Copy of organ transplant 123
Upcoming SlideShare
Loading in...5
×
 

Copy of organ transplant 123

on

  • 1,139 views

 

Statistics

Views

Total Views
1,139
Views on SlideShare
1,139
Embed Views
0

Actions

Likes
1
Downloads
52
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Copy of organ transplant 123 Copy of organ transplant 123 Presentation Transcript

  • ORGAN TRANSPLANT
  • Renal transplant
    Liver transplant
    Pancreatic transplant
    Bowel transplant
  • Types of Transplant
    Heterotopic or Orthotopic
    different same
    Autograft: same being
    Isograft/Syngenetic graft: identical twins
    Allograft/homograft: same species
    Xenograft/heterograft: between species
  • Transplantable Organs/Tissues
    Liver
    Kidney
    Pancreas
    Heart
    Lung
    Intestine
    Face
    Bone Marrow
    Cornea
    Blood
  • Renal transplant
  • Renal TransplantIndications
    Glomerulonephritis
    Diabetic neuropathy
    Hypertensive nephropathy
    Renal vascular disease
    Polycystic disease
    Pyelonephritis
    Obstructive uropathy
    Systemic lupus erythematous
    Analgesic nephropathy
  • 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
  • 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
  • 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
  • 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
    uretericanastomosis
    ureteroneocystostomy
  • Vascular Anastomosis
  • Ureteroneocystostomy
  • 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
  • Ureteric Stones
  • Clot Auria
  • Immunosuppresion
    Corticosteroid
    Cyclosporin
    Tacrolimus
    Azathioprine
    Mycophenolatemofetil
    Antilymphocyte antibodies
  • 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
  • LIVER TRANSPLANTATION
  • Liver TransplantationIndications
    Cirrhosis
    Acute fulminant liver failure
    Metabolic liver disease
    Primary hepatic malignancy
  • Acute liver failure
  • Tools Used to Stratify Transplant Recipients
    MELD/PELD= model for end stage liver disease and pediatric end stage liver disease
    MELD:>12y.o
    Cr, Bili, and INR
    PELD:<12 y.o.
    Alb, BIli, INR, growth failure and age
    MELD>15, CTP>9
  • 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
  • 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
  • Recipient hepatectomy
    Mercedes Benz incision
    Ligaments divided
    Portahepatis exposed
    Veno-venous bypass
    IVC is divided between two clamp
    Liver is explanted
  • 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
  • Liver graft implantation
    Donor suprahepatic IVC
    Donor infrahepatic IVC
    Portal vein
    Hepatic artery
    Biliary drainage
  • 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, biliaryanastomosis
  • 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
  • Immunosuppressive strategies
    Trippleimmunosuppresion-steroid
    calcineurin inhibitors
    mycophenolatemofetil
    Induction with CNI sparing-in renal dysfunction (IL-2receptor antibody)
    Autoimmune diseases-lifelong low dose steroid
  • Complications
    Haemorrhage
    Vascular complications-hepatic artery ,portal vein thrombosis
    Biliary complications-leak,stenosis
    Primary nonfunction
    Infections
  • 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
  • Pancreatic Transplantation
  • 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)
  • 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)
  • complications
    Vascular thrombosis
    Allograft pancreatitis
    Fistula and abscess
    Urologic complications
  • 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%)
  • 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-flouroscopiccannulation of PV
  • Small bowel transplantation
  • Small Bowel Transplantation
    Intestinal atresia
    Necrotisingenterocolitis
    Volvulus
    Mesentric infarction
    Crohns disease
    Trauma
    Desmoidtumours
  • 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
  • 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
  • Outcome
    1 year graft survival rate is 65%
    3 year graft survival rate is 45%
    Patient survival is better after isolated small bowel transplantation
  • Thoracic Organ Transplantation
    Heart tranplantation
    Indications
    ischaemic heart disease
    Valvular heart disease
    Cardiomyopathy
    Myocarditis
    Congenital heart disease
    Heart lung transplantation-pulmonary vascular disease with heart disease
    Lung transplantation-end stage pulmonary disease
  • 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,arterialrevascularisation,veinrepair,tendonrepair and nerve repair
  • New areas of transplantion
    Larynx
    Hand
    Knee
    Abdominal wall
    Face
    Islet cell transplant
  • Thank you