器官移植的发展与未来课件

器官移植的發展與未來器官移植的發展與未來台北榮總 一般外科龍藉泉器官移植的發展與未來台北榮總 一般外科1 1Human chimera,or“homo novo.”Mans original structure has been modified so that he can accept an organ“from elsewhere”Human chimera,or“homo novo.2 2Myth and LegendMyth and Legend3 3Myth and LegendMyth and Legend4 4Myth and LegendMyth and Legend5 5Myth and LegendProf.V.Demikhov and his two-headed dog.photo taken two days after the operation U.S.S.R(1950)Myth and LegendProf.V.Demikho6 6MAIN 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 CENTURYMAIN STEPS IN GRAFT HISTORYTHE7 7FROM GARDEN TO FARMYARDFROM GARDEN TO FARMYARD8 8FROM GARDEN TO FARMYARDFROM GARDEN TO FARMYARD9 919TH CENTURY:ALL FROMS OF GRAFTSBoronios sheep(1804).Successful replacement skin grafts on the back of an ewe.19TH CENTURY:ALL FROMS OF GRA1010Paul Bert next to Claude Bernard,performing a vivisection procedure in his laboratory at the College of France in 1889.Paul Bert next to Claude Berna1111Free split-skin graft on a burn of the shoulder and arm.Free split-skin graft on a bur1212THE KIDNEY:A PILOT ORGANTHE KIDNEY:A PILOT ORGAN1313THE FIRST TRANSPLANTATION IN ANIMAL At the Vienna Medical At 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.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.THE FIRST TRANSPLANTATION IN A1414Dr.Alexis Carrel A magicianDr.Alexis Carrel A magician1515First renal transplantations in man:1906-1913n nIn 1906,Mathieu Jaboulay 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 suffering 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 renal transplantations i1616First transplantation between humans:1933n nIn 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.First transplantation between 1717Serge Voronoff,at the Collge de France.Testicular transplantation from a monkey to man.A retired indian army colonel in fine form after the operation.Serge Voronoff,at the Collge1818The 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 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)The Brigham commando:1947A y1919Paris,Christmas 1952:the present from a mother to her sonMrs Renard and her son Marius to whom she donated a kidney in December 1952.Pelvic implantation of the kidney with restoration of the urinary tract.Paris,Christmas 1952:the pr2020A 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.A real Success:1954John Merr2121Peter Brian Medawar,Nobel Prize in 1960.Rejection was by the action of lymphocytes which described as“immunocomeptent cells“Peter Brian Medawar,Nobel Pri2222MAJOR HISTOCOMPATIBILITY COMPLEX:1952(Jean Dausset,Nobel Prize in 1980)(Human MHC)MAJOR HISTOCOMPATIBILITY COMPL2323Immunosuppression:Total Body Irradiation“Sam”and“Honest John”Immunosuppression:Total Body2424First prolonged survival of renal First prolonged survival of renal transplantation with an unrelated donortransplantation with an unrelated donorMrs Gen and her donor at Foch Hospital in 1960First prolonged survival of re2525Development of Immunosuppressive DrugsMarianne Mattlaer with“Mana”,who received a kidney in 1960 with immunosuppression by azathioprine,with a litter tow years after the transplantation.Development of Immunosuppressi2626Advent of CyclosporineThe primitive fungus from which cyclosporine is extracted(Tolypocladium inflatum)Sir Roy CalneAdvent of CyclosporineThe prim2727Progress in Hemodialysis William J.Kolff,father William J.Kolff,father of the artificial kidney of the artificial kidney and heart.The first and heart.The first artificial kidney artificial kidney designed by Kolff in designed by Kolff in 1945.1945.Progress in Hemodialysis Wil2828Tissue Typing“The centre effect”:Terasaki and statisticsTissue Typing“The centre effec2929Organ PreservationFalkert O.Belzer.The first human kidney preserved on a perfusion machine prior to transplantation in August 1967.Organ PreservationFalkert O.B3030Organ PreservationOrgan Preservation3131Liver TransplantationThomas Starzl in the operating room on March 1,1963,performed the first liver transplantation,the recipient survived five hours after the transplantation.Liver TransplantationThomas St3232Oil painting by Sir Roy Calne(1990)represent a phase of liver transplantation coordinated by the entire surgical team.Oil painting by Sir Roy Calne 3333Pancreas and Intestinal TransplantationRichard LilleheiPancreas and Intestinal Transp3434Heart and Lung TransplantationDenise Darvall,the first human heart”donor”Louis Washkansky,the heart recipient.December 3,1967.Christiaan N.Barnard,cardiovascular surgeon at Capetown.Heart and Lung Transplantation3535Artificial HeartArtificial Heart3636Heart and Lung TransplantationJames D.Hardys 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.Heart and Lung Transplantation3737XenotransplantationThe first blood transfusion from animals to man were attempted in 1628.XenotransplantationThe first b3838XenotransplantationXenotransplantation3939器官移植在臺灣的發展器官移植在臺灣的發展n n腎臟腎臟 1968.05.27 1968.05.27 台大台大 李俊仁李俊仁n n自體骨髓自體骨髓 1983.11.09 1983.11.09 台大台大 陳耀昌陳耀昌n n異體骨髓異體骨髓 1984.03.09 1984.03.09 台大台大 陳耀昌陳耀昌n n肝臟肝臟 1984.03.22 1984.03.22 長庚長庚 陳肇隆陳肇隆n n胰臟胰臟 1984.04.01 1984.04.01 長庚長庚 陳肇隆陳肇隆n n心臟心臟 1987.07.17 1987.07.17 台大台大 朱樹勳朱樹勳n n肺臟肺臟 1991.07.10 1991.07.10 北榮北榮 王良順王良順器官移植在臺灣的發展腎臟 1968.05.4040台灣器官移植之父台灣器官移植之父台灣器官移植之父4141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，台北榮總呼吸加護病房主任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4242How the transplantation is doing?How the transplantation is doi4343How the transplantation is doing?How the transplantation is doi4444SPKTFrom Donor to Recipient From Donor to Recipient From 8 AM to 2 AM 09/20/2019From 8 AM to 2 AM 09/20/2019SPKTFrom Donor to Recipient 4545Liver and Pancreas in Back TableLiver and Pancreas in Back Tab4646Y-graft ReconstructionSMASAEIAIIACIAY-graft ReconstructionSMASAEIA4747Pancreas TransplantationCold/Warm Ischemic Time=452 min/38 minCold/Warm Ischemic Time=452 min/38 minPVDuodenum graftY-graft a.Pancreas graftPancreas TransplantationCold/4848Duodeno-jejunostomy in SPKTPancreasDuodeno-jejunostomy in SPKTPan4949SPKT on 09/19/2019Pancreatico-Duodenal graftKidney graftJejunumSPKT on 09/19/2019Pancreatico-5050First 24 hours Blood Sugar after SPKTFirst 24 hours Blood Sugar aft5151First Month Blood Sugar after SPKTFirst Month Blood Sugar after 5252Renal Function after SPKTRenal Function after SPKT5353SPKT Happy Discharge on 10/09/2019SPKT Happy Discharge on 10/095454Where are we going to?n nImmune Tolerancen nXenograftn nStem Celln nArtificial OrganWhere are we going to?Immune T5555Immune ToleranceImmune Tolerance5656Immune ToleranceImmune Tolerance5757Stem CellsStem Cells5858Stem CellsStem Cells5959Artificial OrganArtificial Organ6060XenotransplantationXenotransplantation6161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美麗新世界的來臨6262器官移植的发展与未来课件6363