Transplantation of individual organs

Limb replantation

The success of engraftment of an amputated segment depends on the time and transport conditions. The surgery is possible within the first 6 hours after the injury. The amputated part itself must be stored at a temperature of 4 °C, and vascular perfusion of the specimen is mandatory prior to transplantation.

Surgical intervention is performed strictly after primary surgical debridement (PSD) and includes the following stages:

1. Osteosynthesis (reliable restoration of the bone framework).
2. Plastic surgery of veins and arteries to restore blood flow.
3. Suturing of damaged nerve trunks.
4. Restoration of the integrity of muscles, tendons, and fascia.
5. Skin suturing.

In the postoperative period, the most important task is the prevention of traumatic toxicosis syndrome. To achieve this, local hypothermia is applied and a strict abacterial environment is maintained.

Kidney and liver transplantation

Kidney transplantation is indicated for patients with functional organ failure and progressive uremia. To reduce intoxication, hemodialysis is performed before surgery and in the early postoperative period. The operation is performed heterotopically — the organ is placed retroperitoneally in the iliac fossa. The graft vessels are anastomosed with the common iliac artery and vein (a. et v. iliaca communis), and the ureter is implanted directly into the urinary bladder. Rejection is indicated by the appearance of lymphocytotoxins in the blood and lymphocytes in the urine.

Liver transplantation is required for rapidly progressive liver failure (against the background of cirrhosis, malignant tumors, or biliary atresia in newborns). Two options are possible:

• Orthotopic — the allogeneic organ is placed in the right upper sector of the abdominal cavity after removal of the patient's own liver.
• Heterotopic — the donor organ is placed in another region.

If necessary, organ function is temporarily supported by short-term extracorporeal perfusion.

Heart transplantation

Indications include severe forms of heart failure caused by cardiomyopathies, left ventricular aneurysms, or uncorrectable defects (e.g., tricuspid atresia). Before a donor organ becomes available, the patient's life can be supported by a pneumatically driven artificial mechanical heart.

The intervention is performed under conditions of cardiopulmonary bypass. The transplantation is always orthotopic, but the recipient's posterior walls of both atria with the orifices of the venae cavae must be left intact. This is necessary to preserve autonomic innervation.

Sequence of suturing:

1. Posterior wall of the left atrium.
2. Interatrial septum.
3. Right atrium.
4. Aorta and pulmonary trunk.

Signs of rejection are first detected on an ECG (tachycardia, extrasystoles, drop in wave voltage), and the final diagnosis is confirmed by endomyocardial biopsy.

Endocrine gland transplantation

Transplantation of endocrine organs (thyroid gland, pituitary gland, testes, ovaries, adrenal glands, pancreas) has a nuance: free tissue implantation provides only a temporary effect until the cells are resorbed. Complete preservation of function is possible only when transplanted on a vascular pedicle (usually the anastomosis is formed with the femoral or brachial artery).

Tissue harvesting is performed within the first 6–10 hours after the donor's death. The vascular pedicle is isolated, perfused with solutions, after which the organ undergoes cryopreservation at -196 °C.

Clinical effects are pronounced: transplantation of ovaries (ovaria) restores menstruation, parathyroid glands (gll. parathyroideae) relieves convulsive syndrome, and the thyroid gland (gl. thyroidea) cures myxedema.

Options for pancreas transplantation (pancreas):

• Organ transplantation: transplantation of fragments (body, tail) with a vascular anastomosis in the iliac fossa.
• Cellular transplantation: injection of isolated islets of Langerhans directly into the liver via the portal vein (v. portae).

Class and exam questions

What else to study on this topic

• Methods for preventing traumatic toxicosis syndrome
• Hemodialysis as a preparation stage for kidney transplantation
• Extracorporeal perfusion for temporary liver function support
• Cellular transplantation: isolation and implantation of islets of Langerhans

Other topics in "CHAPTER 17. PLASTIC (RECONSTRUCTIVE) SURGERY"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.