Transplant Seminar Questions

What is a transplant?

You take one organ from one person and put it in another person or into the same person

Three types of transplant

1. Autograft

   1. Take organ from A and give it back to A (Skin Graft)

2. Allograft

   1. Take organ from A and give it to B

3. Zenograft

   1. Take organ from animal and give it to human

What was the first ever transplant

Zeno transplantation of blood (blood from sheep and into human)

What do Blood banks do?

1. Genetically test blood

2. Try to preserve organ for transplant (via cooling or perfusion)

How can you preserve an organ?

1. Cold Storage (Ice + perfusion)

2. Pulsatile Preservation (Machine working as a heart)

How long can a cold storage preserve and organ for vs machine?

Cold Storage - Kidney: 24h

Machine - Kidney: 24h

Its the same!

What does Time Window mean?

Every cell in our body has a time window - it means how long the cell has until ischemic time

(If cells don’t get O2 by X time → there will be necrosis or cell damage)

What is warm ischemic time and cold ischemic time?

• Warm Ischemic time: the time from when you take out the organ from the body (from the moment you stop circulation to the organ)

  • Important to know bc most cells can only survive 20min in warm ischemic time

  • you must put the organ into cold ischemic time before necrosis starts

• Cold Ischemic time: when you put the organ into the ice with the preservatives

What is the warm / cold ischemic time for a kidney?

• Warm Ischemic Time - 60min

• Cold Ischemic Time - 24h

What is handling / re-warming / Second Ischemic time?

It starts when you take the organ out of cold perfusion and you start to do the transplantation

What is Delayed Graft Function?

When you give the patient the organ, but it doesn’t start functioning right away (usually because of a too long warm ischemic time)

What is the optimal and maximum cold ischemic time of the heart

• Optimal = less than 4h

• Maximum = 6h

What is the optimal and maximum cold ischemic time of the lung

• Optimal = less than 6h

• Maximum = 8h

What is the optimal and maximum cold ischemic time of the liver

• Optimal = less than 8h

• Maximum = 20h

What is the optimal and maximum cold ischemic time of the pancreas

• Optimal = less than 12h

• Maximum = 18h

What is the optimal and maximum cold ischemic time of the kidney

• Optimal = less than 18h

• Maximum = 36h

What is the sequence of organ removal during donation?

1. Pancreas

2. Liver

3. Lung

4. Heart

**want heart last so lessen the warm ischemic time bc up until them, circulation is still going

What is the donation window (ages)?

From 4 - 75 years old

Since we don’t transplant spleens, why do we still remove it?

Because the pancreas is very easy to damage if you touch it (improper handling → saponification) so take out the spleen to “handle” the pancreas

**We also take out part of the duodenum to use for anastomosis (bc you need the pancreatic juices to go where they’re supposed to go)

During the transplantation, we are going to perform flushing via perfusion - why do we flush?

Flushing removes blood from the organ → reduces ischemic time

The blood in the organ can start necrosing → make organ useless

What ports are used for flushing?

1. Vein : used for flushing of the right sided circulation (going towards lung)

2. Artery : used for flushing of the left side of circulation

What are the indications for kidney transplantation?

• Any kind of end stage kidney failure

What is the contra-indication for any type of transplantation?

If the donor has any kind of tumor (bc you don’t wanna transplant any type or remnant of tumor to recipient)

Which one is better, live organ transplant or cadaver transplant?

• Living transplant is better because there is a HUGE waiting list for transplant but with a living transplant there is no waiting list

• From a cadaver we’re doing acute surgery not elective (and acute surgery always has more complications)

Which is better; open or full laparoscopy or hand assisted laparoscopy?

• Open: make a long laparatomy

• Full Laparoscopy: usually on left side

• Hand Assisted Laparoscopy: usually on right side

**Bc hand assisted is faster, and you have shorter warm ischemic time

When do you remove a recipient’s organ?

If there is enlargement of the organ