTeddy

    Aug. 19, 2021
  • AayatShaikh2

    Aug. 16, 2021
  • DikshaChinta

    Aug. 1, 2021
  • sangayDorji11

    Jul. 4, 2021
  • sushanthnayak

    May. 27, 2021
  • RajkumarSubudhi

    Apr. 27, 2021
  • MaungNyein1

    Apr. 1, 2021
  • AmjadAli487

    Mar. 30, 2021
  • zyrillsoriano

    Mar. 22, 2021
  • DonahJanninAgustin

    Mar. 22, 2021
  • meeramohanan10

    Mar. 5, 2021
  • MadhushreeNag

    Mar. 2, 2021
  • faznafahimi

    Mar. 2, 2021
  • DivyVaghela

    Feb. 26, 2021
  • SabeehMn

    Feb. 22, 2021
  • Rakesh_007

    Dec. 2, 2020
  • AYUshi012

    Nov. 16, 2020
  • PatrickEvrard4

    Nov. 8, 2020

organ transplantation. immunology, pre-op, intra and post operative principles

Views

Total views

25,474

On Slideshare

0

From embeds

0

Number of embeds

18

Actions

Downloads

1,584

Shares

0

Comments

0

Likes

104

×