Abstract

In the past 40 years, clinical renal transplantation has evolved from a risky, highly speculative endeavor to a fairly mature, well-established service. There are hundreds of programs around the world, transplanting thousands of patients annually, and reasonably good suecess rates have been achieved. Current expectations are of one year patient survival of 90 - 98%, and one year graft survival of 75 - 90%. In addition, patients who have been successfully transplanted have a markedly improved quality oflife compared with patients on dialysis.v' However, in spite of these encouraging results, there remain significant problems. Among them are acute rejection, which still occurs in 40 - 75%o f cases, and graft loss secondary to rejection, acute or chronic, which limits the half-life of cadaveric kidneys to 8 years. 1 As part of an effort to address these issues, there have been a number of new immunosuppressive agents and therapeutic modalities that have been investigated over the past several years. This chapter will focus on 2 areas of ongoing research in our institution, the use of FK506in renal transplant patients, and the program of combined kidney/bone marrow transplantation.

Abstract

The history of clinical organ transplantation and its development in routine surgical practice has been packed into the last 40 years and is encompassed by the careers of many of the pioneers of transplantation. Improved immunosuppression, surgical, anesthetic, and postoperative management have transformed results and allowed many new organs to be transplanted. Progress in preserving organs for transplantation has lagged behind the other advances in transplantation. Until the introduction of UW solution, no major progress was made after the introduction of machine perfusion preservation by Dr. Belzer in 1967and that of simple cold storage by Dr Collins in 1969. This solution was developed at the University of Wisconsin and has allowed extended simple cold storage of the pancreas, liver, kidney, and more recently, the small bowel prior to transplantation. The UW solution represents a good answer to the problem of short-term storage of organs for transportation and early reimplantation, but equally important, it has also stimulated renewed research interest in this area. A more profound understanding of the events occurring during hypothermic storage and subsequent reperfusion is needed if further advances are to be made. It is anticipated that if long-term organ storage is to be achieved this will require a perfusion preservation system that allows the maintenance of essential metabolic processes.

Abstract

During the past 30 years orthotopic liver transplantation (OLTx)has become a hIghly successful form of therapy, and as of this writing it is being performed at more than 100 institutions in the U.S., and a similar number in Europe. This is testimony to the great advances achieved in this field since the 1960sand 1970s,when there were essentially only two places actively engaged in liver transplantation. Essential to its success have been the technical refinements introduced during the last three decades,7,9 which have allowed many surgeons around the world to be able to do the procedure safely. Liver transplantation is still considered as one of the most complex operations, and therefore the margin of error is small and attention to technical detail is crucial to a satisfactory outcome. This is magnified in importance since OLTx, unlike kidney, heart, pancreas and intestinal transplantation, lacks a back-up system, such as dialysis, ventricular assist device, insulin or total parenteral nutrition. Thus, the smallest mistake in the surgical management of the patient may prove fatal.