Transplantology

The founder of experimental transplantation of vital organs, in particular the heart, is Alexis Carrel , who was awarded the Nobel Prize for this in 1912. He conducted research on organ transplantation in the experiment, their conservation and the technique of applying vascular anastomoses. He developed the basic principles of preservation of the donor organ, its perfusion .

The first organ transplant from person to person in 1933 in Kherson was performed by Yu. Yu. Voronoi . One of the founders of world transplantology is the Russian scientist V.P. Demikhov , who in 1951 developed in detail the transplantation of a donor heart to a dog. On December 3, 1967, a surgeon from South Africa, Christian Barnard , having undergone a preliminary internship at Demikhov, as well as in a number of world surgical clinics, successfully transplanted a heart transplant to a person in Cape Town for the first time in the world. Barnard considered Demikhov his teacher, twice visited his laboratory. However, unlike Barnard, who gained world fame, Vladimir Petrovich died in poverty in a communal apartment. Since then, more than 40 thousand such operations have already been done. In the USSR, the first to perform a heart transplant on November 4, 1968, was the chief surgeon of the Soviet Army Alexander Vishnevsky, and the first successful transplant was an outstanding surgeon, academician of the Russian Academy of Sciences Valery Ivanovich Shumakov on March 12, 1987 . Currently, he is named after the Institute of Transplantology and Artificial Organs in Moscow, which is considered the leading institution of the Russian Federation in the field of clinical and experimental transplantology.

The first successful kidney transplant was in December 1954 between two identical twin brothers by a group of doctors led by Joseph Murrey . Joseph Murray continued his research and made it possible to get a kidney transplant from an unrelated donor, and also examined the properties of immunosuppressants and the rejection mechanism. The first liver transplant was performed in 1956 by Thomas Starzl . A lung transplant was first performed in 1963 by Dr. James Hardy at the University of Mississippi clinic, but the patient died a few days after the operation. Joel Cooper succeeded in one lung transplant in 1983, and in 1986 he successfully transplanted two lungs.

Transplantation of a tissue-engineering trachea is currently the only hope for many patients suffering from severe cicatricial stenotic lesions ^[3] . In June 2008, the first transplant of a human organ grown from stem cells was performed by Professor Paolo Maciarini at a clinic in Barcelona. The patient was an adult woman whose trachea suffered from tuberculosis . The trachea was created according to a complex technology: doctors used the trachea of ​​a recently deceased person, neutralized living cells in it with chemical preparations and introduced stem cells from the patient’s bone marrow into the fibrous protein tissue. These cells developed four days in a special bioreactor , after which the trachea was ready for transplantation. After a month, the blood supply to the transplanted organ was fully restored ^{[4] [5]} .

The record for life expectancy with a donor organ (heart) was the American Tony Huysman, who lived after transplantation for 30 years and died of cancer ^[6] .

In accordance with the Law of the Russian Federation No. 4180-1 of December 22, 1992, both a living person and a corpse can be a donor. However, the collection of a number of organs ( kidneys , heart or lungs ) in this case can be carried out only when the biological death of the donor occurs, and there have been cases when this law was violated. So, on April 11, 2003, doctors of the 20th city hospital in Moscow tried to take the kidneys from a still living person, patient A.T. Orekhov, which was hindered by police officers and resuscitators of the clinical hospital of the Moscow Main Department of Internal Affairs. Despite the efforts of the resuscitators, the patient died, and a criminal case was opened against the doctors of the 20th hospital on charges of attempted murder, since the kidney sampling operation could only begin after an act of ascertaining his biological death was made ^[7] .

In April 2019, doctors of the Scientific Medical Research Center (NMIC) named after Academician V.I. Shumakov performed the first successful lung and liver transplant in a nine-year-old child with cystic fibrosis . The uniqueness of this case lies in the fact that at the time of the operation, the weight of the child was only 30 kilograms. The organs of an adult donor of small stature and weight were transplanted. In this regard, the liver transplanted to the child did not have to be reduced, however, the lungs underwent significant reduction. ^[eight]

For the first time in Russia in 2019, St. Petersburg doctors performed a face transplant. A soldier who received an electric burn underwent transplantation of a complex complex of facial tissues, including a total nose transplant along with the mucosa , with cartilage, bone bases and muscles . Preparation for the operation took two years. Such an operation became the 32nd in a row in the world. ^[9]

At the beginning of the 21st century, transplantation often has a positive result if modern immunosuppressive drugs are used, especially cyclosporine and glucocorticoids , as well as the compatibility of the organs of the donor and the recipient ^[10]

Kidney Transplant

With a kidney transplant, approximately 75% of patients with irreversible loss of renal function have a short-term positive result. ^[10] .

Liver transplant

Liver transplants successfully function for 1 year in 70-80% of cases ^[10] .

Heart Transplant

Successful transplant functioning during the year is observed in 70% of recipients ^[10] .

Some patients with a transplanted heart live for 20 years, in Russia the maximum duration is about 17 years. The statistics are as follows: the first year after surgery, 90% of patients successfully overcome, about 70% live for five years, and about half live for ten years. This is a lot when you consider that all of them were doomed before transplantation.

The discovery of the fact that an increase in the activity of a regulatory protein called DEPTOR in Tregs immune cells allows some hope to allow a heart transplant to live five times longer in mice even without the use of immunosuppressants . Further study of this phenomenon may significantly increase the success of transplants ^[11] .

Pancreas Transplant

The number of successful pancreas transplants reaches 70-80% of cases ^[10] . Recently, attempts have been made to transplant patients with life-threatening type 1 diabetes mellitus, which are extracted by special methods from the donor glands and are responsible for the production of insulin by Langerhans islet cells . To overcome rejection reactions, transplanted cells are trying to isolate the recipient from the immune system. For more information on islet transplantation of Langerhans, see article Transplantation of islet cells .

Use of CAR-modified cells to prevent transplant rejection

• Great Russian Encyclopedia : [in 35 vols.] / Ch. ed. Yu. S. Osipov . - M .: The Great Russian Encyclopedia, 2004—2017.