Joel Arudchelvam Definition Donor types HISTORY OF TRASNPLANTATION in Sri Lanka Transplantation procedure Organ preservation BASIC COMPONENTS OF PRESERVATION SOLUTIONS

1. Joel Arudchelvam
MBBS, MD ( SUR ), MRCS (ENG), FCSSL
ConsultantVascular andTransplant Surgeon
ORGAN
TRANSPLANTATION

2. Transplantation
Removal of organs or tissues from one individual
and placing it in another individual
 Recipient

3. Transplantation
Removal of organs or tissues from one individual
and placing it in another individual
 Recipient

4. Transplantation
Removal of organs or tissues from one individual
and placing it in another individual
 Recipient

5. Transplantation
Removal of organs or tissues from one individual
and placing it in another individual
 Recipient
GRAFT

6. TRANSPLANTATION
The Miracle surgery of Cosmas &
Damian AD 287

7. Organs usually transplanted
 Kidney
 Liver
 Pancreas
 Heart
 Lungs
 Intestine

8. Tissues, cells usually
transplanted
 Skin
 Cornea
 Islets of Langerhans
 Bone marrow
 Heart valve
 Bone

9. Types of graft
 Autograft: From same individual e.g skin,
vein
 Isograft: from genetically identical individual
e.g. identical twins (first kidney
transplantation).
 Allograft: from genetically non-identical
member of the same species.
 Xenograft: from another species, e.g., animal
to man

10. Types of graft
 Complete e.g. Kidney
 Partial e.g. liver

11. Types of organ donors
 Live Donor
 Deceased / Cadaveric Donor
 Donation after brain death (DBD)
 All Brain stem functions are absent/ patient on
ventilator support
 Donation after cardiac death (DCD)
 Patient who has irreversible or an injury
incompatible with life.
 Does not fulfill the brain death criteria

12. HISTORY OF TRASNPLANTATION
 Barriers to transplantation
 Rejection
 SurgicalTechniques

13. HISTORY OF TRASNPLANTATION
 1902 Experimental transplants and
anastomosis techniques in animals -
Alexis Carrel
 1954 First successful kidney transplant
 1961 Prolongation of survival of
experimental kidney transplants by
Azathioprine

14. HISTORY OF TRASNPLANTATION
 1962 Use of azathioprine and steroids
 1963 First liver transplant
 1967 First heart transplant
 1978 Cyclosporine
 1981 Monoclonal antibodies
 1989 Tacrolimus

15. ORGANS TRANSPLANTED IN SRI
LANKA
Organ Year Surgeon
Kidney 1985 Prof. A. H. Sheriffdeen
Liver 2010 Prof Mandika Wijeratne
Lungs 2011 Japanese and SL
surgeons
Pancreas (Simult. Panc / Kid) SPK 2016 Dr . Joel Arudchelvam
En bloc Kidney Transplantation 2017 Dr . Joel Arudchelvam
HeartTransplantation 2017 Kandy team
Lower LimbTransplantation 2017 Dr . Joel Arudchelvam

16. Transplantation procedure
Suitable Donor
Organ retrieval
Organ preservation
Transplantation

17. Live donor nephrectomy
 Lateral decubitus
position
 lower costal margin
over the kidney rest
 kidney rest is raised
and the operating table
is flexed

18. Live donor nephrectomy
 Incision in line with
the 12th rib.
 Kidney, ureter,
vessels mobilised

19. Renal transplantation
• Curved supra inguinal
incision (Modified Gibson)
• Inverted ‘J’/ ‘Hockey stick’

20. Renal transplantation
• Iliac vessels and bladder
dissected extra peritoneally’

21. Renal transplantation –
Iliac vessel mobilisation

22. Renal transplantation
 Renal vessels
ananstomosed to
iliac vessels

23. Renal transplantation
Ureter anastomosed to the
bladder
(Ureteroneocystostomy)

24. Surgical aspects

25. Organ ischemia

26. Organ ischemia

27. Organ ischemia

28. Organ ischemia

29. Organ ischaemia

30. Organ preservation
 Kidney perfused with
cold preservation
solution
 HistidineTryptophan
Ketoglutarate (HTK) solution

31. Organ preservation

32. Organ preservation
Histidine-tryptophan-ketoglutarate (Custodiol
HTK solution)
composition of HTK is similar to that of extracellular fluid
Composition
• Sodium: 15 mmol/L Low
• Potassium: 9 mmol/L Low
• Magnesium: 4 mmol/L
• Calcium: 0.015 mmol/L (S Ca -2.2 to 2.6 mmol/L)
• Ketoglutarate: 1 mmol/L
• Histidine: 198 mmol/L buffering
• Mannitol: 30 mmol/L antioxidant
• Tryptophan: 2 mmol/L

33. BASIC COMPONENTS OF
PRESERVATION SOLUTIONS
 Prevention of oedema
 Impermeants – saccharides e.g – Mannitol
 Anions – citrate, gluconate, lactobionate
 Colloids – dextran,polyethylene glycol
 Prevention of acidosis
 Buffers – phosphate and histidine
 Neutralise the formation of O2 radicals
 Antioxidants – glutathione, tryptophan,
allopurinol

34. Preservation solutions
 Nutrients
 Tryptophan
 Adenosine
 Adenine
 Glutamic acid
 Histidine
 Ketoglutarate

35. Preservation solutions
 Euro-Collins Solution (EC)
 citrate (HOC) solution ( Marshall’s solution)
 University ofWisconsin (UW) solution
 histidine–tryptophan–ketoglutarate (HTK)
solution
 Celsior Solution
 Kept at 0-4 degrees Celsius

36. Complications
 Surgical
 Immunological
 Infections

37. Technical complications
 Vascular thrombosis
 Bleeding/ hematoma formation
 Anastomotic leak
 Wound complications

38. Immunological complications
 Immune response against foreign material i.e
graft
 Graft rejection
 Hyperacute
 Acute
 Chronic

39. Immunological complications
 Hyperacute -
 Occur due to the pre- existing antibodies
 Occurs soon after the organ is reperefused.
 Due to ABO incompatibility / pre-existing HLA
antibodies.
 Acute rejection –
 3 to 5 days following transplantation
 The immune system newly recognises the graft
 Generally T cell mediated (acute cellular rejection)
at times due to antibodies (acute humoral rejection)

40. Immunological complications
 Chronic rejection –
 Due to accumulation of injuries over long period
 Graft gradually loses its function

41. Post transplantation
infections
 Transplant patients are at a higher risk of
infection due to immunosuppressants
 Early (< 1month)
 Intermediate (1m -6 months)
 Late (> 6M)

42. Post transplantation
infections
 Early (< 1month)
 Bacterial (urinary tract infections, respiratory , line
related)
 Intermediate (1m -6 months)
 Cytomegalovirus
 Epstein-Barr virus
 Pneumocystis pneumonia
 Cryptococcal infections
 Tuberculosis

43. Post transplantation
infections
 Late (> 6M)
 Aspergillosis
 Fungal infections
 Late viral infections

44. Transplant antigens
 ABO
 HLA
 I - A,B, C
 II - DP, DQ, DR
 Leucocyte cross match

45. Immunosuppressants
 Antibodies
 Basiliximab (anti-C25 antibody /IL-2 receptor
subunit)
 Steroids
 Methylprednisolone
 Prednisolone
 Calcineurin inhibitors;
 Cyclosporine
 Tacrolimus
 Anti proliferative
 Mycophenolate mofetil

46. ThankYou !