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

2. CMC Transplant Program History 1980 Kidney Transplants 1980 Kidney Transplants 1993 Multi-Organ Program Est. 1993 Multi-Organ Program Est. 1994 1 st Liver Transplant 1994 1 st Liver Transplant 1995 1 st Pancreas & Islet Cell Tx 1995 1 st Pancreas & Islet Cell Tx 2000 1st Pediatric Liver Transplant 2000 1st Pediatric Liver Transplant 2006 Mark Russo, MD 2006 Mark Russo, MD 2010 71 Liver Tx & 141 Kidney Tx (record) 2010 71 Liver Tx & 141 Kidney Tx (record)

3. 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

4. Liver Transplantation

5. The Donor Operation

8. 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)

9. 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

10. Veno-Venous Bypass

13. Hepatic Vascular Anatomy

14. Right Lobe Liver Transplant

15. Kidney Transplant

16. 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

17. NationalN. C. Kidney98,7021,965 K/P 968 12 *Based on UNOS Data Nov 4, 2013 USA Kidney Waiting List 2013*

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

19. Deceased and Living Donors 1996 - 2005 7593 6892

20. Projected years of life from WL by age group Projected years of life WL dialysis Transplant 40 20 0 20–3940–5960–74 Age group Wolfe RA, et al. N Engl J Med 1999;341:1725–30

21. 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

22. Deceased Donor Kidney Procurement

23. Laparoscopic Live Donor Nephrectomy

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

25. Kidney Transplant vs. Dialysis 5 year mortality: 1995-1999

26. Pancreas Transplant

27. 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

28. Pancreas

29. Questions?