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25 - Basic outline of solid organ transplantation

Mathew Jacob
Affiliation:
Freeman Hospital, UK
Jeremy French
Affiliation:
Freeman Hospital, UK
Derek Manas
Affiliation:
Freeman Hospital, UK
Vish Bhattacharya
Affiliation:
Queen Elizabeth Hospital
Gerard Stansby
Affiliation:
Freeman Hospital
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Summary

Key points

  • Solid organ transplantation is now commonplace and is the standard of care for patients with end-stage organ failure

  • Indications have changed over time and there are few absolute contraindications

  • Equity of access to transplant waiting lists is paramount and selecting the correct recipient and donor pair will optimise the outcome

  • The surgical techniques for all organ transplantation are now well established and standardized and as a result there has been a year-on-year improvement in 1-year survival. Most recipeints die because of co-morbidity or poor organ function

  • Live donor transplantation for both kidney and liver recipients has become an extremely important source of donor organs

  • Complications are general to surgical patients but indeed each organ has its own specific risks

  • Immunosuppression has advanced hugely over the past 10 years and, as a result, the overall attrition rate due to acute rejection has reduced considerably

  • The biggest problem facing transplantation today is the donor shortage. In 2008, the organ donor taskforce set up by the Minister of Health has set out a plan to increase donation by 50%

  • Until this happens, transplantation will always have to deal with the ethical dilemmas of allocation, utilization and fairness

Introduction

Solid organ (liver, pancreas and kidney) transplantation is an important treatment modality for end-stage organ failure. Indeed if a vital organ such as the liver fails, transplantation is the only management option currently available.

Organ transplantation increases life expectancy and quality of life (for the recipient and their family), but is not without risk.

Type
Chapter
Information
Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 298 - 316
Publisher: Cambridge University Press
Print publication year: 2011

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References

Devlin, J, O'Grady, J.Indications for referral and assessment in adult liver transplantation: a clinical guideline. British Society of Gastroenterology. Gut 1999; 45 Suppl 6: VI1–VI22.CrossRefGoogle ScholarPubMed
Neuberger, J, Davies, Gimson A et al. and Liver Advisory Group; UK Blood and Transplant. Selection of patients for liver transplantation and allocation of donated livers in the UK. Gut 2008; 57: 252–7.CrossRefGoogle ScholarPubMed
Veatch, RM. Transplantation Ethics. Washington, DC: Georgetown University Press 2000.Google Scholar
,British Transplant Society. Standards for solid organ transplantation, 2003. http://www.bts.org.uk/Forms/standards%20document%20edition%202%20-%20final.pdf (accessed 1 March 2010).
,Forsythe JLR. Transplantation – A Companion to Specialist Surgical Practice, 3rd edn. Philadelphia, PA: Elsevier Saunders, 2005.Google Scholar
,United network for organ sharing. http://www.unos.org/ (accessed 1 March 2010).
The Practice of Liver Transplantation. Oxford: W.B. Saunders, 1995.
Talbot, D, D'Alessandro A. Organ Donation and Transplantation after Cardiac Death. New York: Oxford University Press, 2009.CrossRefGoogle Scholar
Clavier, P-A, Petrowsky, H, OeOlveira, ML, Graf, R.Strategies for safer liver surgery and partial liver transplantation. NEJM 2007; 356: 1545–59.CrossRefGoogle Scholar
Neuberger, J, James, O.Guidelines for selection of patients for liver transplantation in the era of donor-organ shortage. Lancet 1999; 354: 206–14.CrossRefGoogle ScholarPubMed
Hirschfield, GM, Gibbs, P, Griffiths, WJH. Adult liver transplantation: what non-specialists need to know. BMJ 2009; 338: b1670 1321–7.CrossRefGoogle ScholarPubMed

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