Basics of Organ Transplantation Lon Eskind, MD Director Liver Transplant, CMC Assoc. Medical Director of LifeShare.

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Presentation transcript:

Basics of Organ Transplantation Lon Eskind, MD Director Liver Transplant, CMC Assoc. Medical Director of LifeShare

CMC Transplant Program History 1980 Kidney Transplants 1980 Kidney Transplants 1993 Multi-Organ Program Est Multi-Organ Program Est st Liver Transplant st Liver Transplant st Pancreas & Islet Cell Tx st Pancreas & Islet Cell Tx st Pediatric Liver Transplant st Pediatric Liver Transplant 2006 Mark Russo, MD 2006 Mark Russo, MD Liver Tx & 141 Kidney Tx (record) Liver Tx & 141 Kidney Tx (record)

CMC’s Transplant Program CMC’s Transplant Program Largest Abdominal Transplant Largest Abdominal Transplant Center in North Carolina 200 Solid Organ Transplants/Year 200 Solid Organ Transplants/Year 125 Kidney 70 Liver (4 Pediatric) 5 Kidney / Pancreas

Liver Transplantation

The Donor Operation

Stages of a Liver Transplant GETA GETA Invasive Monitoring Invasive Monitoring Back Table Clean Up Back Table Clean Up Laparotomy Laparotomy Exploration Exploration Hepatectomy Hepatectomy Veno-Venous Bypass (not in small children) Veno-Venous Bypass (not in small children)

Stages of a Liver Transplant Anastomosis Anastomosis Hepatic Veins Hepatic Veins Hepatic Artery Hepatic Artery Portal Vein Portal Vein Recirculation Recirculation Hemostasis Hemostasis Bile Ducts Bile Ducts Drains & Close Drains & Close

Veno-Venous Bypass

Hepatic Vascular Anatomy

Right Lobe Liver Transplant

Kidney Transplant

Benefits of Kidney Transplant Increased energy, improved appetite Increased energy, improved appetite Decreased nausea and itching Decreased nausea and itching No more dialysis and the risks associated with it No more dialysis and the risks associated with it Improved survival Improved survival

NationalN. C. Kidney98,7021,965 K/P *Based on UNOS Data Nov 4, 2013 USA Kidney Waiting List 2013*

Kidney Transplants Performed 2012 Deceased Donor10,868 Living Donor5,618 Total16,486

Deceased and Living Donors

Projected years of life from WL by age group Projected years of life WL dialysis Transplant –3940–5960–74 Age group Wolfe RA, et al. N Engl J Med 1999;341:1725–30

KIDNEY TRANSPLANT OUTCOMES 2013 Live donor Live donor 95% (1yr) 95% (1yr) 15 yr median survival 15 yr median survival Deceased Donor Deceased Donor 88% (1yr) 88% (1yr) 12 yr median survival 12 yr median survival

Deceased Donor Kidney Procurement

Laparoscopic Live Donor Nephrectomy

Advantages to the donor Less pain Smaller incision Shorter recovery time Shorter hospital stay

Kidney Transplant vs. Dialysis 5 year mortality:

Pancreas Transplant

Diabetes is the leading cause of blindness, kidney failure, and non- traumatic amputations. Even with insulin therapy, there is no guarantee of protection from disabling complications. Diabetic foot Diabetic retinaRenal failure Diabetes Facts Mortality 5-7 times that of general population. 1 of 6 IDDM patients will die before age 40

Pancreas

Questions?