ORGAN
TRANSPLANTATION
Definition
Donor
Recipient
Graft
Organs usually transplanted
Tissues, cells usually transplanted
Types of organ donors
HISTORY OF TRASNPLANTATION
HISTORY OF TRANSPLANTATION IN SRI LANKA
Transplantation procedure
Live donor nephrectomy
Organ preservation
Renal transplantation
Donor
Post operative management
RECIPIENT – SURGERY
POST-OPERATIVE CARE
Cadaveric Transplantation
Organ ischemia
Immunological complications
9. Types of organ donors
Live Donor
Deceased / Cadaveric Donor
Donation after brain death (DBD)
All Brain stem functions are absent/ patient on
ventilator support
Donation after cardiac death (DCD)
Patient who has irreversible or an injury
incompatible with life.
Does not fulfill the brain death criteria
10. Types of organ donors
Live Donor
Deceased / Cadaveric Donor
Donation after brain death (DBD)
All Brain stem functions are absent/ patient on
ventilator support
Donation after cardiac death (DCD)
Patient who has irreversible or an injury
incompatible with life.
Does not fulfill the brain death criteria
11. HISTORY OF TRASNPLANTATION
1902 Experimental transplants and
anastomosis techniques in animals -
Alexis Carrel
1954 First successful kidney transplant
1963 First liver transplant
12. HISTORY OF TRANSPLANTATION
IN SRI LANKA
Organ Year Surgeon
Kidney 1985 Prof. A. H. Sheriffdeen
Liver 2010 Prof Mandika Wijeratne
Lungs 2011 Japanese and SL
surgeons
Pancreas (Simult. Panc / Kid) SPK 2016 Dr . Joel Arudchelvam
En bloc Kidney Transplantation 2017 Dr . Joel Arudchelvam
HeartTransplantation 2017 Kandy team
Lower LimbTransplantation 2017 Dr . Joel Arudchelvam
14. Live donor nephrectomy
Lateral decubitus
position
lower costal margin
over the kidney rest
kidney rest is raised
and the operating table
is flexed
15. Live donor nephrectomy
Incision in line with
the 12th rib.
Kidney, ureter,
vessels mobilised
28. Donor
On arrival to the theatre check
Documents
Investigations
Renal angiogram
DTPA
TED stockings
29. Donor Nephrectomy -
Equipment
Ligaclips (medium and large)
Right angle * 3
Silk ties (0 /3-0)
4-0 or 5/0 Polypropylene sutures ,round body /
taper point needle ½ , double arm , 17 mm ( for
R nephrectomy)
Rib spreader
1 PDS
30. Back table - for perfusion
of kidney
Large basin
2 L of sterile slush (prepared by freezing saline and crushing)
Fine needle holder
Mosquitoes * 4
De Bakey * 2
Dissecting scissors
KidneyTray
SilkTies (3-0)
5-0 Prolene sutures
18 G cannula
HTK solution – 1L with perfusion set
31. Donor
Post operative management
D0
IV Fluids
MonitorVital Signs
Monitor IP / OP
D1
Mobilise
Remove catheter
Enoxaparin S/C
Start oral
32. RECIPIENT
On arrival to the theatre check
Documents
Investigations
Immunosuppressive drugs
Basiliximab 20mg IV
Methylprednisolone 1000mg IV on induction
Antibiotics - Cefuroxime 750mg IV or co amoxyclav on
induction
Netilmicin / Gentamicin
TED stockings
33. RECIPIENT - SURGERY
Heparinised saline (2500 units in 500ml N-
saline)
Thompson retractor / bookwalter retractor
5F 0r 4.8F double J stent - 12cm, with guide
wire
34. RECIPIENT - SURGERY
5/ 0 Polypropylene sutures ,round body / taper
point needle ½ or 3/8 circle, double arm , 17 mm * 5
6/0 Polypropylene sutures ,round body / taper
point needle ½ circle,double arm Prolene 13mm needle
* 2
5/0 PDS round body / taper point needle ½ or,double
arm Prolene 17 mm needle * 3
35. RECIPIENT - SURGERY
Prior to re-perfusion of the kidney
125ml of 20% Mannitol (25g) and frusemide
100mg IV
Keep warm saline ready
37. Post operative fluid
replacement protocol
Following live donor renal transplantation
polyuria is common
UOP less than 50 ml/hour - UOP + 40ml of fluid
UOP more than 100 ml/hour give volume to volume
replacement of fluid
UOP more than 500 ml/hour - UOP - 50ml of fluid
UOP more than 1000 ml/hour - UOP -100ml of fluid
38. POST-OPERATIVE CARE
SE, Urea, Creatinine, FBC daily
Analgesics - Fentanyl
Cefuroxime – 750mg IV 8-hourly for 48 hours
Mycophenolate mofetil 1g po bd
Cyclosporin 5mg/kg po bd or tacrolimus
0.05mg/kg po bd.
39. From D1
Mobilise
Immunosuppression [ from D1 to 7]– discuss
with nephrologist
Methylprednisolone or prednisolone daily
Mycophenolate mofetil
Cyclosporin or tacrolimus .
Basiliximab 20mg IV – Day 4.
40. From D1
IV fluids ( N saline) is given to replace urine output until
the oral intake improves to more than 1000mls per day.
Start oral diet from D1
Co-trimoxazole
Valganciclovir
Remove catheter on D5 - discuss with surgeon
Clip removal at 3 weeks
Stent removal at 1 month by urologist
41. Cadaveric Transplantation
Keep Ice ready ( frozen hartmann solution /
Saline, at least 16 and slush ice from OTJ )
Back table ready when kidney arrives
44. Immunological complications
Hyperacute -
Occur due to the pre- existing antibodies
Occurs soon after the organ is reperfused.
Due to ABO incompatibility / pre-existing HLA
antibodies.
Acute rejection –
3 to 5 days following transplantation
The immune system newly recognises the graft
Generally T cell mediated (acute cellular rejection)
sometimes due to antibodies (acute humoral
rejection)
46. Rejection diagnosis
How to recognise
Deteriorating renal function
Evidence of increased resistance to blood flow
within the kidney – increased RI
Confirmation renal biopsy