Northwestern University Feinberg School of Medicine
New Trends in organ donation and
TransplantationJuan Carlos Caicedo, MD FACS
Director, Hispanic Transplant Program
Adult transplant Surgeon (NMH)
Pediatric Transplant Surgeon (LCH)
Overview
Introduction
Kidney ( Living / deceased/ combined stem cell)
Liver: whole, split, reduce size, living donor
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Who Needs a Transplant?
Transplantation is offered to patients who:
are in end-stage organ failure
have no other surgical or medical option available to them
have a limited life expectancy without a transplant
have undergone a rigorous and thorough assessment process and meet all necessary criteria
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Type of donorsDeceased (dead) donors-Brain dead donors: intact heartbeat & circulation, on ventilator
less than 3% of all deaths
-Donors after cardiac death: occurs in hopeless cases in the hospital where the decision to withdraw life-support is made (decision is independent of the decision to donate). Organ donation occurs immediately once the heart has stopped and the patient is declared dead
Living donor-Patient chooses to donate one or part of an organ to someone on a transplant waiting list
•can only occur with organs when removal will NOT cause grave harm to the donor-
Northwestern University Feinberg School of Medicine
United States Organ Transplantation
OPTN & SRTR Annual Data Report, 2011
End Stage Renal DiseaseDimension of the problem
>500.000 people in US
Options: Dialysis and kidney transplantation
US kidney waiting list: 105.124 people / 2013
Kidney Failure: Treatment
Kidney Transplantation
“ Best option”
- Replace all functions of the kidney
- Increase survival and quality of life
- Decrease complications
- Cost effective
Northwestern University Feinberg School of Medicine
2013: 105124 Waiting list2012: 16485 Transplanted 758 ( 4.5%) Pediatric pts
Whites :38%AA: 34%Hispanics: 19%Asian: 8%
Living kidney donation
Laparoscopic vs Open
- Safe
- Less pain
- Fast recovery
- POD 1: Home
- Smaller Incisions
Intended kidney transplant procedure type, & percent of intended laparoscopic procedures converted to open
Number of transplants from living donors, by donor relation
All patients receiving a living donor kidney transplant.
USRDS 2010 ADR
Sensitized Patients
PRA Levels of Wait-Listed Patients
64%
21%
15%
0-9% 10-79% >80%
Sensitized
Very Highly Sensitized 36% Sensitized
Total = 17,814 pts
2010: 25% Sensitized
Options for Sensitized and ABO incompatible Patients
Wait and hope
Desensitization•Live Donor
•Deceased Donor
Live Donor Paired Exchange•List Exchange
Wait and hopeDesensitization
Live DonorDeceased Donor
Live Donor Paired ExchangeList Exchange
Acute rejections within the first year post-transplant
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First-time, kidney-only transplant recipients, age 18 & older, with functioning graft at discharge.
Source: USRDS 2010 ADR
The co-existence of two genetically different components in one organism
Chimerism induces tolerance
Mixed Chimeras
How can we make it safe?
Northwestern Clinical Tolerance Protocols
Sequential kidney/HSC in HLA matched related
Simultaneous kidney/HSC in HLA mismatched
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HLA-Matched Protocol
Current Enrollment – 20/20
First patient enrolled January 2008
HLA identical siblings
Excluded if high risk of recurrent disease in the allograft (role of immunosuppression in preventing disease recurrence)
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PI: Joshua Miller
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HSCT mobilized, collected, processed, & cryopreserved (> 2 wks before Tx)
ConditioningFludarabine, cytoxan, 200 cGy
TBI Perform Transplant
Processed donor leukopheresis product/marrow enriched for
HSC, FC and progenitors (FCRx)
Simultaneous FCRx +Kidney Transplant
d0 d +1
Whole Organ Orthotopic Liver Transplant
Standard technique. This figure illustrates a completed liver transplant with vascular and biliary anastomoses.
Partial Liver Transplantation
The split through midplane with right and left lobe graftsReference: Humar A, et al. Amer J Transpl 2001;1:366-72
Schematic drawing of the right lobe after transplantation into the recipient. The major vascular anastomosis and drainage of the bile duct into a Roux loop of bowel is illustrated
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ConclusionTransplantation offers a second chance at life to thousands of people. It has been proven over and over again to be very successful. However, transplantation can only occur if someone consents to the ultimate gift – organ and tissue donation.
liver transplant recipient
Kidney donor and recipient