Cardiac transplantation
- First performed by Barnard in 1967
- More than 55,000 operations have been performed worldwide
- Number of operations performed is declining due to:
- Reduced donor availability
- Improved treatment of heart failure
Indications
- Ischaemic cardiomyopathy
- Idiopathic dilated cardiomyopathy
- Congenital heart disease
- Heart failure due to:
- Anthracyclines
- Active myocarditis
- Amyloid
- Hypertrophic obstructive cardiomyopathy
- Muscular dystrophy
- Sarcoid
- Valvular heart disease
- Refractory angina
- Retransplantation
Lung transplantation
- First heart-lung transplant performed in 1981
- First single lung transplant performed in 1983
- First bilateral lung transplant performed in 1986
Indications
- Emphysema
- Alpha-1 antitrypsin deficiency
- Primary pulmonary hypertension
- Idiopathic pulmonary fibrosis
- Cystic fibrosis
- Retransplantation
Liver transplantation
- First described in 1963
- 700 liver transplants performed annually in United kingdom
- Five-year survival is currently about 80%
Indications
- Chronic liver disease
- Viral hepatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Alcoholic liver disease
- Biliary atresia
- Acute liver failure
- Acute hepatitis
- Paracetamol overdose
- Idiosyncratic drug reactions
- Metabolic liver disease
- Liver tumours
Timing of liver transplantation
- Patients should be assessed for liver transplantation if:
- Chronic liver disease
- Signs of decompensation
- Signs of decompensation in chronic liver disease include
- Tiredness
- Ascites
- Encephalopathy
- peripheral oedema
- Jaundice
- Spontaneous bacterial peritonitis
- Bleeding oesophageal varices
- Low serum albumin
- Raised prothrombin time
Pancreatic transplantation
- Often performed simultaneously with a renal transplant in diabetic renal failure
- Pancreatic transplantation alone can be considered in:
- Prerenal failure
- Unstable diabetic control
- Severe neuropathy
- Transplanted pancreas is anastomosed to the iliac vessels
- Pancreatic duct is joined bladder or loop of small bowel
- Successful transplantation greatly improves quality of life
- Patients can stop exogenous insulin
- Have normal glycosylated haemoglobin levels by three months
- Pancreatic islet cell transplantation is currently under investigation
Bibliography
Neal K L, Gimson A ES. Liver transplantation. Hosp Med 2003; 64:
200-204.
Prasad K R, Lodge J P A. Transplantation of the liver and pancreas. Br Med J 2001;
322: 845-847. |