Transcript Titel

Der Einfluss der norditalienischen
Universitäten auf die Entwicklung
der Chirurgie in Innsbruck
R. Margreiter
Univ.-Klinik für Visceral-, Transplantations- und Thoraxchirurgie
Department für Operative Medizin
Medizinische Universität Innsbruck
Tirolisch-Venezianisch-Lombardische Chirurgenvereinigung, Schloss Maretsch, 26.6.2008
Hippolytus Guarinonius
(1571-1654)
1. namhafter Arzt in Tirol
1593-1597: Medizinstudium in Padua
1598:
Hausarzt am Damenstift in Hall
1601:
Stadtmedikus in Hall
1609:
Arzt der Bergwerkstrupppen
Hieronymus Leopold Bacchettoni
1724/25: Medizinstudium in Padua und Bologna
1726:
Promotion zum Doktor der Medizin in
Innsbruck
1736:
1. Lehrstuhl für Chirurgie in der
Habsburger Monarchie
Karl Anton Gerstner
(1713-1797)
Medizinstudium in Padua bei Giovanni
Battista Morgani
1741: 1. Lehrstuhl für Pathologie und Praxis
Die Geschichte der
Transplantationsmedizin
Tirolisch- Venezianisch- Lombardische Chirurgenvereinigung, Schloss Maretsch, 26.6.2008
The history of renal transplantation
Experimental
~1895 A.v. Lexer
1899 A.v.
DecastelloRechtwehr
1902 E. Ullmann
1905 A. Carrel,
C.C. Guthrie
1907 R. Stich
first attempt
partial success
first successful renal Tx
vascular anastomoses
uretero-neocystostomy
Alfred von Lexer ~1895
Vienna
Early vascular thrombosis?
Lesky E: Münch. Med. Wschr. 116, 1081 (1974)
Alfred von Decastello-Rechtwehr 21.12.1899
Vienna
1200 cc urine, died after 40 hours (hemorrhage)
Decastello Av: Wien. Klin. Wschr. 15, 317 (1902)
The history of renal transplantation
Experimental
~1895 A.v. Lexer
1899 A.v. DecastelloRechtwehr
1902 E. Ullmann
1905 A. Carrel,
C.C. Guthrie
1907 R. Stich
first attempt
partial success
first successful renal Tx
vascular anastomoses
uretero-neocystostomy
Emerich Ullmann
Vienna
7 March 1902: Report on first
successful kidney
transplant
autotransplant to neck-vessels (dog)
cuff technique
function for 5 days
Ullmann E: Wien. Klin. Wschr. 11,281 (1902)
The history of renal transplantation
Experimental
~1895 A.v. Lexer
1899 A.v. DecastelloRechtwehr
1902 E. Ullmann
1905 A. Carrel,
C.C. Guthrie
1907 R. Stich
1924 Avramovici
first attempt
partial success
first successful renal Tx
vascular anastomoses
uretero-neocystostomy
preservation
Alexis Carrel
1905
renal transplants with
vascular
anastomoses
Carrel A: Science 22, 473 (1905)
The history of renal transplantation
Experimental
~1895 A.v. Lexer
1899 A.v. DecastelloRechtwehr
1902 E. Ullmann
1905 A. Carrel,
C.C. Guthrie
1907 R. Stich
first attempt
partial success
first successful renal Tx
vascular anastomoses
uretero-neocystostomy
R. Stich
1907
autotransplants
uretero-neocystostomy
Stich R: Arch. Klin. chir. 83, 494 (1907)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
M. Jaboulay
24.01.1906:
09.04.1906:
pig kidney > 48y female
goat kidney > 50y female
Implantation site: elbow
function: no
died after 3 and 9 days
Jaboulay M: Lyon Med. 107, 575 (1906)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
Ernst Unger
1910
en bloc subhuman primate kidneys >
female 21y
implantation site:
tigh
function:
no
outcome:
died after 32 hours
Unger E: Berl. Klin. Wschr. 573: 13 (1910)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
M. Neuhof
1923
sheep kidney > 48y male
function: no
outcome: died day 9
Neuhof H: Transplantation of tissues,
Appleton, New York (1923)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
Yuri Voronoy
1933
donor:
recipient:
trauma victim, blood group „B“
37y male, blood group „0“
mercury poisoning
warm ischemia: 6 hours
implantation site: tigh
function:
no
outcome:
died after 48 hours
4 further transplants
Hamilton D.N.H., Reid W.A: YoYo Voronoy and the first human
kidney allograft: Surg. Gyn. Obst. 159,289 (1954)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
Landsteiner, Hufnagel
1945
recipient:
36y female, acute renal failure
implementation site: elbow
function:
no
outcome:
survived
graft removed after 48 hours
Cited: Hume D.M.: J. Clin. Invest. 34, 327 (1955)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
R.H. Lawler et al
17.6.1950
donor:
woman 49y – blood group: „AB“
hemorrhages from esophageal varices
recipient: woman 44y – blood group: „AB“
polycystic kidney disease (Cr. 1.8 mg%)
implantation site: orthotopic, left
ureteroureterostomy
function: yes
outcome: Cr. 1.2 mg%
no function at month 9
R.H. Lawler et al: JAMA 144, 844 (1950)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
R. Küss
C. Dubost
U. Servelle
„The „free kidneys‘ in those days came
from children with hydrocephalos, who
had one kidney removed (Matson‘s
procedure) to use the ureter from
drainage of the catheter from the brain.“
1951 live donors
implantation site: iliac fossa
function: partial
outcome: no longterm survivor
Küss R. et al: Mem. Acad. Chir. 77, 755 (1951)
Dubost C. et al: Bull. Soc. Med. Hop. Paris 67, 1372 (1951)
Sevelle U. et al: Bull. Soc. Med. Hop. Paris 67, 99 (1951)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
D.M. Hume
(1917-1973)
1952-1953
10 transplants
implantation site:tigh
life sustaining function
for 6 months
Hume D.M. et al: J. Clin. Invest. 34,
327 (1955)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
L. Michon
1953
donor:
recipient:
function:
outcome:
mother
male 16y
22 days
died day 23
Michon L et al: Presse Med. 61: 1419 (1953)
History of Kidney Transplantation
1906
M. Jaboulay
1st Xenotransplantation
1910
E. Unger
monkey kidneys en bloc
1923
H. Neuhof
sheep kidneys
1933-1949
Y. Voronoy
1st allotransplantation
1945
Landsteiner, Hufnagel
acute kidney failure
1950
R.H. Lawler
partial success
1951
R. Küss
Iive donors
1951
C. Dubost
iliac implantation
1951
U. Servelle
cutaneous ureterostomy
1952-1953
D.M. Hume
16 months function
1953
L. Michon
living donation
1954
J. Murray
1st long-term survivor
J. Murray
23/12/1954
donor:
monozygotic twin
implantation site: iliac fossa
uretero-neocystostomy
function:
excellent
outcome:
died at 8 years
(myocardial infarction)
First Successfull Kidney Transplant
December 23rd, 1954
History of pancreas transplantation
Year
1852
1927
27.12.1967
1973
1978
1982
Author
Minkowski
Gayet, Giullaumie
Kelly, Lillehei
Gliedmann
Dubernard
Sollinger
Sutherland
Type of TX
Pancreatic tissue
Pancreas (dog)
Pancreas (clinical)
Urinary tract drainage
Duct occlusion
Bladder drainage
international registry
Minneapolis 2006
Mrs Lillehei 2006
History of Liver Transplantation
1955 Welch
1958 Starzl
Moore
1963 Starzl
1983 Margreiter
1984 Bismuth
1989 Pichlmayr
1989 Raia
1990 Pichlmayr
experimental, auxiliary
experimental, orthotopic
clinical orthotopic
combined liver-kidney
segmental transplantation
splitting
living donor
APOLT
1st Liver Transplantation
March 1st 1963
TE. Starzl
1st Liver Transplantation in Europe
R. Calne
May 2nd 1968
46-year old female with HCC
survived for 11 weeks (HAT)
Innsbruck
First combined Liver-Kidney Transplant
December 5th 1983
Combined Liver and
Kidney Transplantation
Margreiter R, Kramar R, Huber C,
Steiner E, Niederwieser D, Judmaier G,
Vogel W
Lancet, 330: 1077-1078, 1984
Hannover
Liver Splitting
Hannover
Auxiliary Partial Orthotopic Liver Transplantation
History of Heart Transplantation
Year
1905
1933
1949
1959
Author
Carrel, Guthrie
Mann
Demikhov
Cass, Brock
Type of TX
first experiments
exp. heterotopic
Experimental
atria remain with
recipient
1960
Lower, Shumway first long term surviving
dogs
23.1.1964 Hardy J.
clinical – xeno
2.12.1967 Barnard
clinical – allo
1969
Barnard
clinical-heterotopic
Vladimir Demikhov
(1916-1998)
First Human
Heart Transplant
January 27, 1964
1st Heart Allotransplantation
First Heart Allotransplant
Philipp Bleiberg
1st long-term
survivor
History of Lung and Heart-Lung
Transplantation
1949 Demikhov
heart-lung experimental
1951 Junelle
lung auto experimental
1963 Hardy
single lung clinical
1968 Cooley
heart-lung clinical
1968 Derom
single lung
1981 Reitz
heart-lung clinical successful
1st Lung Transplant Recipient
June 1963
1st successfull Lung Transplant
14.11.1968
Fritz Derom
Joel Cooper
1981
1st successfull Heart-Lung Transplant
March 9, 1981
History of Intestinal Transplantation
1959
Lillehei
small bowel experimental
1960
Starzl
multivisceral experimental
1967
Lillehei
small bowel clinical
1983
Starzl
multivisceral clinical
1988
Deltz
1st successful small bowel
1989
Margreiter 1st successful multivisceral
1990
Grant
1st liver intestine
• Starzl, Calne MGT in
reith
First Combined Liver-Intestinal
Transplantation
13.11.1988 London (Ontario) D. Grant
41 year-old woman
with short-gut syndrome
due to antithrombin III deficiency
IS: OKT3-CyA-Aza-Ster
Grant D, Wall W, Mimerault R et al: Succesful small bowel-liver
transplantation.
Lancet 1990; 335, 181-184.
History of
Multivisceral Transplantation
Year
Centre
Age Sex Patient
Survival
Cause of
Death
1983
Pittsburgh
6,8
f
30 hours
exsanguination
1986
Chicago
1,4
m
4 days
exsanguination
1987
Pittsburgh
3,5
f
192 days
lymphoma
1988
Chicago
0,7
m
109 days
lymphoma
49
m
9 months
tumor
recurrence
f
6,5
months
lymphoma
26.12.1989 Innsbruck
1990
London, Ont 27
First Successfull Multivisceral
Transplantation
History of Composite Tissue
Transplantation
1965
Sept 1998
Colombia
Dubernard
Jan 2000
17.02.2003
30.11.2005
Dubernard
Innsbruck
Devauchelle
Dubernard
single hand
first successfull
single hand
double hand
double forearm
partial face
1st Successfull Hand Transplantation
1st Double Forearm Transplant
1st Partial Face Transplant