Indications for organ transplantation

Transplantology is a branch of medicine that studies the problems of organ transplantation (in particular, kidneys, liver, heart), as well as the prospects of creating artificial organs.

Transplantation – in medicine transplantation of any organ or tissue, for example, kidney, heart, liver, lung, bone marrow, stem hemopoietic cells, hair.

The organism from which organs or tissues are taken for transplantation is called a donor.

The organism to which tissues or organs are transplanted is called a recipient.

To denote the transplantation of a transplant, the term “re-transplantation” is used.

There are experimental and clinical transplantation. Experimental transplantation is necessary as a preclinical stage of development of all biological, surgical and organizational problems of transplantation of certain organs or tissues. In the experiment, almost all tissues and organs are transplanted. Experimental transplantation is necessary for further study of immune reactions on the part of the recipient after transplantation of donor organs and tissues. Experimental transplantation is extremely important for the development of new drugs (cyclosporine), which facilitate normal adaptation of transplanted genetically distinct organs and tissues.

History of transplantation

The founder of the experimental transplantation of vital organs, in particular the heart, is Alexis Carrel, awarded in 1912 for this Nobel Prize. He carried out research on organ transplantation in the experiment, their conservation and technique of superimposition of vascular anastomoses. He developed the basic principles of conservation of the donor organ, its perfusion.

The first organ transplantation from person to person in 1933 in Kherson was performed by Yu. Yu. Voronoi. One of the founders of Russian transplantology is the Russian scientist VP Demikhov, who in 1951 developed in detail the transplantation of a donor heart to a dog. December 3, 1967, a surgeon from South Africa, Christian Barnard, after pre-training at Demikhov, as well as in a number of world surgical clinics, for the first time in the world successfully transplanted the heart to a man in Cape Town. Barnard considered Demikhov his teacher, twice visited his laboratory. However, unlike Barnard, who gained world fame, Vladimir Petrovich died in poverty, in a communal apartment. Since then, more than 40,000 such operations have been done. In the USSR, the first heart transplant was performed on November 4, 1968 by the chief surgeon of the Soviet Army, Aleksandr Aleksandrovich Vishnevsky, and the first successful transplant was the outstanding surgeon, Academician of the Russian Academy of Sciences Valery Ivanovich Shumakov March 12, Currently, his name is the Institute of Transplantology and Artificial Organs in Moscow, considered the head institution of the Russian Federation in the field of clinical and experimental transplantology.

The first successful kidney transplant was performed in December 1954 between two identical twin brothers by a group of doctors led by Joseph Murray. Joseph Murray continued the research and achieved the possibility of kidney transplantation from an unrelated donor, and also examined the properties of immunosuppressants and the mechanism of rejection. The first liver transplantation was performed in 1956 by Thomas Starzl. Lung transplantation was first carried out in 1963 by Dr. James Hardy at the clinic of the University of Mississippi, but the patient died a few days after the operation. Successful transplantation of one lung succeeded Joel Cooper in 1983, he also in 1986 carried out a successful transplantation of two lungs.

In June 2008, the first transplant of a human organ, grown from stem cells, was conducted by Professor Paolo Machiarini in the clinic of Barcelona. The patient was an adult woman whose trachea was affected by tuberculosis. Trachea was created using a complex technology: physicians used the trachea of a recently deceased person, neutralized the living cells with chemical preparations and injected stem cells from the patient’s bone marrow into fibrous protein tissue. These cells developed four days in a special bioreactor, after which the trachea was ready for transplantation. A month later the blood supply of the transplanted organ was completely restored.

Modern efficiency of transplantation

Medicine develops to protect and restore people’s health. With the development of Transplantology, the most hopeless patients received a chance to escape. Assistance is free Chief transplantologist of the Ministry of Health of Russia, head of the FNTS Transplantology and Artificial Org. Shumakova S. V. Gauthier defines donation in such a way that it should not cause any damage to health, this is the basis for all lifetime donation, otherwise it is better not to do it.

The guard of organs in Russia is not only the laws of the Russian Federation, but also an international convention. No one is immune from the fact that citizens will not travel to another country as donors or recipients.

At the beginning of the XXI century transplantations often have a positive result under the condition of using modern immunosuppressive agents, especially cyclosporine and glucocorticoids, and also compatibility of donor and recipient organs

Kidney transplantation

In a kidney transplant, a short-term positive result is observed in approximately 75% of patients with an irreversible loss of renal function.

Liver transplantation

Liver transplants successfully function for 1 year in 70-80% of cases.

Heart transplant

Successful functioning of the transplant during the year is noted in 70% of recipients.

Some patients with a transplanted heart live for 20 years, in Russia the maximum duration is about 17 years. Statistics are as follows: the first year after the operation, 90% of patients successfully overcome, five years live about 70%, ten years – about half. This is a lot, considering that all of them were doomed before the transplant.

Pancreas transplantation

The number of successful transplants of the pancreas reaches 70-80% of cases. Recently, attempts are being made to transplant patients with life-threatening type 1 diabetes mellitus who are extracted from the donor glands by special methods responsible for the production of insulin cells from the islets of Langerhans. To overcome the rejection reactions, the transplanted cells are trying to isolate the transplanted cells from the immune system of the recipient, which is realized in the implantable “bio-artificial pancreas”, being developed in Israel at the stage of clinical trials. For more information on transplanting the islets of Langerhans, see Islet Cell Transplantation.

Contraindications to transplantation

Absolute and relative contraindications to organ transplantation

The word transplantology comes from the Latin “transplantare” – transplanted. By the beginning of the 20th century, the prerequisites for organ transplantation had been created. Anatomy, physiology were well studied and the possibility of their survival outside the body was proved, the problem of cross-linking vessels, aseptic problems, antiseptics and anesthesia were solved.

There are the following types of transplantation: allotransplantation – transplantation of organs and tissues from one person to another by the principle of compatibility. Autotransplantation involves a transplant within one organism. Xenotransplantation – transplantation of organs, tissues and cells of animals to humans.

The main sources of donor organs can be: deceased, who have been diagnosed with brain death, donors with a confirmed biological death, living persons who are with the recipient in a genetic relationship.

Donor organs are removed from the body of the deceased by a whole complex. The essence of multi-organ donation is that the maximum number of different organs that can be transplanted to several recipients should be collected. First, the heart and lungs are removed, then the liver and pancreas, kidneys.

The organs that can be obtained from a living donor without causing damage to health are the kidney, liver fragments, the distal fragment of the pancreas, a fragment of the pancreas, and the lobe of the lung. The undeniable advantage of transplantation from a living donor is the possibility of scheduling the operation depending on the condition of the recipient, a higher quality of the transplant.

Indications for transplantation are specific for a particular organ. But contraindications have a certain generality. They are absolute and relative.

Absolute contraindications include: not amenable to medical treatment violations of vital organs; presence of infectious processes, tuberculosis, AIDS, oncological diseases outside the organ to be transplanted.

Relative contraindications, which obviously complicate the technical performance of the operation, are considered relative.

In order to avoid rejection of the donor organ, lifelong immunosuppressive therapy is carried out later. The choice of the scheme of immunosuppressive treatment depends on the quality of the donor organ, the coincidence of the blood group and tissue compatibility. In parallel, the prevention of complications provoked by this therapy should be carried out.

After a human organ transplantation a long period of rehabilitation is awaited, it will be necessary to abandon bad.

III. Conclusion