Update of some results of Organ Transplantation

Nội dung text: Update of some results of Organ Transplantation

1. Journal of military pharmaco-medicine 7-2013 update of some results of Organ Transplantation Le Trung Hai* et al Summary The first organ transplantation (Tx) in Vietnam such as kidney Tx in June 1992, liver Tx in January 2004 and heart Tx in June 2010) were successfully performed at 103 Hospital, Military Medical University. Until August 2013, nearly 850 cases of kidney Tx were performed in 12 Vietnamese hospitals, including 48 cadaveric kidney Tx and more than 160 living donor nephrectomy by endoscopy. Thirty three cases of liver Tx, including 20 living donor liver Tx (LDLT) and 13 cases from brain death patients, were carried out in 5 centers of our country. Nine cases of heart Tx were performed from brain death donor in 3 hospitals. In recent years, the organ Tx in Vietnam has been remarkably improved and innovated with promising results for new domestic treatment of end-stage organ failure, which pushed up development of medicine field in our country and helped us upgrade the level of organ Tx in the world. The success of organ Tx has contributed intensification of unity and cooperation among scientists in general as well as domestic and international medical centers in particular and brought a lot of economic and social benefits. * Key words: Organ transplantation; Kidney transplantation; Liver transplantation; Heart transplantation. Introduction In Vietnam, the success of the first kidney Tx on June 4, 1992, liver Tx (January 2004) Organ Tx is one of the greatest success and heart Tx (October 2010) at 103 Hospital, of medicine in the 20th century, and is a dream under Military Medical University has opened of Vietnamese surgery as well. It helps replace a new field of Vietnamese surgery - organ Tx. a part of body or organ disease with healthy Up to now, kidney Tx has been performed organ. in 12 hospitals, liver transplant in 5 medical centers and heart Tx in 3 hospitals. In addition, In the world, the first organ Tx study was study on experimental pancreas Tx has been carried out at the beginning of last century, started. Until August 2013, about nearly 850 the first case of kidney Tx was performed cases of kidney Tx were performed in Vietnam, in 1954, the first liver transplant in 1963, including 48 cadaveric kidney Tx and more the first heart transplant in 1967 and other than 160 living donor nephrectomy by organs later. Approximately 50,000 organ endoscopy. The article aims to Report some Tx are performed annually over the world at results of organ Tx in Vietnam in general 1 and 5 year survival rate of 80 - 90%. and at 103 Hospital in particular. * 103 Hospital Address correspondence to Le Trung Hai: 103 Hosptal E.mail: lthai@fpt.vn
2. Journal of military pharmaco-medicine 7-2013 results OF kidney Tx at 103 + Incision: trans-peritoneal 24.6% and hospital extra-peritoneal 72.5%. + Laparoscopic living donor nephrectomy: 1. General characters. 4 cases. (1992 - 2012) 146 cases (including 142 + Kidney graft artery: ≥ two arteries 22.6% living donor kidney Tx and 4 cadaveric kidney (33 cases) and one artery 80.8%. Tx - CKT). + Kidney graft vein: two veins 4.1% - The majority of recipients were males (6 cases) and one vein 96.2%. (74.7%), recipients’mean age was 34.7 (14 Plasty procedure was performed for some - 65 years old) and donors’ was 44.1 (21 - cases with more than one artery. 67 years old). 38.4% of the recipients was at the age from 21 to 30. - Graft perfusion: EC solution 14.4%, HTK solution and/or ringer lactate 85.6%. - The relationship between donor and recipient: most of them were parents (40.4%), + Anaesthesia: general 25.3% - Recipient brothers and sisters. operation: (37 cases), spinal with epidural catheter 74.7% (109 cases). - All patients were end-stage chronic renal failure with hemodialysis (91.1%) or + Position of graft: iliac fossa: right 96.6% and left 3.4%. peritoneal dialysis (3.4%) and 56.2% of them has not been transfused blood before + Anastomosis: kidney graft artery to transplant. recipient internal iliac artery (end-to-end) 75.3%, external iliac artery: 18.5% and both 2. Immunological compatiblity. of above arteries with 2 anastomoses (6.2%). - HLA compatiblity for living donor kidney + Donor ureter to recipient bladder Tx (LDKT): more than 1 haplotype (≥ 3/6 anastomosis by Leadbetter-Politano: 18.5% locus with all class of A, B, DR) 72.6%, 6/6 and by Lich-Gregoir: 81.5%. locus: 3.4% (5 cases), 0/6 locus: 7.5% (11 cases) (including 4 CKT). - Prosensitivity reaction with negative or positive < 20%: 99.3%. - Crossmatch (-): 100%. - Blood group compatiblity: 91.8%. 5.5% of donor (8 cases) blood group O and recipient A or B and 2.7% of donor (4 cases) group A or B and recipient AB. 3. Surgical technique. - Donor operation: except 4 cases of CKT with bilateral nephrectomy, 142 cases of LDKT were performed: + Left nephrectomy 97.9% and right Photo 1: Kidney Tx form brain death patient nephrectomy 2.1%. at 103 Hospital.
3. Journal of military pharmaco-medicine 7-2013 4. Post-transplant treatment. - Patients: 11 hepatocellular carcinoma - Immunosuppressive therapy: triple therapy (HCC), 3 fulminant hepatic failure, 8 liver with neoral (or prograf), cellcept and corticoid. cirrhosis, 10 biliary atresia and 1 NICCD Some cases with low immunological compatiblity (neonatal intrahepatic cholestasis caused used combined with simulect (day 0 and day by citrin deficiency). 4 after Tx) for prevention of acute rejection - Donor: except 13 brain death patients - Others: antibiotics (bactrim), antivirus (including 1 child aged 5), there are 20 (acyclovir). living related donors with mean age of 36.7 5. Post-transplant results. (28 - 56 years old). - Complication: surgical complication: 7.5%, + The relationship between living donor rejection and other complications and recipient (20 cases): mother: 9 cases, - Mortality rate in first 6 months after kidney father: 3 cases, grandmother: 3 cases and Tx: 6/1992 - 3/6/2002: 18.8%, 4 -6 - 2002 to other relatives: 5 cases. 6 - 2012: 3%, 5 latest years: < 1%. + Living donor hepatectomy (20 cases): -.Post-transplant follow-up: One-year . Left lateral: 12 cases. survival rate was 86.4%, 5 latest years: one-year survival: 98% and that of graft . Left lateral + caudate lobe: 1 case. 93%. The longest survival: 20 years (patient . Left liver: 1 case. Le Thanh Nghiem). . Right liver: 6 cases. - In general, after kidney Tx, most recipients - Outcome: come back to normal work, study. These patients have given a birth to healthy children. + For living donors: 100% had good postoperative result. - All the donors are in good health condition with normal working and living. + For recipients: One - year survival time was 85%. SOME resultS OF LIVER TX IN VIETNAM From 2004 to August 2013: 33 cases of liver Tx (including 20 LDLT and 13 cases from brain death patient) were performed in 5 centers of Vietnam, including 103 Hospital, National Pediatric Hospital, the Second Children Hospital of Hochiminh City, Vietduc Hospital and Choray Hospital. - Recipient: 16 adults; mean age 53.2 (38 - 74 years old) and 17 children (6 cases: Photo 2: The first pair of liver Tx in Vietnam 5-16 years old and 11 cases under 2 years old). after 9 years.
4. Journal of military pharmaco-medicine 7-2013 results OF heart Tx IN VIETNAM new domestic treatment of end-stage organ failure, which pushed up development of Until now, 9 cases of heart Tx were medicine field in our country and helped carried out in 3 Vietnamese hospitals (103 us to upgrade the level of organ Tx in the Hospital, Hue Central Hospital and Vietduc world. Hospital). - The success of organ Tx has contributed - Patients: 8 cases of dilative cardiomyopathy intensification of unity and cooperation with NYHA IV and 1 case of cardiac infarct among scientists in general as well as (with ECMO in 2 weeks and the patient had domestic and international medical centers diabetes melitus, hepatitis diseases and in particular and brought a lot of economic underwent previous kidney Tx). and social interests. - Recipients’mean age: 38.6 (13 - 58 - Organ transplant and multi-organ Tx years old). from brain death patient was performed with - Operation technique: Orthotopic heart good results, which needs to continue to Tx (1 case of biatrial and 8 cases of bicaval develop, push up the consultation and anastomosis). communication, create assistance of community - Outcome: 3 dead (in POD2, 13 months and insurance for organ Tx. and 28 months after heart Tx), the rest (6 cases) are in good health and cardiac - Improvements in patient and donor function. selection, surgical procedures and post- - German heart Tx experts’opinion: Heart transplant management are required to Tx is an established procedure with acceptable, achieve optimal outcomes for graft function predictable long-term results and good quality and patients’ health. The key to success of of life up to 20 years. living donor liver Tx is mainly dependent on donor safety. study on experimental pancreas Tx References Nowadays, about nearly 40 cases of experimental study on pancreas transplant 1. §ç TÊt C•êng vµ CS. NhËn xÐt ®Æc ®iÓm on pigs were performed in Military Medical l©m sµng vµ kÕt qu¶ ®iÒu trÞ c¸c BN sau ghÐp University with good initial results. The thËn vµ cho thËn. T¹p chÝ Y häc Qu©n sù. 2000, simultaneous pancreas and kidney Tx for tr.51-54. treatment of patients with type I diabetes 2. Ph¹m M¹nh Hïng. MiÔn dÞch ghÐp. BÖnh and renal failure has been done. häc Ngo¹i khoa Sau ®¹i häc tËp I. Häc viÖn Qu©n y. NXB Qu©n ®éi nh©n d©n. Hµ Néi. 2002, discussion and conclusion tr.156-165. - In recent years, the organ Tx in 3. NguyÔn ThÞ ¸nh H•êng. Nghiªn cøu phÉu Vietnam has been remarkably improved thuËt lÊy thËn ghÐp ë ng•êi sèng cho thËn. LuËn and innovated with promising results for ¸n TiÕn sü Y häc. Hµ Néi. 2008.
5. Journal of military pharmaco-medicine 7-2013 4. Bïi V¨n M¹nh. Nghiªn cøu l©m sµng, cËn l©m sµng vµ mét sè chØ tiªu miÔn dÞch ë BN sau ghÐp thËn. LuËn ¸n TiÕn sü Y häc. Hµ Néi. 2009. 5. Bïi §øc Phó. Quy tr×nh kü thuËt vµ hÖ thèng tæ chøc trong ghÐp tim lÊy tõ ng•êi cho chÕt n·o. Nhµ xuÊt b¶n §¹i häc HuÕ. 2009, tr.55-78. 6. TrÇn Ngäc Sinh vµ CS. KÕt qu¶ ghÐp thËn tõ ng•êi cho sèng t¹i BÖnh viÖn Chî RÉy. Kû yÕu Héi nghÞ Ngo¹i khoa ViÖt Nam 5/2002. T¹p chÝ Ngo¹i khoa. 2002, tr.481-483. 7. Phan Hång V©n. NhËn thøc, th¸i ®é vµ sù chÊp nhËn cña céng ®ång ®èi víi viÖc hiÕn ghÐp m«, bé phËn c¬ thÓ ng•êi t¹i Hµ Néi, §µ N½ng vµ TP. HCM. LuËn ¸n TiÕn sü Y hoc. Tr•êng §H Y tÕ C«ng céng. Hµ Néi. 2012. 8. G. Ahmad et al. Renal replacement therapy - Clinical practice guidelines. Second Edition. Ministry of Health. Malaysia. 2004, pp.187-194. 9. S.T. Fan et al. Living donor liver Tx. Takungpao Publishing. Hong Kong, China. 2007. 10. T. Kalbe et al. Guidelines on renal Tx. European Association of Urology. Arnhem, Netherlands. 2003, pp.39-40.
6. Journal of military pharmaco-medicine 7-2013