Transcript History of Transplantation

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)
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History of Transplant
Organ Transplantation – The Past
1906
First human kidney transplant - xenograft
Mathieu Jaboulay (1860 – 1913)
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History of Transplant
Organ Transplantation – The Past
1930s
First human kidney transplant – allograft
Yu Yu Voronov (1895 – 1961)
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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)
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History of Transplant
Developments in Renal Transplantation
1940s
Rejection
defined
(Medawar
and Gibson)
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History of Transplant
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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)
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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
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History of Transplant
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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)
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History of Transplant
Developments in Renal Transplantation
1960s
Sir Ron Calne (1930 – )
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History of Transplant
Developments in Renal Transplantation
1960s
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History of Transplant
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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
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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
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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
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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
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History of Transplant
Developments in Renal Transplantation
Diagnostic aids
Radioisotape
scan
Ultrasound
scan
Core biopsy
Angiography
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History of Transplant
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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
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History of Transplant
Developments in Renal Transplantation
Interventional radiology
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History of Transplant
Developments in Renal Transplantation
Interventional radiology
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History of Transplant
Organ Transplantation – The Future
Tolerance
Stem cell technology
Xenotransplantation
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History of Transplant
Developments in Renal Transplantation
2010s
Grow your own kidney!
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History of Transplant
How did we get where we are today?
• Teamwork
• Hard work
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A MEMBER OF THE RUSSELL GROUP