presentation---organ-transplantation

LOGO1OrganTransplantationTeammembers:WangHangtao2014214462WenTao2014214463GuoMinzhang2014214465ChenXuewei2014214464SheZhanpeng2014214466LOGO2OrganTransplantation(Tx)wasoneofthemostoutstandingmedicalachievementsofthe20thcentury.Asthedevelopmentinthefieldofsurgicaltechniques,immunotherapyresearchandnewimmunosuppressives,OrganTxhasbecomeaeffectivemethodtohealtheendstageorganfailurepatients.LOGOOrgansthatcanbetransplantedare1.Heart2.Kidneys3.Liver4.Lungs5.othersLOGOHeartTransplantWhatishearttransplant?removesadiseasedheartreplacesitwithadonorheartWhocanbe?receptor:mostlyhasend-stageheartfailure,probablydiein1year.donor:recentlydeceasedorbrain-deathwithhealthyheart.LOGOProcedures•Duringtransplant,amechanicalpumpcirculatesbloodthroughthebodywhilethesurgeonremovesthediseasedheartandreplacesitwithahealthyheart.•Thesurgeonconnectsthedonorhearttothemajorbloodvesselsandhookstheheartuptowiresthattemporarilycontroltheheartbeat.•Topreventthebodyfromrejectingthedonorheart,doctorwillgiveyouimmunosuppressantsimmediatelyaftersurgery,andyoumustcontinuetotakethem.LOGOOutcomesRisksBenefits•About87%surviveforatleast1year.About50%survive10years.•Mostpeoplecanhaveagoodqualityoflifeaftertheirtransplant.Theycanbeactive,haveasociallife,andreturntowork.•Rejectionofthedonorheart.•Infection.•Cloggingofthearteries(atherosclerosis)thatmaydevelopinthedonorheart.•Death.LOGOrenalphysiologicalfunctionmaintainsthestabilityoftheinternalenvironment：1.regulationofwaterandelectrolyte2.Thedischargemetabolites3.regulatingacid-basebalanceLOGORenaltransplantationWhenitisinadvancedKidneyfailure,itcannotworkanylongerRenaltansplantationthatmaybelife-extendingisareplacementtherapyinsurgeryLOGORenaltransplantationchronicglomerulonephritischronicpyelonephritispolycystickidneydiabeticnephropathyinterstitialnephritisAutoimmunekidneydiseaseLOGOLOGOQualifyingconditions27%chronicobstructivepulmonarydisease(COPD),includingemphysema;16%idiopathicpulmonaryfibrosis;14%cysticfibrosis;12%idiopathic(formerlyknownasprimary)pulmonaryhypertension;5%alpha1-antitrypsindeficiency;2%replacingpreviouslytransplantedlungsthathavesincefailed;24%othercauses,includingbronchiectasisandsarcoidosis.LOGOTypesoflungtransplantLobeSingle-lungDouble-lungHeart-lungLOGOLOGOWhoneedsalivertransplant?1.eitheracuteorchronicliverfailure2.cirrhosis3.cancersoriginatingintheliver4.biliaryatresiaLOGOAbout80to85percentoftransplantedliversarefunctioningafter1year.Peoplewhohavealivertransplantareusuallyabletoreturntonormalactivitiesafterrecoveringforseveralmonths.LOGO16CrossmatchingABOcompatibleHLAcompatiblepositivecomplement-dependentTcelllymphocytotoxicitycross-matchPRALOGO17BarriersoforganTxSourcesofDonorGraftRejectionOperativetechniquesLOGO18ThedonormustbeABO-compatiblewiththerecipient.Livingdonorsshouldbeingoodhealthbothphysicallyandpsychologically.Aboveall,thelivingdonorshouldbeavolunteerandmustclearlyunderstandthenatureoftheproceduresothatinformedconsenttotheoperationcanbegiven.Donorsmustbeoflegalage.SourcesofDonorLOGO19GraftRejectionCategoriesThemajorhazardforthepostoperativeallografi(同种异体移植物)recipientisrejection.Mostrejectionsoccurwithinthefirst3months.LOGO201.Hyperacuterejection2.Acceleratedrejection3.Acuterejection4.ChronicrejectionFourkindsofrejectionLOGO21HyperacuterejectionItisduetopreformedcytotoxicantibodiesagainstdonorlymphocytesorrenalcells.Thisreactionbeginssoonaftercompletionoftheanastomosisandcompletegraftdestructionoccursin24-48hours.Thereisnoeffectivemethodoftreatingthisreaction.Pretransplantcrossmatchtestingcaneliminatethistypeofrejection.LOGO22AcceleratedrejectionThisreactionusuallyappearswithin5daysafteraperiodofgoodfunction.Itisbelievedtoberelatedtosubliminalpreformedcytotoxicantibodiesagainstdonorcellsnotdetectedbytheusualcytotoxicitytechniques.LOGO23AcuterejectionItisthemostcommontypeofrejectionepisodeduringthefirst3monthsafterTx.Itisprimarilyanimmunecellularreactionagainstforeignantigens.Thistypeofrejectionprocessmaybereversedbyincreasingthedosageofcorticosteroids.Ifthisisunsuccessful,anALGorATGpreparationormuromonab-CD3canbeused.LOGO24AcuterejectionThesymptomsofacutekidneytransplantrejectionaccompaniedby:painoveranenlargedkidneygraft,hypertension,decreasedurinaryoutput,fluidretention,increasedserumcreatininelevels,andradioisotoperenographyindicatingdecreasedrenalbloodflow,glomerularfiltration,andtubularfunction.LOGO25ChronicrejectionItisalatecauseofrenaldeteriorationmediatedbyhumoralfactors.ApositiveBcellcross-matchorapositiveflowcross-matchagainstdonorBorTcellsisconsideredbysometobepredictiveofchronicrejectionandpoorerlong-termgraftsurvivals.Itismostoftendiagnosedonthebasisofslowlydecreasingrenalfunctioninassociationwithproteinuria,hypertension,interstitialfibrosis,vascularchanges,andminimalmononuclearcellinfiltration.Chronicrejectionisresistanttocorticosteroidtherapyandgraftlosswilleventuallyoccur.LOGO26ImmunosuppressionImmunosuppressivedrugregimenscommonlyincludeaglucocorticoidincombinationwithotherdrugssuchascycl