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The History of Transplantation

The History of Transplantation. Prof Chris Rudge. A (brief) History of (the story behind)Transplantation. Prof Chris Rudge. First Human Heart Transplant Cape Town, 3 rd December 1967. The Times Sept 3 rd 2001. The Times Sept 3 rd 2001. The Times Sept 3 rd 2001.

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The History of Transplantation

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  1. The History of Transplantation Prof Chris Rudge

  2. A (brief) History of (the story behind)Transplantation Prof Chris Rudge

  3. First Human Heart TransplantCape Town, 3rd December 1967

  4. The Times Sept 3rd 2001

  5. The Times Sept 3rd 2001

  6. The Times Sept 3rd 2001 Nelson Mandala recalled………….

  7. The Times Sept 3rd 2001 Nelson Mandala recalled…………. Chris Rudge said…………

  8. Time-line • BC Chinese and Indian mythology • 280 AD Saints Cosmos and Damian

  9. Saints Cosmos and Damian

  10. Saints Cosmos and Damian

  11. Time-line • 1902 Alexis Carrel, Jaboulay: Vascular anastamosis • 1906-23 Jaboulay, Unger and others Animal kidney transplants • 1933-6 Voronoy Human kidney transplants

  12. Time-line • 1940s and 50s Gorer, Snell, Dausset, Terasaki, Medawar The immune system • 1951-4 Kuss, Dubost, Servelle in France, Murray, Merrill and Hume in Boston: Deceased and live donor kidney transplants • 1964 Relevance of ABO compatability • 1965 Relevance of Anti-HLA antibodies • 1966-9 Cytotoxic cross match • 1965-69 HLA system defined

  13. Anecdotes • 1950 Calne: Guy’s • 1951 Medawar: Oxford • 1952 Kuss : Paris • 1969 Batchelor: Guy’s

  14. Transplants: Clinical Firsts • 1905 Cornea Eduard Zirm • 1933 (1951-3) Deceased donor kidneys • 1952 (Dec 24th) Living donor kidney • 1954 (Dec 23rd) First Successful human transplant (LD Kidney) • 1963 Liver • 1966 Pancreas • 1967 Heart • 1963 (1980-83) Lung

  15. World’s first successful transplant The Herrick twins – Richard and Ronald Boston USA 23rd Dec 1954

  16. Rene Kuss and Tom Starzl

  17. Liver Transplantation:Tom Starzl and Roy Calne

  18. Pancreas Transplantation:R Lillehei and David Sutherland

  19. Heart Transplantation:Christiaan Barnard and Norman Shumway

  20. Immunosuppression • 1958 Whole-body irradiation • 1960s Anti-lymphocyte serum • 1960 Methotrexate, Cyclophosphamide, 6 –MP • 1961 Azathioprine • 1960 Corticosteroids

  21. My three eras of transplantation • Pre 1983: will it ever work? • 1983-2001: how can we make it better? • 2001-2011: why can’t more people have a transplant?

  22. Pre 1983 • Will it ever work?

  23. 3 Month kidney survival 1963

  24. 3 Month kidney survival 1963

  25. 3 Month kidney survival 1963

  26. 1Year survival 1975

  27. 1Year survival 1975

  28. UK: Kidney Transplantation 1972 – 1976 Graft survival (N=2260) Patient Survival (N=2098) Survival % (95% CI) 1 year 73 (71– 75) 5 year 56 (54 – 58) 10 year 45 (42 – 47) 20 year 26 (24 – 28) Survival % (95% CI) 1 year 54 (52 – 57) 5 year 41 (39 – 43) 10 year 34 (32 – 36) 20 year 26 (24 – 28)

  29. Anecdotes • My first patient

  30. UK Kidney Transplantation • 1955 St Mary’s • 1959 Leeds and Royal Free Hospital • 1960 Edinburgh • 1962 Hammersmith

  31. UK Liver Transplantation:Roy Calne and Roger Williams Addenbrooke’s King’s College Cambridge London 1968

  32. UK Heart Transplantation: Terence English and MagdiYacoub PapworthHarefield 1979 1980

  33. Anecdotes • My first heart donor:

  34. Anecdotes • My first heart donor: “To wrench the quivering heart from a freshly dead corpse is not a procedure with which I wish to be associated”

  35. The BTS: memoir of John Hopewell • “In the intervening years (1960-1968) I was occupied by forming the London Transplant Group, which became an almost nationwide organization for the exchange of donor kidneys, ultimately to become the National Kidney Registry. Toward the end of the 1960’s, Leslie Brent of the British Society of Immunology, and I realised that both bodies were planning to become a British Transplantation Society and we had support from each to form a single society under that name. Its inaugural meting was held at the Royal Free Hospital on 12th April 1972, when Sir Peter Medawar was elected as the first president”.

  36. What’s happened since 1983? • Good things: • Immunosuppression • Cyclosporin, Tacrolimus, MMF, Rapamycin, Monoclonal Abs • Surgery, anaesthesia and intensive care • Histocompatability science • Antibiotics and other agents • Biopsy/biomarkers for diagnosis of rejection

  37. What’s happened since 1983? • Bad things: • The donor shortage • Changing donor demographics • Less DBD donors • Age • Co-morbidity

  38. UK Kidney Transplantationthen v now Patient survival Graft survival Log-rank p<0.001 Log-rank p<0.001 Survival % (95% CI) N (10 year) 1998-2002 69 (68 – 71) 6091 1972-1976 34 (32 – 36) 1931 Survival % (95% CI) N (10 year) 1998-2002 74 (72 – 75) 5074 1972-1976 45 (42 – 47) 2098

  39. Challenges for the future

  40. Challenges for the future • New science • All the “-omics”

  41. Challenges for the future • New science • All the “-omics” • New forms of transplantation • Face • Limbs • ? Ovary/uterus

  42. Challenges for the future • New science • New forms of transplantation • Managing expectations • Number of organs available • Organ quality • Outcomes

  43. ‘Ideal’ donors <60 years, BMI<30, no history of smoking or hypertension No. of donors

  44. Challenges for the future • New science • Newforms of transplantation • Managing expectations • Avoid complacency • Obsessional care • Continuity of care

  45. UK: Kidney Transplantation 1972 – 1976 Patient Survival N=2098) Graft survival (N=2260) rvival Survival % (95% CI) 1 year 54 (52 – 57) 5 year 41 (39 – 43) 10 year 34 (32 – 36) 20 year 26 (24 – 28) Survival % (95% CI) 1 year 73 (71– 75) 5 year 56 (54 – 58) 10 year 45 (42 – 47) 20 year 26 (24 – 28)

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