HELLO 1

Transplant Medicine (20 seconds)

Transplant medicine is the field of medicine involving the transfer of an organ, tissue,
or cells from one person (the donor) to another person (the recipient). These
surgeries are often used to treat organ failure, such as failure of the kidneys, heart,
lungs, or liver. Transplant surgeries require careful matching to ensure the recipient's
body does not reject the donated organ. Transplant medicine also involves
immunosuppressive therapy to prevent organ rejection.
History (40 seconds)
Ancient times: As early as ancient Greece and Rome, people had attempted skin
grafts and tissue transplants. These attempts were mainly focused on wound repair
and plastic surgery. (Records are incomplete, so it's unclear how patients fared
afterwards.)
Early 20th century: In the early 20th century, French surgeon Alexis Carrel first
attempted animal organ transplant experiments, but had little success.
1950s: In the 1950s, organ transplants began to be performed on humans. In 1954,
American surgeon Joseph Murray successfully transplanted a kidney from one twin
brother to the other. Around the same time, other surgeons also began attempting
kidney and skin transplants.
1960s: With the development of immunosuppressive drugs, organ transplant
technology made significant progress. In 1967, South African surgeon Christiaan
Barnard performed the world's first heart transplant.
1970s to present: With continued technological advancements, organ transplant
surgeries have become increasingly common. In the 1970s and 1980s, transplants of
the liver, lungs, and intestines also began. The development of transplant medicine
has also included the application of new technologies like tissue engineering and
stem cell research.
Principles (1 minute 30 seconds)
Autograft: Transplanting tissue or organs from the patient's own body, such as
autologous bone marrow transplant.
Example of autologous heart transplant surgery:
https://www.youtube.com/watch?v=RE-9pMyfnF0
For severe upper and lower jaw bone defects, microvascular surgery is used to
transplant the fibula bone from the leg to reconstruct the jaw. The shape and
curvature of the fibula is quite different from the jaw bones, so precise osteotomy
and fitting is required to achieve a similar bite anatomy.
Organ cultivation from one's own cells: Through in vitro cultivation of the patient's
own cells, organs or tissues can be grown, such as culturing skin cells to treat large-
scale burns. The new skin can then be transplanted back into the patient.
Example: In 2022, the world's first case of using 3D-printed ear grown from the
patient's own cells to treat microtia (small ear). The medical team first scanned the
patient's normal left ear to match the shape, then extracted ear cartilage cells and
cultured them, before 3D-printing the ear for transplantation. Since the new ear is
made from the patient's own cells, the risk of rejection is low, and the cartilage tissue
will continue to regenerate, achieving a similar appearance and feel to the original
ear.

Here is a concise summary of the key points about transplant immunology:

Transplant immunology is critical to understanding organ rejection. The immune

system views transplanted organs as foreign invaders and mounts a rejection
response[1][2][5]. This is because transplanted cells have unique markers that the
immune system recognizes as non-self.

To overcome rejection, transplant recipients require immunosuppressive therapy to

inhibit the immune response and reduce rejection of the transplanted organ[1][2].
Examples include:

- In 1966, a cocktail of anti-lymphocyte globulin (ALG), steroids, and azathioprine was

developed[5]
- Cyclosporine, an immunosuppressant extracted from fungi, selectively inhibits
helper T cells without affecting the bone marrow or most antibody-producing B
cells[5]

Transplants between genetically identical individuals, such as identical twins, are

called syngeneic grafts and do not trigger an immune response[3][5]. The first
successful organ transplant in 1954 was an identical twin kidney transplant[3].

Despite immunosuppression, transplant recipients still face challenges like side

effects of immunosuppressive drugs and long-term graft failure[5]. The next section
will explore in more depth the reasons for transplant failure.

Citations: