Clinical Transplantation

Kidney Function Restoration Program

Kidney Damage Treatment Diet

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For a number of illnesses, a transplant is the only means of therapy. Figure 21-10 summarizes the major organ and cell transplants being performed at the present time. In addition, certain combinations of organs, such as heart and lung or kidney and pancreas, are being transplanted simultaneously with increasing frequency. Since the first kidney transplant was performed in the 1950s, approximately 400,000 kidneys have been transplanted worldwide. The next most frequently transplanted solid organ is the liver (52,000), followed by the heart (42,000) and, more distantly, by the lung (6,000) and pancreas (2,000). Bone-marrow transplants number around 80,000. Although the clinical results of transplantation of various cells, tissues, and organs in humans have improved considerably in the past few years, major obstacles to the use of this treatment exist. As explained above, the use of immu-nosuppressive drugs greatly increases the short-term survival of the transplant, but medical problems arise from use of these drugs, and chronic rejection is not prevented in most cases. The need for additional transplants after rejection exacerbates the shortage of organs which is a major obstacle to the

VISUALIZING CONCEPTS

VISUALIZING CONCEPTS

Cornea

From cadaver

Immunosuppression not required 40,000 transplants per year

Lung

From brain-dead donor

Procedure recently developed;

little data available

955 transplants in 2000

Often heart/lung transplant (47 in 2000)

Heart

From brain-dead donor

HLA matching useful but often impossible

Risk of coronary artery damage, perhaps mediated by host antibody 2172 transplants in 2000

Liver

From cadaver

Surgical implantation complex Resistant to hyperacute rejection Risk of GVHD 4816 transplants in 2000

Cornea

From cadaver

Immunosuppression not required 40,000 transplants per year

Clinical Transplantation

Skin

Mostly autologous (burn victims) Temporary grafts of nonviable tissue Allogeneic grafts rare, require immunosuppression

Bone marrow

Needle aspiration from living donor Implanted by IV injection ABO and HLA matching required Rejection rare but GVHD a risk

Skin

Mostly autologous (burn victims) Temporary grafts of nonviable tissue Allogeneic grafts rare, require immunosuppression

Bone marrow

Needle aspiration from living donor Implanted by IV injection ABO and HLA matching required Rejection rare but GVHD a risk

Blood

Transfused from living donor ABO and Rh matching required Complications extremely rare An estimated 14 million units used each year

Pancreas

From cadaver

Islet cells from organ sufficient 420 transplants in 2000 Increasingly, pancreas/kidney transplant for advanced diabetes (910 in 2000)

Kidney

From live donor or cadaver ABO and HLA matching useful Immunosuppression usually required Risk of GVHD very low 13,258 transplants in 2000

FIGURE 21-10

Transplantations routinely used in clinical practice. For the solid organs, the number of transplants performed in the United States in 2000 is indicated. Estimates are included for other transplants if available.

widespread use of transplantation. Several of the organ systems for which transplantation is a common treatment are considered below. The frequency with which a given organ or tissue is transplanted depends on a number of factors:

■ Clinical situations in which transplantation is indicated

■ Availability of tissue or organs

■ Difficulty in performing transplantation and caring for post-transplantation patients

■ Specific factors that aid or hinder acceptance of the particular transplant

The urgency of the transplantation may depend on the affected organ. In the case of the heart, lung, and liver, few alternative procedures can keep the patient alive when these organs cease to function. Although dialysis may be used to maintain a patient awaiting a kidney transplant, there are no comparable measures for the heart or lungs if the allograft fails. Research on artificial organs is ongoing but there are no reports of long-term successes.

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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