Transplantation

Aka: Transplantation, Autograft, Synergeneic Graft, Syngraft, Isograft, Allogeneic Graft, Allograft, Homologous Transplantation, Xenogeneic Graft, Xenograft, Transplant Anti-Rejection Drugs

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II. Definitions

  1. Transplant
    1. Biologic object transferred from one anatomic site to another

III. Types

  1. Autograft
    1. Transplantation of tissue within the same patient (e.g. skin graft)
  2. Synergeneic Graft (Syngraft, Isograft)
    1. Transplantation of tissue between identical twins
  3. Allogeneic Graft (Allograft)
    1. Transplant between non-genetically identical persons (e.g. Blood Transfusion)
  4. Xenogeneic Graft (Xenograft)
    1. Transplant between species (e.g. bovine Heart Valve transplant in humans)

IV. Epidemiology

  1. Transplantant Incidence: Approaches 39,719 per year with over 7397 live donor transplants (2019, U.S.)
    1. Kidney Transplant (23,401)
    2. Liver Transplant (8,896)
    3. Heart Transplant (3,552)
    4. Lung Transplant (2,714)
    5. Kidney-Pancreas Transplant (872)
    6. Pancreas Transplant (143)
    7. Intestine Transplant (81)
    8. Heart-Lung Transplant (45)
  2. References
    1. United Network for Organ Sharing (UNOS, accessed 11/6/2020)
      1. https://unos.org/data/transplant-trends/

V. Physiology

  1. Graft success depends on Immune System acceptance of the transplanted tissue
    1. Autografts (from self) and Syngrafts (between twins) are accepted as self
    2. Blood Transfusions are matched between donor and recipient by ABO, Rh (and other Antigens)
  2. Allogenic grafts are rejected without HLA matching and suppressing immune response
    1. Major Histocompatibility Complex or MHC (Human Leukocyte Antigen or HLA Complex) matching
    2. Immunosuppressive Medications (e.g. Corticosteroids, cyclosporin, Tacrolimus, Sirolimus)

VI. Types

  1. Cardiopulmonary
    1. Lung Transplant
    2. Heart Transplant
  2. Eye
    1. Cornea Transplant
  3. Gastrointestinal
    1. Liver Transplant
    2. Kidney Transplant
    3. Pancreas Transplant
    4. Intestine Transplant
  4. Hematologic
    1. Blood Transfusion
    2. Bone Marrow Transplant
  5. Skin (Autografts)
    1. Hair Transplant
    2. Skin Transplant

VII. Precautions: Transplant Anti-Rejection Drugs

  1. See Transplant Rejection
  2. Continuation of antirejection drugs at appropriate dose is critical to prevent rejection and serious adverse events
    1. Antirejection drugs have a narrow Therapeutic Index, Drug Interactions, and Immunosuppression risks
  3. Clarify anti-rejection drugs and doses, as well as monitoring (e.g. target trough levels) at Transitions of Care (e.g. hospital admission)
    1. Specific drug formulations and concentrations may vary significantly and are high risk for error
    2. Consult transplant team when patient is NPO or with Nasogastric Tube
    3. Consult transplant team regarding possible adverse effects (e.g. nephrotoxicity with Tacrolimus or Cyclosporine)
    4. Also consult when there is the potential for Drug Interactions
  4. References
    1. (2023) Presc Lett 30(10): 59

VIII. References

  1. Mahmoudi (2014) Immunology Made Ridiculously Simple, MedMaster, Miami

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