器官移植的发展与未来.ppt

器官移植的發展與未來,台北榮總一般外科龍藉泉,Humanchimera,or“homonovo.”Mansoriginalstructurehasbeenmodifiedsothathecanacceptanorgan“fromelsewhere”,MythandLegend,MythandLegend,MythandLegend,MythandLegend,Prof.V.Demikhovandhistwo-headeddog.phototakentwodaysaftertheoperation,U.S.S.R(1950),MAINSTEPSINGRAFTHISTORY,THEPLANTGRAFT:VERYEARLYINMANSHISTORYTHEANIMALGRAFT:18THCENTRURYTHEHUMANGRAFT:18THCENTURYORGANTRANSPLANTATION:20THCENTURY,FROMGARDENTOFARMYARD,FROMGARDENTOFARMYARD,19THCENTURY:ALLFROMSOFGRAFTS,Boroniossheep(1804).Successfulreplacementskingraftsonthebackofanewe.,PaulBertnexttoClaudeBernard,performingavivisectionprocedureinhislaboratoryattheCollegeofFrancein1889.,Freesplit-skingraftonaburnoftheshoulderandarm.,THEKIDNEY:APILOTORGAN,THEFIRSTTRANSPLANTATIONINANIMAL,AttheViennaMedicalSocietymeetingheldinJanuary1902,thesurgeonEmerichUllmannreportedthefirstcaseofrenaltransplantationperformedintheneckofadog.Theureter,broughtouttotheskin,oozeda“liquidwhichresembleurine”overaperiodoffivedays.,Dr.AlexisCarrelAmagician,Firstrenaltransplantationsinman:1906-1913,In1906,MathieuJaboulayperformedrenaltransplantationinman.Hetransplantedtheleftkidneyofapig,killed3hourspreviously,intotheleftelbowofawomansufferingfromnephroticsyndrome.Thegraftremovedonthethirddayandthevesselswerefoundtobeobstructedbyclots.,Firsttransplantationbetweenhumans:1933,In1933,therussiansurgeonVoronoy(1896-1961)performedthefirsthomologousrenaltransplantationinmanusingahumancadaverkidney.,SergeVoronoff,attheCollgedeFrance.Testiculartransplantationfromamonkeytoman.Aretiredindianarmycolonelinfineformaftertheoperation.,TheBrighamcommando:1947,Ayoungwomanwasinprofoundcomawithanuriafor10daysfollowinganabortioncomplicatedbyacutetubulopathyduetosepticshockandincompatibletransfusion.,DavidM.Hume(1917-1973),Paris,Christmas1952:thepresentfromamothertoherson,MrsRenardandhersonMariustowhomshedonatedakidneyinDecember1952.Pelvicimplantationofthekidneywithrestorationoftheurinarytract.,ArealSuccess:1954,JohnMerrillandJosephMurry(NobelPrize1991)attheBrighamin1953,Firstsusccessfultransplantationbetweentwoidenticaltwinsin1954bytheMurry,MerrillandHarrisonteam.,PeterBrianMedawar,NobelPrizein1960.,Rejectionwasbytheactionoflymphocyteswhichdescribedas“immunocomeptentcells“,MAJORHISTOCOMPATIBILITYCOMPLEX:1952,(JeanDausset,NobelPrizein1980),(HumanMHC),Immunosuppression:TotalBodyIrradiation,“Sam”and“HonestJohn”,Firstprolongedsurvivalofrenaltransplantationwithanunrelateddonor,MrsGenandherdonoratFochHospitalin1960,DevelopmentofImmunosuppressiveDrugs,MarianneMattlaerwith“Mana”,whoreceivedakidneyin1960withimmunosuppressionbyazathioprine,withalittertowyearsafterthetransplantation.,AdventofCyclosporine,Theprimitivefungusfromwhichcyclosporineisextracted(Tolypocladiuminflatum),SirRoyCalne,ProgressinHemodialysis,WilliamJ.Kolff,fatheroftheartificialkidneyandheart.ThefirstartificialkidneydesignedbyKolffin1945.,TissueTyping,“Thecentreeffect”:Terasakiandstatistics,OrganPreservation,FalkertO.Belzer.ThefirsthumankidneypreservedonaperfusionmachinepriortotransplantationinAugust1967.,OrganPreservation,LiverTransplantation,ThomasStarzlintheoperatingroomonMarch1,1963,performedthefirstlivertransplantation,therecipientsurvivedfivehoursafterthetransplantation.,OilpaintingbySirRoyCalne(1990)representaphaseoflivertransplantationcoordinatedbytheentiresurgicalteam.,PancreasandIntestinalTransplantation,RichardLillehei,HeartandLungTransplantation,DeniseDarvall,thefirsthumanheart”donor”,LouisWashkansky,theheartrecipient.December3,1967.,ChristiaanN.Barnard,cardiovascularsurgeonatCapetown.,ArtificialHeart,HeartandLungTransplantation,JamesD.Hardysteam,performedthefirsthumanlungtransplantationonJune11,1963,sevenandahalfmonthsbeforetheyperformedthefirsthumanheterologushearttransplantation.,Xenotransplantation,Thefirstbloodtransfusionfromanimalstomanwereattemptedin1628.,Xenotransplantation,器官移植在臺灣的發展,腎臟1968.05.27台大李俊仁自體骨髓1983.11.09台大陳耀昌異體骨髓1984.03.09台大陳耀昌肝臟1984.03.22長庚陳肇隆胰臟1984.04.01長庚陳肇隆心臟1987.07.17台大朱樹勳肺臟1991.07.10北榮王良順,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,Howthetransplantationisdoing?,Howthetransplantationisdoing?,SPKTFromDonortoRecipientFrom8AMto2AM09/20/2003,LiverandPancreasinBackTable,Y-graftReconstruction,SMA,SA,EIA,IIA,CIA,PancreasTransplantationCold/WarmIschemicTime=452min/38min,PV,Duodenumgraft,Y-grafta.,Pancreasgraft,Duodeno-jejunostomyinSPKT,Pancreas,SPKTon09/19/2003,Pancreatico-Duodenalgraft,Kidneygraft,Jejunum,First24hoursBloodSugarafterSPKT,FirstMonthBloodSugarafterS