The Use Of ECMO to Ameliorate Ischaemic Injury in the Non Heart Beating Donor Liver

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Table of Contents

LIST OF FIGURESIII

LIST OF TABLESIV

CHAPTER 1: HISTORY OF LIVER TRANSPLANTATION1

Introduction1

Genesis of liver transplantation4

Animal studies5

Human trials12

Revival of liver transplantation14

Immunosuppression18

Tissue Typing and Immunologic Methods36

Time line of legislative and regulatory landmarks relevant to organ transplantation41

Organ donation43

CHAPTER 2: NON HEART BEATING DONATION AND LIVER TRANSPLANT46

CHAPTER 3: ORGAN PRESERVATION AND NON-HEART BEATING LIVER DONORS58

CHAPTER 4: ECMO IN ABDOMINAL ORGAN TRANSPLANTATION IN NON- HEART BEATING DONOR75

REFERENCES85

List of Figures

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Fig.4.1 ………………………………………………………………………………………. 70

List of Tables

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Table 4.1: ……………………………………………………………………………… 72

Chapter 1: History of Liver Transplantation

Introduction

In the 6th century B.C. Hindu surgeons carried out the earliest known transplants of organ, peeling off the skin patches from the thighs and arms of the patient for applying to the patient's nose in a reconstructive surgery. Nonetheless, it was not until 20tm century the advanced medical techniques, anesthesia, and blood transfusions permitted much complicated transplants of organs. The initial successful transplant of organ happened on 23rd, December 1954 in Boston in which a patient was given a kidney of his identical twin brother and the patient lived for another 8 years. The donor (the identical twin brother) survived even survived the surgery. The process of transplantation was performed by Joseph Edward Murray (1999) and afterward shared the Nobel Prize of the year 1990 in Medicine or Physiology for his accomplishment.

the first successful transplant of liver was carried out by surgeon Thomas E. Starzl (1926), in a Denver hospital on 5th, May, 1963, although three weeks later the patient died. Transplants of Liver are believed to be particularly challenging as around half of the blood within the body goes from the liver each minute. In the year 1967 the trials were resumed, and at the Colorado University the chair of Pediatrics Henry Kempe supported the trials. As a result, all of the subsequent 8 patients were children and infants. Every patient survived the surgery; however, 4 of them died after two to six months from the gangrene development within a transplanted liver's portion with lethal sepsis and infection. Rest of the 4 patients had an astonishingly extended survival time. A couple of them that got transplanted for cancer of liver died of reappearance above one year after the transplant; the 3rd patient whose actual ailment was biliary atersia survived for two and a half years prior to its death due to chronic rejection. On 20th, January, 1970, the very last child was transplanted; the patient turned out to be the liver recipient that survived for the longest duration, being presently thirty-tow and half year after transplant, and also not on any medication for around eight years. This patients actual ailment was biliary atresia in the company of incidental hepato cellular cancer that never happened again. In Denver the liver trials, by the month of March of the year 1980, ...