1. Principles of Transplant Surgery Ruth Mitchell, BA, BSc, BMBS Neurosurgical Resident Royal Melbourne Hospital Thursday, 25 th March 2010

2. Types of Transplants  Autograft Skin graft, CABG, autologous blood  Allograft Organ or tissue from genetically non-identical members of the same species  Isograft Organ or tissue from genetically identical source  Xenograft/xenotransplantation Organ or tissue from one species to another Porcine heart valves, piscine-primate islet cells

3. More types of transplants  Split transplants Deceased donor – liver to 2 recipients (adult and child)  Domino transplants Cystic Fibrosis: heart and lungs from deceased donor to CF patient, heart from CF patient to another recipient Living donor kidney transplants

5. History  Which organ was the first to be transplanted?

6. History of organ transplantation  1905 Cornea  1954 Kidney  1966 Pancreas  1967 Liver  1967 Heart  1981 Heart/lung  1986 double lung  1995 live-donor laparoscopic nephrectomy  1998 live-donor partial pancreas  1998 hand  2005 face transplant  2008 double arm  2008 baby born from transplanted ovary

7. Challenges  Transplant surgery is easier than transplant medicine  Rejection of transplanted organs is a bigger challenge than the technical expertise required to perform the surgery  Ethical and cultural issues must be considered  Ischemic time, logistical nightmares

8. Immunobiology of Rejection  Histocompatibility antigens: MHC, in humans the Human leukocyte antigen or HLA  Clinical stages of rejection Hyperacute rejection – pre-existing antibodies work in minutes to hours Acute rejection – within 6 months, both cellular and humoral Chronic rejection – months to years, fibrosis and scarring (accelerated atherosclerosis, bronchiolitis obliterans, vanishing bile duct syndrome, nephropathy)

9. Anti-rejection therapy  Corticosteroids  Calcineurin inhibitors: tacrolimus, cyclosporine  Antiproliferative agents: mycophenolate mofetil, azathioprine  Monoclonal antibodies: basiliximab, daclizumab  SIDE EFFECTS

10. Organ donation in Australia

11. Description of procurement

12. Thank you! Questions?