copy of organ transplant 123
DESCRIPTION
TRANSCRIPT
![Page 1: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/1.jpg)
ORGAN TRANSPLANT
![Page 2: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/2.jpg)
• Renal transplant• Liver transplant• Pancreatic transplant• Bowel transplant
![Page 3: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/3.jpg)
Types of Transplant
• Heterotopic or Orthotopic
different same
• Autograft: same being• Isograft/Syngenetic graft: identical twins• Allograft/homograft: same species• Xenograft/heterograft: between species
![Page 4: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/4.jpg)
Transplantable Organs/Tissues
• Liver• Kidney• Pancreas• Heart • Lung• Intestine• Face• Bone Marrow• Cornea• Blood
![Page 5: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/5.jpg)
Renal transplant
![Page 6: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/6.jpg)
Renal TransplantIndications
1. Glomerulonephritis2. Diabetic neuropathy3. Hypertensive nephropathy4. Renal vascular disease5. Polycystic disease6. Pyelonephritis7. Obstructive uropathy8. Systemic lupus
erythematous9. Analgesic nephropathy
![Page 7: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/7.jpg)
Recipient evaluation and preparation
• Multidisciplinary team including surgeon and physician
• Determine presence of co morbidity
• Malignancy and systemic sepsis• Evaluate against organ specific
criteria for transplantation• Psychological evaluation• Need for preparative surgery• Optimize recipient condition for
surgery
![Page 8: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/8.jpg)
Living Donor Nephrectomy
• Loin incision or midline incision
• Lateral border and upper pole mobilized first
• On left side adrenal and gonadal veins are divided
• Traction of renal artery is avoided
• Ureter mobilization• Diuresis • Laparoscopic nephrectomy
![Page 9: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/9.jpg)
Cadaveric donor• Optimisation of donor • Midline incision• Canulation of aorta• Infusion of cold
preservation solution• Kidneys mobilized• Distal aorta and
venacava are divided• Transfered to cold
solution
![Page 10: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/10.jpg)
The Recipient Operation
Oblique incision-
• Vascular anastomosis –Artery-end to end (internal
iliac) end to side (external
iliac)Renal vein- end to side to
external iliac vein• ureteric anastomosis• ureteroneocystostomy
![Page 11: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/11.jpg)
Vascular Anastomosis
![Page 12: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/12.jpg)
Ureteroneocystostomy
![Page 13: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/13.jpg)
Complications of renal transplant
• Vascular complications; Renal artery,vein thrombosis
• Urological complications; urinary
leaks, ureteric obstruction• lymphocele• Acute tubular necrosis-
reperfusion injury • Infections• Gastointestinal complication• Hyperparathyroidism• Tumors
![Page 14: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/14.jpg)
Ureteric Stones
![Page 15: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/15.jpg)
Clot Auria
![Page 16: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/16.jpg)
Immunosuppresion
• Corticosteroid• Cyclosporin• Tacrolimus• Azathioprine• Mycophenolate mofetil• Antilymphocyte antibodies
![Page 17: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/17.jpg)
Outcome after renal transplantation
• Improves quality and duration of life• Chronic rejection is most common cause of
graft failure• Half life of graft- living donor is longer than
cadaveric grafts• Deceased donor graft-13 yrs• Living unrelated graft -14 yrs • Living haploidentical graft-15 yrs• Living identical sibling graft-27 yrs
![Page 18: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/18.jpg)
LIVER TRANSPLANTATION
![Page 19: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/19.jpg)
Liver TransplantationIndications
• Cirrhosis• Acute fulminant liver failure• Metabolic liver disease• Primary hepatic malignancy
![Page 20: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/20.jpg)
Acute liver failure
Kings college criteria
Acetaminophen induced
pH <7.3
INR >6.5,Cr>3m
g,Encephalop
athy iii,iv
Non Acetaminophen induced
INR>6.5,
Age <10>40Bil>17.5mg,I
NR>3.5Jaundice to
coma.>7Drug
toxicity,nonA –E
hepatiis
![Page 21: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/21.jpg)
Tools Used to Stratify Transplant Recipients
• MELD/PELD= model for end stage liver disease and pediatric end stage liver disease
• MELD:>12y.oCr, Bili, and INR
• PELD:<12 y.o.Alb, BIli, INR, growth failure and age
MELD>15, CTP>9
![Page 22: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/22.jpg)
Donor Assesment
• Respiratory and haemodynamic support
• Serial follow up of liver enzymes• Hepatitis ,transmissible diseases
screening• History of alcohol intake• Marginal and expanded criteria
donor• Donor and recipient matching-
ABO compatibility and size
![Page 23: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/23.jpg)
Deceased Donor Liver Recovery
• Midline incision• Expose IVC ,IMV, infra renal
aorta • Cannulate - Aorta and IMV • Dissection of liver done• Perfusion with cold
preservative solution • Liver removed with celiac
artery, portal vein,CBD,retro hepatic vena cava
![Page 24: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/24.jpg)
Recipient hepatectomy
• Mercedes Benz incision • Ligaments divided • Porta hepatis exposed • Veno-venous bypass• IVC is divided between two
clamp• Liver is explanted
![Page 25: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/25.jpg)
Living Donor Hepatectomy
• Left lobe - children , Right - adults
• Mercedes Benz incision • Liver is mobilized• Right hepatic vein -right
lobe donation ,middle and left for left lobe donation
• Hilar dissection• Vessels occluded-ischemic
plane marked-divided
![Page 26: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/26.jpg)
Liver graft implantation
• Donor suprahepatic IVC • Donor infrahepatic IVC• Portal vein • Hepatic artery• Biliary drainage
![Page 27: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/27.jpg)
Piggyback Liver Transplant
• It is a IVC preserving technique
• Initial steps similar to classic technique
• Hepatic veins divided , stumps joined to form common cloaca-IVC
• Donor infrahepatic IVC is closed with ligatures
• PV, hepatic artery, biliary anastomosis
![Page 28: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/28.jpg)
Pediatric Liver Transplantation
• Major limiting factor –lack of donors
• Transplantation of left lateral segments split from cadaveric donor or living donor is standard practice
• Procedure require precise knowledge of the hepatic anatomy of the donor
![Page 29: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/29.jpg)
Immunosuppressive strategies
• Tripple immunosuppresion-steroid
calcineurin inhibitors
mycophenolate mofetil
• Induction with CNI sparing-in renal dysfunction
(IL-2receptor antibody)
• Autoimmune diseases-lifelong low dose steroid
![Page 30: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/30.jpg)
Complications
• Haemorrhage• Vascular complications-
hepatic artery ,portal vein thrombosis
• Biliary complications-leak,stenosis
• Primary nonfunction• Infections
![Page 31: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/31.jpg)
Outcome after liver transplantation
• Chronic liver disease-best results
• Acute liver failure-higher mortality
• Tumors –recurrence• Hepatitis B,C-graft failure
because of recurrent viral disease
![Page 32: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/32.jpg)
Pancreatic Transplantation
![Page 33: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/33.jpg)
Pancreatic Transplantation• It obviates need of insulin in diabetic
patient
• Reduces the progression of vascular disease retinopathy,nephropathy
• Reserved for patients with type 1 diabetes mellitus (<55yrs)
• For most patients simultaneous kidney transplant is also undertaken(SPKT,PAKT,PTA)
![Page 34: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/34.jpg)
SurgicalTechnique• Transplantation of whole
pancreas is done with segment of duodenum
• SPKT - through midline incision
• Pancreas graft-intraperitoeally on right side in the pelvis, kidney graft on left
• Donor vessel -recipient iliac vessels
• Exocrine drainage (enteric drainage,urinary drainage)
![Page 35: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/35.jpg)
complications
• Vascular thrombosis• Allograft pancreatitis• Fistula and abscess• Urologic complications
![Page 36: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/36.jpg)
Outcome
• Prolong life in diabetic patients
• After SPKT 1 year patient survival rate is >95%
• Most deaths are due to cardiovascular complications or infections
• Results of PTA graft is not as good (1 year graft survival 70%)
![Page 37: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/37.jpg)
Pancreatic islet transplantation
• Islet of langerhans – scattered throughout pancreas
• Transplantation restores normal glucose metabolism
• Problems- isolation ,several donor cells used• Pancreas perfused with collagenase ,density
gradient purification,in vitro culture• Liver infusion-flouroscopic cannulation of PV
![Page 38: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/38.jpg)
Small bowel transplantation
![Page 39: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/39.jpg)
Small Bowel Transplantation
• Intestinal atresia• Necrotising enterocolitis• Volvulus• Mesentric infarction• Crohns disease • Trauma • Desmoid tumours
![Page 40: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/40.jpg)
Bowel transplant
Types• Small bowel with or without
portion of colon• Combined liver- Small bowel
grafts• Multivisceral transplant
• Should be considered for patients in whom long term TPN has failed
![Page 41: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/41.jpg)
Technique
• SMA of graft is anastomosed to recipient aorta(with a aortic patch)
• SMV is anastomosed to IVC or to portal vein
• Proximal end is anastomosed to recipient duodenum or jejunum
• Distal end is anastomosed to side of colon(with a loop ileostomy) or fashioned as end -ileostomy
![Page 42: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/42.jpg)
Outcome
• 1 year graft survival rate is 65%
• 3 year graft survival rate is 45%
• Patient survival is better after isolated small bowel transplantation
![Page 43: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/43.jpg)
Thoracic Organ Transplantation
• Heart tranplantation
Indications• ischaemic heart disease• Valvular heart disease• Cardiomyopathy• Myocarditis• Congenital heart diseaseHeart lung transplantation-pulmonary
vascular disease with heart diseaseLung transplantation-end stage
pulmonary disease
![Page 44: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/44.jpg)
Composite tissue allotransplantation
• Transplantation of multiple tissues of ectodermal and mesodermal origin
• Involves simultaneous transplantation –skin muscle,nerve,bone and tendons
• Donor-brain dead,ABO compatible
• Sequency-bony fixation,arterial revascularisation,vein repair,tendonrepair and nerve repair
![Page 45: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/45.jpg)
New areas of transplantion
• Larynx• Hand• Knee• Abdominal wall• Face• Islet cell transplant
![Page 46: Copy of organ transplant 123](https://reader033.vdocument.in/reader033/viewer/2022061218/54b5b5be4a79598e708b4690/html5/thumbnails/46.jpg)
Thank you