器官移植的发展与未来byfq.pptx

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1、器官移植的發展與未來器官移植的發展與未來台北榮總台北榮總 一般外科一般外科龍藉泉龍藉泉Human chimera,or“homo novo.”Mans original structure has been modified so that he can accept an organ“from elsewhere”Myth and LegendMyth and LegendMyth and LegendMyth and LegendProf.V.Demikhov and his two-headed dog.photo taken two days after the operation U

2、.S.S.R(1950)MAIN STEPS IN GRAFT HISTORYn nTHE PLANT GRAFT:VERY EARLY IN MANS HISTORYn nTHE ANIMAL GRAFT:18TH CENTRURYn nTHE HUMAN GRAFT:18TH CENTURYn nORGAN TRANSPLANTATION:20TH CENTURYFROM GARDEN TO FARMYARDFROM GARDEN TO FARMYARD19TH CENTURY:ALL FROMS OF GRAFTSBoronios sheep(1804).Successful repla

3、cement skin grafts on the back of an ewe.Paul Bert next to Claude Bernard,performing a vivisection procedure in his laboratory at the College of France in 1889.Free split-skin graft on a burn of the shoulder and arm.THE KIDNEY:A PILOT ORGANTHE FIRST TRANSPLANTATION IN ANIMAL At the Vienna Medical At

4、 the Vienna Medical Society meeting held in Society meeting held in January 1902,the January 1902,the surgeon Emerich surgeon Emerich Ullmann reported the Ullmann reported the first case of renal first case of renal transplantation transplantation performed in the neck performed in the neck of a dog

5、.The ureter,of a dog.The ureter,brought out to the skin brought out to the skin,oozed a“liquid which,oozed a“liquid which resemble urine”over a resemble urine”over a period of five days.period of five days.Dr.Alexis Carrel A magicianFirst renal transplantations in man:1906-1913n nIn 1906,Mathieu Jab

6、oulay performed renal In 1906,Mathieu Jaboulay performed renal transplantation in man.transplantation in man.n nHe transplanted the left kidney of a pig,He transplanted the left kidney of a pig,killed 3 hours previously,into the left elbow killed 3 hours previously,into the left elbow of a woman suf

7、fering from nephrotic of a woman suffering from nephrotic syndrome.syndrome.n nThe graft removed on the third day and the The graft removed on the third day and the vessels were found to be obstructed by vessels were found to be obstructed by clots.clots.First transplantation between humans:1933n nI

8、n 1933,the russian surgeon Voronoy(1896-1961)In 1933,the russian surgeon Voronoy(1896-1961)performed the first homologous renal performed the first homologous renal transplantation in man using a human cadaver transplantation in man using a human cadaver kidney.kidney.Serge Voronoff,at the Collge de

9、 France.Testicular transplantation from a monkey to man.A retired indian army colonel in fine form after the operation.The Brigham commando:1947n nA young woman was in A young woman was in profound coma with profound coma with anuria for 10 days anuria for 10 days following an abortion following an

10、abortion complicated by acute complicated by acute tubulopathy due to tubulopathy due to septic shock and septic shock and incompatible incompatible transfusion.transfusion.David M.Hume(1917-1973)Paris,Christmas 1952:the present from a mother to her sonMrs Renard and her son Marius to whom she donat

11、ed a kidney in December 1952.Pelvic implantation of the kidney with restoration of the urinary tract.A real Success:1954John Merrill and Joseph Murry(Nobel Prize 1991)at the Brigham in 1953First susccessful transplantation between two identical twins in 1954 by the Murry,Merrill and Harrison team.Pe

12、ter Brian Medawar,Nobel Prize in 1960.Rejection was by the action of lymphocytes which described as“immunocomeptent cells“MAJOR HISTOCOMPATIBILITY COMPLEX:1952(Jean Dausset,Nobel Prize in 1980)(Human MHC)Immunosuppression:Total Body Irradiation“Sam”and“Honest John”First prolonged survival of renal F

13、irst prolonged survival of renal transplantation with an unrelated donortransplantation with an unrelated donorMrs Gen and her donor at Foch Hospital in 1960Development of Immunosuppressive DrugsMarianne Mattlaer with“Mana”,who received a kidney in 1960 with immunosuppression by azathioprine,with a

14、litter tow years after the transplantation.Advent of CyclosporineThe primitive fungus from which cyclosporine is extracted(Tolypocladium inflatum)Sir Roy CalneProgress in Hemodialysis William J.Kolff,father William J.Kolff,father of the artificial kidney of the artificial kidney and heart.The first

15、and heart.The first artificial kidney artificial kidney designed by Kolff in designed by Kolff in 1945.1945.Tissue Typing“The centre effect”:Terasaki and statisticsOrgan PreservationFalkert O.Belzer.The first human kidney preserved on a perfusion machine prior to transplantation in August 1967.Organ

16、 PreservationLiver TransplantationThomas Starzl in the operating room on March 1,1963,performed the first liver transplantation,the recipient survived five hours after the transplantation.Oil painting by Sir Roy Calne(1990)represent a phase of liver transplantation coordinated by the entire surgical

17、 team.Pancreas and Intestinal TransplantationRichard LilleheiHeart and Lung TransplantationDenise Darvall,the first human heart”donor”Louis Washkansky,the heart recipient.December 3,1967.Christiaan N.Barnard,cardiovascular surgeon at Capetown.Artificial HeartHeart and Lung TransplantationJames D.Har

18、dys team,performed the first human lung transplantation on June 11,1963,seven and a half months before they performed the first human heterologus heart transplantation.XenotransplantationThe first blood transfusion from animals to man were attempted in 1628.Xenotransplantation器官移植在臺灣的發展器官移植在臺灣的發展n n

19、腎臟腎臟腎臟腎臟 1968.05.27 1968.05.27 1968.05.27 1968.05.27 台大台大台大台大 李俊仁李俊仁李俊仁李俊仁n n自體骨髓自體骨髓自體骨髓自體骨髓 1983.11.09 1983.11.09 1983.11.09 1983.11.09 台大台大台大台大 陳耀昌陳耀昌陳耀昌陳耀昌n n異體骨髓異體骨髓異體骨髓異體骨髓 1984.03.09 1984.03.09 1984.03.09 1984.03.09 台大台大台大台大 陳耀昌陳耀昌陳耀昌陳耀昌n n肝臟肝臟肝臟肝臟 1984.03.22 1984.03.22 1984.03.22 1984.03.22

20、長庚長庚長庚長庚 陳肇隆陳肇隆陳肇隆陳肇隆n n胰臟胰臟胰臟胰臟 1984.04.01 1984.04.01 1984.04.01 1984.04.01 長庚長庚長庚長庚 陳肇隆陳肇隆陳肇隆陳肇隆n n心臟心臟心臟心臟 1987.07.17 1987.07.17 1987.07.17 1987.07.17 台大台大台大台大 朱樹勳朱樹勳朱樹勳朱樹勳n n肺臟肺臟肺臟肺臟 1991.07.10 1991.07.10 1991.07.10 1991.07.10 北榮北榮北榮北榮 王良順王良順王良順王良順台灣器官移植之父台灣器官移植之父台灣肺臟移植的先驅王良順教授，台北榮總呼吸加護病房主任王良順教授

21、，台北榮總呼吸加護病房主任How the transplantation is doing?How the transplantation is doing?SPKTFrom Donor to Recipient From Donor to Recipient From 8 AM to 2 AM 09/20/2003From 8 AM to 2 AM 09/20/2003Liver and Pancreas in Back TableY-graft ReconstructionSMASAEIAIIACIAPancreas TransplantationCold/Warm Ischemic Ti

22、me=452 min/38 minCold/Warm Ischemic Time=452 min/38 minPVDuodenum graftY-graft a.Pancreas graftDuodeno-jejunostomy in SPKTPancreasSPKT on 09/19/2003Pancreatico-Duodenal graftKidney graftJejunumFirst 24 hours Blood Sugar after SPKTFirst Month Blood Sugar after SPKTRenal Function after SPKTSPKT Happy Discharge on 10/09/2003Where are we going to?n nImmune Tolerancen nXenograftn nStem Celln nArtificial OrganImmune ToleranceImmune ToleranceStem CellsStem CellsArtificial OrganXenotransplantation美麗新世界的美麗新世界的來臨來臨總是需要更多總是需要更多的心的心去參與去參與