Surgery Online

Surgery and Surgical Procedure

Transplantation

Historical perspective
Since early times the idea of tissue and organ transplantation has captured the imagination of successive generations, and over the centuries numerous fanciful descriptions of success­ful transplants have been recorded. One of the most widely cited early examples is that of the Christian Arab saints Cosmas and Damien. They were reputed, around 300 AD, to have successfully replaced the diseased leg of a patient with that from a black man who had died several days earlier . The modern era of transplantation began in the 1950s and relied on surgical techniques for anastomosing blood vessels which had been developed at the beginning of the twentieth century by Mathieu Jaboulay and Alexis Carrel. The first successful kidney transplant was a living donor transplant performed between identical twins in 1954 at the Brigham Hospital in Boston by Joseph Murray and colleagues. This and other kidney transplants between identical twins demonstrated the technical feasibility of kidney transplantation, but attempts to perform renal transplantation when the donor and recipient were not genetically identical failed because no effective immunosuppressive therapy was available . Then, in 1959, Schwartz and Dameshek discovered that 6-mercaptopurine had immunosuppressive properties, and Roy Caine showed that azathioprine, a derivative of 6-mercaptopurine, prevented rejection of canine kidney transplants. From the early 1960s, a combination of azathioprine and corticosteroids was used with success in the clinic to prevent graft rejection after kid­ney transplantation. These chemical agents were sometimes supplemented with a polyclonal antilymphocyte antibody given at the time of transplantation as immunoprophylaxis or used to treat an episode of graft rejection. The cyclosporin era began in the late 1970s following the discovery of the new agent by Borel at the Sandoz laboratories in Basle and the demonstration, by Caine, of its potent immunosuppres­sive properties in clinical studies. The introduction of cyclosporin was a major advance and cyclosporin (usually given together with azathioprine and steroids) not only improved the results of renal transplantation but also allowed transplantation of the heart and liver to be undertaken with acceptable results. Organ transplantation is now well established as an effective treatment for selected patients with end-stage organ failure. Transplantation of the kidney, liver, pancreas, heart and lungs are all routine procedures, and transplantation of the small intestine is becoming more widely practised. Today, transplant activity is limited only by the shortage of cadaveric organs.
Definitions
•  Allograft (synonymous with the old term homograft) — an organ or tissue transplanted from one individual to another.
•  Syngeneic graft (isograft) — a transplant between identical twins.
•  Orthotopic graft — a transplant placed in its normal anatomical site.
•  Heterotopic graft — a transplant placed in a site different to that where the organ is normally located.
•  Xenograft — a graft performed between different species.

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October 7, 2008 - Posted by | Transplantation | , ,

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