Deep Good Text: The previous life of organ transplantation BMC Anesthesiology。

Journal:
Dmitri Bezinover and Fuat Saner
DOI:10.1186/s12871-019-0704-z
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Organ Transplant
is one of the most successful advances in modern medicine. For patients with end-stage organ disease, organ transplantation is their only chance of survival. Long before the first organ transplant, it was recognized that the success of organ transplantation must depend on multidisciplinary joint efforts. The development of organ transplantation involves a series of major medical breakthroughs, which have a profound impact on the whole field of health care. But in the history of organ transplantation for nearly a century, the contributions of anesthesiologists and specialists in intensive care medicine have been rarely mentioned.earliest descriptions of organ transplants can be traced back to mythological stories from ancient Greece, Rome, China and India, including bone, skin, teeth, limbs and heart transplants. In the 16th century, Italian surgeon Gasparo Tagliacozzi used skin grafts for plastic reconstruction. For the first time, he describes the immune response that we now know about allogeneic organs. It was not until the end of the nineteenth century that the research records on organ transplantation began to become systematic and formalized. The first transplanted animal model was
at this time.
the early 20th century, French surgeon Alexis Carrel
invented a new method of vascular matching, successfully performed several kidney transplants on dogs, and set out to try cold preservation of ionospheric organs. Dr. Alexis Carrel won the 1912 Nobel Prize in Physiology or Medicine for his pioneering work.
1933, Ukrainian surgeon U.U. Voronoy performed the first human-to-human kidney transplant in the Soviet Union. The kidneys used at the time were obtained six hours after the death of the recipient, which did not match the blood type of the recipient, so although the recipient survived the operation for 2 days, the transplanted kidney did not produce urine. Despite the rapid progress of surgery, organ transplantation was not very successful because of the lack of knowledge of immunology at the time.
breakthrough in organ transplants should be attributed to British biologist Sir Peter Brian Medawar, who specializes in immunology. During the Second World War, Sir Medawar worked in the Burns Department at Glasgow Hospital, where he studied the issue of skin transplants of the same type. He was awarded the 1960 Nobel Prize in Physiology or Medicine for his achievements in transplant rejection and access to immune tolerance, known as the "Father of Transplantation".
1951-1952, Hume et al. performed nine kidney transplants at Boston's Bregan Hospital. Despite immunosuppression using cocoa pine, rejection occurred in 9 cases. Dr. Thomas Murray successfully overcame this problem by performing the first successful kidney transplant among identical twins. The patient survived the operation for 8 years and the transplanted kidney functioned normally. Dr. Murray also won the 1990 Nobel Prize in Medicine. This success has inspired great enthusiasm among researchers and clinicians in the field of organ transplantation.
1963, Dr. James Hardy performed his first lung transplant in Jackson, Mississippi, usa, after extensive animal experiments. The patient survived 18 days after surgery and no rejection reaction was observed. Over the next 10 years, a series of lung transplants were performed around the world, but patients had poor postoperative outcomes, mainly related to healing problems at the site where the surgery was performed.
Thomas Starzl first attempted a liver transplant in 1963 and completed the first successful liver transplant at the University of Colorado in 1967. A year later, Dr Roy Calne performed Europe's first liver transplant in the UK. Also in 1967, Dr. Christiaan Barnard performed his first heart transplant in South Africa. The patient was 53 years old and survived 18 days after surgery. Over the next 12 months, more than 100 heart transplants were performed worldwide. Unfortunately, the overall survival rate after transplantation is low, mainly due to the inability to effectively suppress the immune response.
1950s, the first attempt to rely on systemic irradiation for immunosuppression after a kidney transplant was successful. The use of immunosuppressive drugs, from the initial use of 6- glycol, to the subsequent combination of thiopental and steroids, avoided the problems caused by irradiation and significantly improved the prognostics of patients. The introduction of cyclosporine is another boon for transplant patients. The discovery of cyclosporine in 1967 and the on-use of cyclosporine in 1984 significantly improved the one-year survival rate (
) of patients with kidney and liver transplantation. Modern immunosuppressants
the results of transplant surgery and reduce adverse immunosuppressive reactions.
milestone in the development of organ transplantation is the establishment of the United States Organ Sharing Network
1984. The organization coordinates all transplant activities in the United States, including maintaining transplant lists for all types of organ transplants nationwide, data collection, and organizing organ transplant missions. There are many organizations in Europe and Asia that do similar work.。 The first surgeon to perform an organ transplant,
, was known by little, but little is known about Dr. Antonio Aldrete, who not only proposed a post-anaesthetic resuscitation score, invented the first needle for spinal/epidural joint anesthesia, but also participated in the first liver transplant mentioned above. Dr. Aldrete, who has been involved in more than 180 liver transplants, describes his experience in the form of publications and lectures. Dr. Thomas Starzl believes Aldrete's contribution is critical to the success of transplant surgery, but unfortunately the name Aldrete has been almost forgotten in the history of organ transplantation.
1992, under the leadership of Dr. Yoogoo Kang of the University of Pittsburgh, a number of anesthesiologists and intensive care specialists established a multidisciplinary organization to meet the educational needs of medical personnel in the field of organ transplantation and to improve the quality of care for transplant recipients. The first two meetings were held in Pittsburgh in 1984 and 1986, focusing on preoperative care. In 1990, the International Society of Peri-surgical Care for Liver Transplantation was established and later renamed the International Society for Liver Transplantation. Around the same time in Europe, Dr. John Farman established the European Liver Intensive Care Organization. Recently
we have also seen the establishment of the Transplant Anaesthetic promotion
.Advances in the field of anesthesia and intensive care, focusing on preoperative assessment and optimization, intraoperative management and postoperative care, are significant for the success of organ transplantation, and the most important contributions include:
. Development of assessment and treatment options for transplant candidates with coronary heart disease (CAD), cirrhosis, alcoholic cardiomyopathy, valve-pulmonary hypertension, hepatic and pulmonary syndrome and other combinations, and recommendations for the management of hyponatrexemia;
. Introduction of perioperative ultrasound and inoperative TEE monitoring
. Management of abnormal blood clotting function, advice on blood viscosity testing, part transfusion therapy, etc.
Assessment and management of unstable blood flow during perioperative surgery, including refill syndrome and vascular paralysis syndrome
. Management of infection in immunosuppressive patients
The same is true of most mainstream anesthesia journals. But that is changing.is a new section of BMC Anesthesiology that aims to provide a platform for anesthesiologists and intensive care specialists to share their work and research in the field of organ transplantation. Dr. Saner and Dr. Bezinover, editors of this section, have many years of transplant experience, are experts in peri-surgical management for critically ill patients, and are important members of multiple transplant associations such as ILTS, LICAGE, and the Transplant Society (TTS).challenges in the field of organ transplantation, which can be said to be fertile ground for research. The most important challenge facing organ transplants is the serious imbalance between supply and demand of organs. Strategies to overcome this problem include the use of extended standard donors, cardiac death donor
, the use of machine perfusion to preserve
donors, live donor transplants, and split liver transplants. Other challenges include peri-surgical patient management, organ transplant survival, immunosuppression programme optimization, and several related studies are currently under way. In addition to these, transplantation of each organ also has its own problems to be solved.
Nephal Transplantation
In the case of kidney transplantation, the main research direction is to increase the number of available donors and improve postoperative survival, including optimizing in vitro perfusion of donor organs, developing programs for expanding standard donors, preoperative candidate evaluation, matching of transplanted organs and patients, and preoperative pre-treatment of patients and donors
. To alleviate the shortage of transplanted kidneys, UNOS recently launched a paired donor transplant pilot program designed to help patients who have identified a mismatched donor find a matching donor and successfully receive the transplant.there are several strategies to increase the number of liver sources: live donor transplantation
, split liver transplantation, transplantation using extended standard donor and heart death donor donor. Although the liver's ability to regenerate is well known, live liver transplantation is much more complex than kidney transplantation, and donors may be at greater risk. Today, a number of countries have established dedicated LDLT projects, with South Korea, Turkey, Japan and the United States leading the way in this field.
liver transplantation also offers the possibility of transplanting a liver to two different recipients. Unfortunately, because the transplanted liver is smaller than a normal liver transplant, this method is limited and can only be used in children or smaller adults.
other ways to improve the availability of livers include transplants using extended standard donors, cardiac death donor donors, or donors that were previously considered unusable. Because the quality of these organs is not as good as those donated by patients with traditional brain death, they are used in lower proportions during transplants. There are two main problems with transplantation using a heart death donor: 1) the primary insexual inability of the transplanted organ, and 2) the stenosis of the liver bile duce caused by prolonged ischemic ischemic
, which is difficult to avoid in the heart death donor. Nevertheless, the use of such grafts in transplants is increasing. Studies have shown that the use of machine perfusion during organ
can significantly improve organ quality, thus making transplant surgery a success.
liver replacement therapy is also an important area of research. Some of the artificial systems or bio-artificial systems under study can serve as transitions for transplantation. Liver cell transplantation also shows some application prospects. At present, the efficacy of these methods is limited and is still in the research stage. Bioengineered liver is a more forward-of-the-way concept and is now under development.1966, Dr. Richard Lillehei and Dr. William of the University of Minnesota completed the first joint pancreatic kidney transplant. Two years later, in 1968, they completed their first separate pancreas transplant. Due to the high incidence of diabetic nephropathy, co-transplantation of pancreatic kidneys is very common today. Isolated islet transplants are also on the rise, and many studies are under way.first attempt at intestinal transplantation in the 1960s was unsuccessful, with most patients developing rejection, infection and surgical complications after transplantation. The introduction of cyclosporine
the introduction of intestinal transplants. In 1988, Germany's E. Dr. Deltz completed the first successful intestinal transplant. Intestinal transplants can be performed alone or in multi-organ surgery. Although postoperative survival has improved significantly, rejection and cytomevirus infection remain important issues that cannot be ignored. The improvement of existing immunosuppression programs and the development of new drugs are the focus of research in this field.the United States began using cardiac death donor donors for heart and lung transplants in 1933. Although there have been successful cases of transplants using cardiac death donor donors, the risk of using such lower-quality transplanted organs is very high. Studies have shown that continuous perfusion during organ
beneficial.
other methods currently used to increase the supply of heart transplants include using a heart with mild coronary heart disease (CAD) or using a transplanted heart.
areas under study in the field of cardiopulmonary transplantation include prevention and control of chronic rejection, prevention of postoperative infections and malignancies, improvement of postoperative outcomes, improvement of surgical techniques, and assessment of donor organ resuscitation.not a new concept, and now it is once again attracting the interest of researchers - heterogeneity transplants may solve many of the problems associated with organ banks. In the early 1990s, Dr. Thomas Starzl performed two radon-human liver transplants. At present, heterogeneous transplantation is still in the research stage, and there are still many unresolved physiological, microbiological and immunological problems.
in recent years, face, uterus and limb transplants have had some success and are likely to be further clinically extended in the future. Of course, we must assess the long-term outcomes of these patients.recently launched a new plate, the anaesthetic and peri-surgical treatment of solid organ transplants
. This section focuses on the anaesthetic and peri-surgical treatment of organ transplant patients, including the relatively mature liver, kidneys, pancreas, intestines, heart, lungs and other single or multi-organ joint transplantation, in addition to some of the nas relatively fledged transplant operations, such as the face, uterus, limbs and so on. We sincerely invite anaesthetic and intensive care specialists and other transplant practitioners to contribute to
new section of the New World Health Organization!
(Source: Science.com)