History of Transplantation

Report
POSTGRADUATE
SCHOOL OF MEDICINE
HOW DID WE GET WHERE WE ARE TODAY?
Andrew T. Raftery
MDSC175: Transplantation Science for Transplant Clinicians
(Online)
A MEMBER OF THE RUSSELL GROUP
CONTINUING PROFESSIONAL DEVELOPMENT
History of Transplant
Organ Transplantation – The Past
1902
First successful experimental kidney transplant
Emerich Ullmann (1861 – 1937)
2
History of Transplant
Organ Transplantation – The Past
1906
First human kidney transplant - xenograft
Mathieu Jaboulay (1860 – 1913)
3
History of Transplant
Organ Transplantation – The Past
1930s
First human kidney transplant – allograft
Yu Yu Voronov (1895 – 1961)
4
History of Transplant
Organ Transplantation – The Past
1930s
First human kidney transplant – allograft
5
History of Transplant
Organ Transplantation – The Past
1930s
Alexis Carrell (1873 – 1944)
6
History of Transplant
Developments in Renal Transplantation
1940s
Rejection
defined
(Medawar
and Gibson)
7
History of Transplant
8
Developments in Renal Transplantation
1950s
First successful kidney transplant between identical
twins
•
•
Joseph Murray, Peter Bent
Bingham Hospital,
Boston USA 1954
First description of leucocyte
antigens
History of Transplant
Developments in Renal Transplantation
1950s
David Hume (1918 – 1973)
9
History of Transplant
Developments in Renal Transplantation
1960s
First successful cadaver kidney transplant
•
Peter Bent Bingham Hospital, Boston, USA
•
Kidney Functioned for 21 months
First use of azathioprine for rejection (Calne)
First use of tissue matching to select donor and recipient
10
History of Transplant
11
Developments in Renal Transplantation
1960s
• Recognition that positive cross match leads to hyperacurate
rejection
• Hypothermic pulsatile perfusion for kidney preservation
• First successful UK kidney transplant
•
Sir Michael Woodruff
•
Edinburgh, October 1960
History of Transplant
Developments in Renal Transplantation
1960s
Sir Michael Woodruff (1911 – 2001)
12
History of Transplant
Developments in Renal Transplantation
1960s
Sir Ron Calne (1930 – )
13
History of Transplant
Developments in Renal Transplantation
1960s
14
History of Transplant
15
Developments in Renal Transplantation
1970s
•
Introduction of UK code of practice on brain stem death – 1976
•
First clinical use of cyclosporin (Calne 1978)
•
Clinical application of HLA matching (Ting and Morris 1979)
•
First Transplant coordinators appointed
History of Transplant
16
Developments in Renal Transplantation
1980s
Monoclonal
antibodies –
OKT3
ABO
incompatible
kidney
transplant
Human Organ
Transplant Act
1979
Unrelated Live
Transplant
Regulatory
Authority
(ULTRA)
History of Transplant
17
Developments in Renal Transplantation
1990s
First clinical use of FK506
(Tacrolimus)
First clinical use of
mycophenolate mofetil
(MMF)
First clinical use of Anti –
IL – 2 monoclonal
antibodies (Basiliximab)
Laparoscopic live donor
nephrectomy
History of Transplant
18
Developments in Renal Transplantation
2000s
• Human Tissue Act 2004
• Expansion of donation after cardiac death (DCD)
• Return to hypothermic pulsatile perfusion
• Introduction of normothermic perfusion with
autologous blood
History of Transplant
Organ Transplantation – The Present
Immunosuppression
Irradiation
Steroids
Steroids
Steroids
Steroids Azathioprine
Azathioprine
Azathioprine
Ciclosporin
ALG
ALG
ATG
ATG
OKT3
Steroids Azathioprine Ciclosporin ALG ATG OKT3 Tacrolimus
MMF
Sirolimus Basiliximab
Daclizumab
Rituximab
19
History of Transplant
Developments in Renal Transplantation
Diagnostic aids
Radioisotape
scan
Ultrasound
scan
Core biopsy
Angiography
20
History of Transplant
21
Developments in Renal Transplantation
Interventional radiology
•
Renal biopsy – under ultrasound control
•
Percutaneous transluminal angioplasty for renal artery stenosis
and stenting
•
Antegrade pyelography – dilatation and stenting of ureteric
obstruction
•
Percutaneous drainage of lymphocoeles
History of Transplant
Developments in Renal Transplantation
Interventional radiology
22
History of Transplant
Developments in Renal Transplantation
Interventional radiology
23
History of Transplant
Developments in Renal Transplantation
Interventional radiology
24
History of Transplant
Organ Transplantation – The Future
Tolerance
Stem cell technology
Xenotransplantation
25
History of Transplant
Developments in Renal Transplantation
2010s
Grow your own kidney!
26
History of Transplant
How did we get where we are today?
• Teamwork
• Hard work
27
FACULTY OF HEALTH & LIFE SCIENCES – CPD
Institute for Learning & Teaching
Faculty of Health & Life Sciences
Room 2.16A, 4th Floor
Thompson Yates Building
Brownlow Hill
Liverpool
L69 3GB
www.liv.ac.uk/learning-and-teaching/cpd
A MEMBER OF THE RUSSELL GROUP

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