器官移植的发展与未来课件

器官移植的發展與未來台北榮總一般外科龍藉泉器官移植的發展與未來台北榮總一般外科1Humanchimera,or“homonovo.”Man’soriginalstructurehasbeenmodifiedsothathecanacceptanorgan“fromelsewhere”Humanchimera,or“homonovo.2MythandLegendMythandLegend3MythandLegendMythandLegend4MythandLegendMythandLegend5MythandLegendProf.V.Demikhovandhistwo-headeddog.phototakentwodaysaftertheoperation

U.S.S.R(1950)MythandLegendProf.V.Demikho6MAINSTEPSINGRAFTHISTORYTHEPLANTGRAFT:VERYEARLYINMAN’SHISTORYTHEANIMALGRAFT:18THCENTRURYTHEHUMANGRAFT:18THCENTURYORGANTRANSPLANTATION:20THCENTURYMAINSTEPSINGRAFTHISTORYTHE7FROMGARDENTOFARMYARDFROMGARDENTOFARMYARD8FROMGARDENTOFARMYARDFROMGARDENTOFARMYARD919THCENTURY:ALLFROMSOFGRAFTSBoronio’ssheep(1804).Successfulreplacementskingraftsonthebackofanewe.19THCENTURY:ALLFROMSOFGRA10PaulBertnexttoClaudeBernard,performingavivisectionprocedureinhislaboratoryattheCollegeofFrancein1889.PaulBertnexttoClaudeBerna11Freesplit-skingraftonaburnoftheshoulderandarm.Freesplit-skingraftonabur12THEKIDNEY:APILOTORGANTHEKIDNEY:APILOTORGAN13THEFIRSTTRANSPLANTATIONINANIMAL

AttheViennaMedicalSocietymeetingheldinJanuary1902,thesurgeonEmerichUllmannreportedthefirstcaseofrenaltransplantationperformedintheneckofadog.Theureter,broughtouttotheskin,oozeda“liquidwhichresembleurine”overaperiodoffivedays.THEFIRSTTRANSPLANTATIONINA14Dr.AlexisCarrel–AmagicianDr.AlexisCarrel–Amagician15Firstrenaltransplantationsinman:1906-1913In1906,MathieuJaboulayperformedrenaltransplantationinman.Hetransplantedtheleftkidneyofapig,killed3hourspreviously,intotheleftelbowofawomansufferingfromnephroticsyndrome.Thegraftremovedonthethirddayandthevesselswerefoundtobeobstructedbyclots..Firstrenaltransplantationsi16Firsttransplantationbetweenhumans:1933In1933,therussiansurgeonVoronoy(1896-1961)performedthefirsthomologousrenaltransplantationinmanusingahumancadaverkidney.Firsttransplantationbetween17SergeVoronoff,attheCollègedeFrance.Testiculartransplantationfromamonkeytoman.Aretiredindianarmycolonelinfineformaftertheoperation.SergeVoronoff,attheCollège18TheBrighamcommando:1947Ayoungwomanwasinprofoundcomawithanuriafor10daysfollowinganabortioncomplicatedbyacutetubulopathyduetosepticshockandincompatibletransfusion.DavidM.Hume(1917-1973)TheBrighamcommando:1947Ay19Paris,Christmas1952:thepresentfromamothertohersonMrsRenardandhersonMariustowhomshedonatedakidneyinDecember1952.Pelvicimplantationofthekidneywithrestorationoftheurinarytract.Paris,Christmas1952:thepr20ArealSuccess:1954JohnMerrillandJosephMurry(NobelPrize1991)attheBrighamin1953Firstsusccessfultransplantationbetweentwoidenticaltwinsin1954bytheMurry,MerrillandHarrisonteam.ArealSuccess:1954JohnMerr21PeterBrianMedawar,NobelPrizein1960.Rejectionwasbytheactionoflymphocyteswhichdescribedas“immunocomeptentcells“PeterBrianMedawar,NobelPri22MAJORHISTOCOMPATIBILITYCOMPLEX:1952(JeanDausset,NobelPrizein1980)(HumanMHC)MAJORHISTOCOMPATIBILITYCOMPL23Immunosuppression:TotalBodyIrradiation“Sam”and“HonestJohn”Immunosuppression:TotalBody24FirstprolongedsurvivalofrenaltransplantationwithanunrelateddonorMrsGenandherdonoratFochHospitalin1960Firstprolongedsurvivalofre25DevelopmentofImmunosuppressiveDrugsMarianneMattlaerwith“Mana”,whoreceivedakidneyin1960withimmunosuppressionbyazathioprine,withalittertowyearsafterthetransplantation.DevelopmentofImmunosuppressi26AdventofCyclosporineTheprimitivefungusfromwhichcyclosporineisextracted(Tolypocladiuminflatum)SirRoyCalneAdventofCyclosporineTheprim27ProgressinHemodialysis

WilliamJ.Kolff,fatheroftheartificialkidneyandheart.ThefirstartificialkidneydesignedbyKolffin1945.ProgressinHemodialysisWil28TissueTyping“Thecentreeffect”:TerasakiandstatisticsTissueTyping“Thecentreeffec29OrganPreservationFalkertO.Belzer.ThefirsthumankidneypreservedonaperfusionmachinepriortotransplantationinAugust1967.OrganPreservationFalkertO.B30OrganPreservationOrganPreservation31LiverTransplantationThomasStarzlintheoperatingroomonMarch1,1963,performedthefirstlivertransplantation,therecipientsurvivedfivehoursafterthetransplantation.LiverTransplantationThomasSt32OilpaintingbySirRoyCalne(1990)representaphaseoflivertransplantationcoordinatedbytheentiresurgicalteam.OilpaintingbySirRoyCalne33PancreasandIntestinalTransplantationRichardLilleheiPancreasandIntestinalTransp34HeartandLungTransplantationDeniseDarvall,thefirsthumanheart”donor”

LouisWashkansky,theheartrecipient.December3,1967.ChristiaanN.Barnard,cardiovascularsurgeonatCapetown.HeartandLungTransplantation35ArtificialHeartArtificialHeart36HeartandLungTransplantationJamesD.Hardy’steam,performedthefirsthumanlungtransplantationonJune11,1963,sevenandahalfmonthsbeforetheyperformedthefirsthumanheterologushearttransplantation.HeartandLungTransplantation37XenotransplantationThefirstbloodtransfusionfromanimalstomanwereattemptedin1628.XenotransplantationThefirstb38XenotransplantationXenotransplantation39器官移植在臺灣的發展腎臟1968.05.27台大李俊仁自體骨髓1983.11.09台大陳耀昌異體骨髓1984.03.09台大陳耀昌肝臟1984.03.22長庚陳肇隆胰臟1984.04.01長庚陳肇隆心臟1987.07.17台大朱樹勳肺臟1991.07.10北榮王良順器官移植在臺灣的發展腎臟1968.05.40台灣器官移植之父台灣器官移植之父41台灣肺臟移植的先驅王良順教授，台北榮總呼吸加護病房主任台灣肺臟移植的先驅王良順教授，台北榮總呼吸加護病房主任42Howthetransplantationisdoing?Howthetransplantationisdoi43Howthetransplantationisdoing?Howthetransplantationisdoi44SPKT

FromDonortoRecipient

From8AMto2AM09/20/2003SPKT

FromDonortoRecipient

45LiverandPancreasinBackTableLiverandPancreasinBackTab46Y-graftReconstructionSMASAEIAIIACIAY-graftReconstructionSMASAEIA47PancreasTransplantation

Cold/WarmIschemicTime=452min/38minPVDuodenumgraftY-grafta.PancreasgraftPancreasTransplantation

Cold/48Duodeno-jejunostomyinSPKTPancreasDuodeno-jejunostomyinSPKTPan49SPKTon09/19/2003Pancreatico-DuodenalgraftKidneygraftJejunumSPKTon09/19/2003Pancreatico-50First24hoursBloodSugarafterSPKTFirst24hoursBloodSugaraft51FirstMonthBloodSugarafterSPKTFirstMonthBloodSugarafter52RenalFunctionafterSPKTRenalFunctionafterSPKT53SPKT

HappyDischargeon10/09/2003SPKT

HappyDischargeon10/0954Wherearewegoingto?ImmuneToleranceXenograftStemCellArtificialOrganWherearewegoingto?ImmuneT55ImmuneToleranceImmuneTolerance56ImmuneToleranceImmuneTolerance57StemCellsStemCells58StemCellsStemCells59ArtificialOrganArtificialOrgan60XenotransplantationXenotransplantation61美麗新世界的來臨總是需要更多的心去參與美麗新世界的來臨62器官移植的發展與未來台北榮總一般外科龍藉泉器官移植的發展與未來台北榮總一般外科63Humanchimera,or“homonovo.”Man’soriginalstructurehasbeenmodifiedsothathecanacceptanorgan“fromelsewhere”Humanchimera,or“homonovo.64MythandLegendMythandLegend65MythandLegendMythandLegend66MythandLegendMythandLegend67MythandLegendProf.V.Demikhovandhistwo-headeddog.phototakentwodaysaftertheoperation

U.S.S.R(1950)MythandLegendProf.V.Demikho68MAINSTEPSINGRAFTHISTORYTHEPLANTGRAFT:VERYEARLYINMAN’SHISTORYTHEANIMALGRAFT:18THCENTRURYTHEHUMANGRAFT:18THCENTURYORGANTRANSPLANTATION:20THCENTURYMAINSTEPSINGRAFTHISTORYTHE69FROMGARDENTOFARMYARDFROMGARDENTOFARMYARD70FROMGARDENTOFARMYARDFROMGARDENTOFARMYARD7119THCENTURY:ALLFROMSOFGRAFTSBoronio’ssheep(1804).Successfulreplacementskingraftsonthebackofanewe.19THCENTURY:ALLFROMSOFGRA72PaulBertnexttoClaudeBernard,performingavivisectionprocedureinhislaboratoryattheCollegeofFrancein1889.PaulBertnexttoClaudeBerna73Freesplit-skingraftonaburnoftheshoulderandarm.Freesplit-skingraftonabur74THEKIDNEY:APILOTORGANTHEKIDNEY:APILOTORGAN75THEFIRSTTRANSPLANTATIONINANIMAL

AttheViennaMedicalSocietymeetingheldinJanuary1902,thesurgeonEmerichUllmannreportedthefirstcaseofrenaltransplantationperformedintheneckofadog.Theureter,broughtouttotheskin,oozeda“liquidwhichresembleurine”overaperiodoffivedays.THEFIRSTTRANSPLANTATIONINA76Dr.AlexisCarrel–AmagicianDr.AlexisCarrel–Amagician77Firstrenaltransplantationsinman:1906-1913In1906,MathieuJaboulayperformedrenaltransplantationinman.Hetransplantedtheleftkidneyofapig,killed3hourspreviously,intotheleftelbowofawomansufferingfromnephroticsyndrome.Thegraftremovedonthethirddayandthevesselswerefoundtobeobstructedbyclots..Firstrenaltransplantationsi78Firsttransplantationbetweenhumans:1933In1933,therussiansurgeonVoronoy(1896-1961)performedthefirsthomologousrenaltransplantationinmanusingahumancadaverkidney.Firsttransplantationbetween79SergeVoronoff,attheCollègedeFrance.Testiculartransplantationfromamonkeytoman.Aretiredindianarmycolonelinfineformaftertheoperation.SergeVoronoff,attheCollège80TheBrighamcommando:1947Ayoungwomanwasinprofoundcomawithanuriafor10daysfollowinganabortioncomplicatedbyacutetubulopathyduetosepticshockandincompatibletransfusion.DavidM.Hume(1917-1973)TheBrighamcommando:1947Ay81Paris,Christmas1952:thepresentfromamothertohersonMrsRenardandhersonMariustowhomshedonatedakidneyinDecember1952.Pelvicimplantationofthekidneywithrestorationoftheurinarytract.Paris,Christmas1952:thepr82ArealSuccess:1954JohnMerrillandJosephMurry(NobelPrize1991)attheBrighamin1953Firstsusccessfultransplantationbetweentwoidenticaltwinsin1954bytheMurry,MerrillandHarrisonteam.ArealSuccess:1954JohnMerr83PeterBrianMedawar,NobelPrizein1960.Rejectionwasbytheactionoflymphocyteswhichdescribedas“immunocomeptentcells“PeterBrianMedawar,NobelPri84MAJORHISTOCOMPATIBILITYCOMPLEX:1952(JeanDausset,NobelPrizein1980)(HumanMHC)MAJORHISTOCOMPATIBILITYCOMPL85Immunosuppression:TotalBodyIrradiation“Sam”and“HonestJohn”Immunosuppression:TotalBody86FirstprolongedsurvivalofrenaltransplantationwithanunrelateddonorMrsGenandherdonoratFochHospitalin1960Firstprolongedsurvivalofre87DevelopmentofImmunosuppressiveDrugsMarianneMattlaerwith“Mana”,whoreceivedakidneyin1960withimmunosuppressionbyazathioprine,withalittertowyearsafterthetransplantation.DevelopmentofImmunosuppressi88AdventofCyclosporineTheprimitivefungusfromwhichcyclosporineisextracted(Tolypocladiuminflatum)SirRoyCalneAdventofCyclosporineTheprim89ProgressinHemodialysis

WilliamJ.Kolff,fatheroftheartificialkidneyandheart.ThefirstartificialkidneydesignedbyKolffin1945.ProgressinHemodialysisWil90TissueTyping“Thecentreeffect”:TerasakiandstatisticsTissueTyping“Thecentreeffec91OrganPreservationFalkertO.Belzer.ThefirsthumankidneypreservedonaperfusionmachinepriortotransplantationinAugust1967.OrganPreservationFalkertO.B92OrganPreservationOrganPreservation93LiverTransplantationThomasStarzlintheoperatingroomonMarch1,1963,performedthefirstlivertransplantation,therecipientsurvivedfivehoursafterthetransplantation.LiverTransplantationThomasSt94OilpaintingbySirRoyCalne(1990)representaphaseoflivertransplantationcoordinatedbytheentiresurgicalteam.OilpaintingbySirRoyCalne95PancreasandIntestinalTransplantationRichardLilleheiPancreasandIntestinalTransp96HeartandLungTransplantationDeniseDarvall,thefirsthumanheart”donor”

LouisWashkansky,theheartrecipient.December3,1967.ChristiaanN.Barnard,cardiovascularsurgeonatCapetown.HeartandLungTransplantation97ArtificialHeartArtificialHeart98HeartandLungTransplantationJamesD.Hardy’steam,performedthefirsthumanlungtransplantationonJune11,1963,sevenandahalfmonthsbeforetheyperformedthefirsthumanheterologushearttransplantation.HeartandLungTransplantation99XenotransplantationThefirstbloodtransfusionfromanimalstomanwereattemptedin1628.XenotransplantationThefirstb100XenotransplantationXenotransplantation101器官移植在臺灣的發展腎臟1968.05.27台大李俊仁自體骨髓1983.11.09台大陳耀昌異體骨髓1984.03.09台大陳耀昌肝臟1984.03.22長庚陳肇隆胰臟1984.04.01長庚陳肇隆心臟1987.07.17台大朱樹勳肺