Introduction

The earliest recorded attempts at organ transplant date back thousands of years.1 More than a few apocryphal descriptions exist from ancient Egypt, China, India, and Rome describing experimentation with transplantation. For example, an Indian text from 2nd century BC describes the procedure for nasal reconstruction surgery with the use of autografted skin. Also, Roman Catholic lore has saints Damian and Cosmas replacing the gangrenous leg of a man with the leg of a recently deceased man in the third century AD.

French surgeon, Alexis Carrel, pioneered the art of surgical techniques for transplantation in the early 1900s.1 Together with Charles Guthrie, Carrel experimented in artery and vein transplantation. Using revolutionary methods in anastomosis operations and suturing techniques, Carrel laid the groundwork for modern transplant surgery. He was one of the first to identify the dilemma of rejection, an issue that remained nearly impossible to circumvent for nearly half a century.1

Prior to the work of Alexis Carrel, malnourishment was the prevailing theory regarding the mechanism of allograft rejection.1 However, in 1910, Carrel noted that tissue damage in the transplanted organ was likely caused by multiple, circulating biological factors. It was not until the late 1940s with the work of Peter Medawar that we began to gain a better understanding of transplant immunology. Medawar was able to define the immunologic nature of rejection using skin allografts. In addition, George Snell observed that grafts shared between inbred animals were accepted but were rejected when transplanted between animals of different strains.1

Table 55-1 Solid Organ Transplant History

Year

Event

]963

First successful deceased doctor kidney transplant

1966

First successful pancreas transplant

1967

First successfuf liver transplant

1967

First successfuf heart transplant

1981

Hrst successfuf heart-lung transplant

1983

TUst successful Single lung transplant

1987

First successful double-lung transplant

1937

First successfuf intestine transplant

19S9

Hrst successful living donor liver transplant

1990

first successful living donor lung transplant

1998

First successful iive-donor partial pancreastransplant

The seminal work by early transplant researchers event uallyled to the concept of histocompatibility1'2 Histocompatibility describes the process where polymorphic genes encode cell membrane antigens that serve as targets for immune response, even within a species. Further research in transplant immunobiology has led to an accurate understanding of the immune response after transplantation.1'

Joseph Murray performed the first successful organ transplant in 1954/ It was a kidney transplant between identical twins. This was a success in large part because no immunosuppression was necessary due to the fact that the donor and recipient were genetically identical. Murray's success led to attempts with other organs (Table 55-1).

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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