1 / 31

Kidney Transplantation An Overview

Kidney Transplantation An Overview. Mark W. Johnson, MD, Assoc. Professor of Surgery Director of Liver Transplantation University of North Carolina Chapel Hill. History of Transplantation. Kidney Transplantation Surgical Milestones. Ulman, 1902 – kidney to neck vessels

sally
Download Presentation

Kidney Transplantation An Overview

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Kidney TransplantationAn Overview Mark W. Johnson, MD, Assoc. Professor of Surgery Director of Liver Transplantation University of North Carolina Chapel Hill

  2. History of Transplantation

  3. Kidney Transplantation Surgical Milestones • Ulman, 1902 – kidney to neck vessels • Carrel, 1912 – vascular techniques • Kolff, 1940’s – dialysis machine • Hume, 1947 – kidney to arm vessels • Murray, 1956 – identical twin transplant

  4. Alexis Carrel 1912

  5. Kolff, 1940’s : Hemo-dialysis machines

  6. Hume, 1950’s – kidney to femoral vessels

  7. Murray, 1956 – current transplant position

  8. Murray, 1956 – current transplant position

  9. Renal transplant: Venous anastomosis

  10. Renal transplant: Arterial anastomosis

  11. Renal transplant: Reperfusion

  12. Renal transplant: Ureteral anastomosis

  13. Kidney-Pancreas transplantation Why?

  14. Non-Uremic Patients Sequellae of diabetes have to be considered worse than short term surgical risks and the long term risks of chronic immunosuppression.

  15. History of Pancreas Transplantation 1913 Hedon: pancreas segment to neck of dog 1921 Banting & Best: extraction of insulin 1966 Kelly/Lillehei: 1st clinical pancreas tx • 60 grafts/56 pts. 3% graft/39% pt @ 1 yr. 1978 Introduction of cyclosporin • 295grafts/276 pts. 40% graft/77% pt @ 1 yr

  16. History of Pancreas Transplantation (cont’d) since 1984: • improved vascular techniques (“Y” graft) • drainage of exocrine function (bladder vs. enteric) • improved immunosuppression (FK506, MMF) • improved rejection therapy (OKT3) • improved antibiotics (anti-viral, fungal agents)

  17. Pancreas transplant: Vascular anatomy

  18. Lillehei 1966: current transplant position

  19. Pancreas transplant: enteric anastomosis

  20. “You are about to experience something rare in your life, Stan – Rejection.”

  21. P. B. Medawar, 1953: “Actively Acquired Tolerance of Foreign Cells.”

  22. Recognizing Non-self

  23. Major Histocompatibility Complex Class I MW 45k single polymorphic chain ß-2 microglobulin A, B, and C loci Expressed on all cells Class II MW33k and 28k two polymorphic chains DP, DQ, and DR loci Expressed on macrophages, B cells, activated T cells, dendritic cells, etc.

  24. Varieties of Rejection

  25. ImmunosuppressionEvolution Tacrolimus Mycophenolate mofetil Rapamycin Brequinar Leflunomide IL2r antibodies monoclonal antibodies Cyclosporin Azathioprine OKT3 ATG ALG Steroids ?????

  26. Progress in Immunosuppression 1950 vs. 2000 Ready-Fire-Aim Ready-Aim-Fire

  27. Renal Transplant Graft Survivals

  28. Pancreatic Graft Survivals

  29. The Solution

More Related