外科学PPT教学课件 14-Organ Transplantation for MD-PhD Program students.pptx
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外科学PPT教学课件 14-Organ Transplantation for MD-PhD Program students.pptx
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,OrganTransplantation,意,Female,49yPrettyRichSingleandSad,PolycysticliverandkidneydiseaseHermotherandeldersisterbothdiedofthesamedisease.Onhemodialysis,Comparisontonormalliver&kidney,Normal,Polycysticliverandkidney,Removedorgansandgrafts,Intensivecareunit(ICU)anddischarge,Followup,Heryoungersistersufferedfromthesamedisease.Historyrepeateditself.,ANewDayHasCome,OrganTransplantation,OverviewoftransplantationTransplantationimmunityandpreventionProcurementandpreservationofgraftsOrgantransplantationFuturefortransplantation,Historyoftransplantation,FantasystageEmpiricalstudystageClinicalearlystageClinicaldevelopingstage,Clinicalearlystage,JosephMurray(USA)Kidneytransplantationbetweenidenticaltwins,inC19a5d4averickidneytransplantation,in1962NobelPrizewinnerin1990,Clinicaldevelopingstage,CyclosporineLacy,Kostianovsky,Survival40-50%80-Islettransplantation,197819906%7,FacialTransplantation,France2005,China2006,MilestonesinOrgantransplantation,cyclosporine,UnderlowTconditionDevelopmentKeypointFundament,Startedin1960sDevelopedrapidlyduringthelasttwodecadesAllkindsoftransplantationscanbeperformedOver7000patientsunderwenttransplantations/yearThenumbersoftransplantationaddeduptomornthan100,000.,OrgantransplantationinChina,Conceptionoftransplantation,Transplantation,Transplantationisthemovingofviablecells,tissuesororgansfromonebodytoanother(orfromadonorsiteonthepatientsownbody),forthepurposeofreplacingtherecipientsdamagedorfailingcell,tissueororganwithaworkingonefromthedonorsite.,TermsofTransplantation,Thetransplantedcell,tissueororganiscalledgraft.Thepersonwhodonatesgraftsiscalleddonor.Thepersonwhoreceivesgraftsiscalledrecipient.,Classification,AccordingtothegeneticdifferenceAutotransplantationIsotransplantationAllotransplantationXenotransplantation,Autotransplantation,Transplantbacktothesameperson,Isotransplantation,Organsortissuesaretransplantedfromadonortoageneticallyidenticalrecipient,Allotransplantation,Organsortissuesaretransplantedfromadonortoageneticallynon-identicalmemberofthesamespecies,Xenotransplantation,Transplantingorgansortissuesfromonespeciestoanother,Classification(accordingtothesiteoftransplants),orthotopictransplantationheterotopictransplantationParatopictransplantation,OrthotopicTransplantation,HeterotopicTransplantation,ParatopicTransplantation,Insitulateralpartiallivertransplantation,OrganTransplantation,OverviewoftransplantationTransplantationimmunityProcurementandpreservationofgraftsOrgantransplantationFuturefortransplantation,Transplantimmunity,Hostagainstinvader,Rejectionisthebiggestobstaclefortransplantation.RejectionresultsfromthedifferenceoftheMHCAg,Transplantationantigen,MHCantigen(HLA)Classi:
HLA-A,B,C,expressedoncellsurfaceofallnucleatedcellsandrecognizedbyCD8+T-cellsClassii:
HLA-DR,DQ,DP,expressedoncellsurfaceofAPCcellsandrecognizedbyCD4+T-cellsmHCantigen(minorhistocompatibilityantigen)EndothelialglycoproteinsABOblood-groupantigens,Keycomponentsoftheimmunesystem,今天要向大家汇报的内容就是结合文献复习以及我们中心的应用经验,总结雷帕霉素在器官移植中的应用。
CsATac,OKT3,细胞毒T淋巴细胞相关抗原4融合蛋白(CTLA4-Ig),抗CD154单抗,抗CD25单抗,SirolimusEverolimus,酪氨酸激酶3(JAK3)抑制剂,MechanismforAcuteRejection,MPAFK778,抗CD52单抗,FTY720,Aza,Typesofrejection,Hyperacuterejection,HARAcutevascularrejectionAcuterejection,ARAcutecellularrejectionChronicrejection,CR,Hyperacuterejection,MediatedbypreformedantibodiesrecognizingforeignAgOccurswithinminutestohoursaftervascularanastomosisResultfrompriorexposuretoalloantigensfrombloodtransfusions,pregnancy,orprevioustransplantation,HyperacuteRejection,RequireImmediateremovaloftransplantRapidagglutinationofthebloodoccursPreventedbytransplantingonlyABO-compatiblegraftsRapidthromboticocclusionofthevascularofthetransplantedallograft,AcuteVascularRejection(AcceleratedRejection),Occursonday3-5post-transplantationIgGAbagainstendothelialantigenandactivationofcomplementT-cellalsocontributetotheacceleratedrejectionLysisoftheendothelialcellsandinfiltrationofinflammatorycells,Acutecellularrejection,Usuallyoccursonday4-90PTCausedbymismatchedHLACellularandhumoralimmunityinvolvedinthisepisode,Acutecellularrejection,Clinicalsymptomsandsigns:
anemia,edema,hypourocriniaandtransplantedkidneydysfunctionLaboratorytesting+TissuebiopsyEarlydiagnosisandtreatmentareveryimportant90%ARcanbereverted,AcuteCellularRejection,ThepresenceofT-cellsinfiltratingthetransplantedtissueEvidenceofstructuralinjurytothetransplantedtissueInjurytothebloodvesselsinthetransplantedtissue,ChronicRejection,Atermusedtodescribealong-termlossoffunctionintransplantedorgans.ThemechanismofCRislessclearlydefined.Proliferationofendothelialcellsandsmoothmusclecells,therebyleadingtoluminalocclusion,Chronicrejection,Over3monthsaftertransplantationImmunologicalandnon-immunologicalcausesinvolvedNoeffectivetreatmentuptillnowRe-transplantationistheonlydefinitivetreatment,PreventionofRejection,HLAtyping,HLA-A,HLA-B,HLA-DR,ABObloodtypinglymphocytotoxicitytestPre-existingAbdetection,Panelreactivityantibody(PRA),OrganTransplantation,OverviewoftransplantationTransplantationimmunityProcurementandpreservationofgraftsOrgantransplantationFuturefortransplantation,OrganTransplantationOverviewoftransplantationTransplantationimmunityProcurementandpreservationofgraftsOrgantransplantation,Graftsprocurement&preservation,GraftsTrimming,Vascularanastomosis,Recoveryofbloodcirculation,Ureteroneocystostomy,OrganTransplantation,OverviewoftransplantationTransplantationimmunityandpreventionProcurementandpreservationofgraftsOrgantransplantationFuturefortransplantation,我怎能在别人的苦难面前转过身去。
切格瓦拉,
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