Primary non functioning graft
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Primary non functioning graft

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Primary non function of a transplant is the most catastrophic outcome in kidney transplantation.

Primary non function of a transplant is the most catastrophic outcome in kidney transplantation.

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Primary non functioning graft Presentation Transcript

  • 1. Mr. Adil El Tayar FRCS, FEuBTS Consultant Transplant Surgeon Ibn Sina Hospital
  • 2. Transplantation Transplantation is the transfer (engraftment) of human cells, tissues or organs from a donor to a recipient with the aim of restoring function(s) in the body
  • 3. Types of grafts  Auto graft No immunogenic barrier.  Isograft Genetically identical monozygotic twins and inbred strains.  Allograft Genetically non identical individuals  Xenograft Across species barrier
  • 4. GRAFT Function PNF means total and irreversible loss of function after transplantation. P dysfunction G means irreversible but partial impairment of function DGF means the organ fails to function at first but start to function later.
  • 5. Alex Carrel in 1901  Alex Carrel in 1901 wrote “I have started research into the procedure of vascular anastomosis in order to be able to transplant certain organs.....”
  • 6. Alex Carrel technique  He defined the two factors essential to the success of this anastomosis:  a meticulous surgical technique  protection against the risk of infection.
  • 7. First hand transplant: by Professor Jean-Michel Dubernard in Lyon. In 1998
  • 8. They made the mistake of picking the wrong patient.
  • 9. Mrs. Renard and her son Marius
  • 10. Causes of PNF      1. 2. 3.   1. 2. 3.   Xenotransplantation ABO incompatibility Sensitized patients Non heart beating kidney donation Ischemia time Warm Ischemia Cold Ischemia Re-warm Ischemia Perfusion fluid Surgical complications Renal artery thrombosis Venous thrombosis Urological obstruction Drugs Toxicity Recurrent of primary disease
  • 11. Xenotransplantation  Transplantation across species barrier  Discordant when there is a preformed anti bodies similar to Blood grouping ( pig to man)  Concordant when there is no preformed antibodies ( baboon to man)
  • 12. Mathieu Jaboulay 1906  First Xenotransplantation ( Left kidney from a pig into the cubital fossa of woman with nephrotic syndrome)
  • 13. Hyper acute Rejection  Xenotransplantation  ABO incompatible  Pre formed Anti HLA antibodies
  • 14. Cortical necrosis a histopathological feature of severe vascular rejection
  • 15. C4d positive immunohistological marker of humoral rejection
  • 16. Avoid Hyper acute rejection  Blood group compatible  Initial cross match  Final cross match  DSA  Desensitization CDC test Flow cytometry
  • 17. Yu Yu Voronoy 1933  The first human kidney allograft, carried out in Kiev in 1933 using the thigh location
  • 18. Non-heart beating kidney donation  Categories of non heart beating donors: 1. Dead on arrival 2. Unsuccessful resuscitation 3. Awaiting cardiac arrest. 4. Cardiac arrest during or after brain stem diagnosis
  • 19. Strategies of Organ Preservation  To maintain survival capacity over the necessary time and to ensure rapid resumption of function after transplantation: 1. Simulate as exactly as possible the physiological environment of the organ during the extracorporeal phase. 2. Use of hypothermia and pharmacological inhibition to slow down metabolic process in the ischemic /anoxic organ
  • 20. Renal vein thrombosis
  • 21. Transplant Clinical and Business Multidisciplinary Team Transplant Surgeon Public Relatio Information n Technology Transplant Anaesthesia Transplant Physician Transplant Administration Patient Registration Financial Coordination OPO Relatio n Transplant Patient Transplant Coordinator Transplant Sister Social Worker Ward Manager Impatient Unit Cost Reporting Transplant Dietation Data Management Transplant Pharmacist Routine Laboratory HLA Laboratory