Zvinopfuura 500 000 nhengo dzomuviri dzakaputika dzakaita muUnited States
Maererano neUnited Network for Organ Sharing (UNOS), pakati peJanuary 1, 1988, uye Gumiguru 30, 2016, inofungidzirwa nhengo 669 565 dzakasimwa muUnited States. Kunyange zvazvo nhamba idzi dziri dzinonakidza zvinoshamisa, pane zvisiri izvo zvikamu zvakakwana zvinowanikwa kune avo vanozvida. Pari zvino, vanhu 120,139 vari kushaiwa kuponeswa kwemuviri.
Hezvino idzi nhanhatu dzinowanikwa dzakawanda-sechigunhi chinogadziriswa kuitira kuti chiwedzere kuwedzerwa. Nhengo-yega yega inogadziriswa inotsanangurwa nokuti vagashiri vechirungu vanowanzogamuchira imwe nhengo imwechete panguva imwe chete. Semuenzaniso, nhamba yeinso / pancreas transplants (21 727) panguva yakataurwa pamusoro apa inopfuura nhamba yepascreas transplants chete (8 235).
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KidyoNhamba yeinso inopindirana pakati peJanuary 1, 1988 uye June 30, 2016, yaiva 395,510
Itsvo ndiyo nhengo inonyanya kudhindwa. Muna 2011, paiva nevane 11 835 vakafa-donor transplants uye 5772 vapenyu-vanopa zvipo.
Kuchinja kwepyiyo kunoshandiswa kuporesa vanhu vane chirwere chekupedzisira chechirwere chechirwere, kana mafungiro asina kukwana. Kazhinji, kukanganisa kwakadaro kwetsvo kunokonzerwa nechirwere cheshuga kana kuwedzerwa kwehutano. Pamusoro pezvo, mafungiro epipi anowedzera kubudirira kudarika dialysis uye anovandudza mararamiro ehupenyu uye anowedzera hupenyu hwekutarisira kune imwe yakakura kudarika dialysis .
Muma1960, mishonga yemuviri inofanirwa kukunda kurambwa kwezviitiko yaiva azathioprine uye prednisone. Nemhaka yokuti taive nemishonga miviri yakawanda yemuviri mumakore ekutanga ekugadziriswa, itsvo dzakapiwa kubva kune vanopa mhuka dzaiwanzotora kupfuura tsitsi dzakapiwa kubva kune vakafa.
Nhasi, tine mishonga yemishonga yakasiyana-siyana kubatsira kubatsira kudzivirira mafungiro evomuviri muvanhu vanogamuchira mafungiro ekuchinja. Kunyanya, mishonga iyi inodzvinyirira mhando dzakasiyana dzezvirwere zvekuzvidzivirira pamuviri, kusanganisira izvo zvinokonzerwa nemaabhakitiriya, fungi, uye zvironda zvinouraya.
Nhengo dzinoshandiswa kupomesa kurambwa dzinosarudzwa zvakadzama sevashandi vekuchera kana maitiro ekugadzirisa . Induction agents vanoderedza mukana wekurambwa kwakanyanya uye anopiwa panguva yekufambisa. Muvanhu vanogamuchira itsvo, avo vanoshandiswa muzvinyorwa zvinosanganisira zvirwere zvinopedza kushandiswa kwe steroid kana calcineurin inhibitors (cyclosporine uye tacrolimus) uye zvinosanganiswa nezvinobatwa.
Maintenance therapy inobatsira kudzivisa kukanganwa nekurasikirwa kwepso. Kazhinji, varwere vanowana kurapa kunotevera: prednisone (steroids), calcineurin inhibitor uye antimetabolite (funga azithioprine kana, kazhinji, mycophenolate mofetil). Maintenance therapy inogadziriswa kwenguva.
Vongai nekuvandudzirwa kwezvirwere zvemunosuppressive, kurasikirwa kwetsvo dzakatemwa nekuda kwekuregererwa kwakanyanya hazviwanzo. Kubva munaDecember 2012, nhamba yevhunyi vaigashira vari vapenyu mushure memazuva mashanu, kana makore mashanu ekupona kwemazana, yaiva 83.4 muzana yeitsvo dzakawanikwa kubva kune vakafa vakapa uye 92 muzana yeitsvo dzakapiwa kubva kune vanorarama.
Nokufamba kwenguva, zvisinei, basa rekutsvaira mafungiro rinokurudzirwa nehurongwa husingaperi hunonzwisisika, hunosanganisira interstitial fibrosis, tubular atrophy, vasculopathy, uye glomerulopathy. Nokudaro, chiyero chekutarisira hupenyu kune avo vanogamuchira itsvo kubva kune avo vanorarama vari makore makumi maviri uye kuti kune vanogamuchira nhengo dzevakafa vakafa makore 14.
Vapi vanozvipira vanozvipira vanofanira kuregererwa chero zvirwere zvakakomba, uye vafa havafaniri kuve nemarudzi ose ezvirwere zvinogona kupararira kune anogamuchira, zvakadai seHIV, hepatitis kana metastatic cancer.
Vopa vanowirirana nevagashiri vachishandisa ropa remazana antigens (funga neropa rudzi) uye antigens eHLA huru histocompatibility jen complex. Vagashiri vesso vanonyanya kufanana neHLA vari nani zviri nani pane avo vane maHLA asina kunaka. Kazhinji, chikwata chekutanga chizvarwa chinowanzokwanisa kuratidza kufanana kweHLA kupemha antigens. Mune mamwe mazwi, yekutanga-degree pachiyero inowanzopa nhengo yakagadzikana inotora zviri nani kudarika itsvo kubva kumunhu akafa.
Kuvhiyiwa kwepyiyo kunenge kusingasviki uye nhengo iri kuiswa ku inguinal fossa pasina chidimbu chokuputsa piritoneal cavity. Kana zvose zvikafamba zvakanaka, mupi wemutsipa anogona kutarisira kubudiswa kubva kuchipatara mune zvakanaka kwazvo mushure memazuva mashanu.
Itsvo dzinowanikwa kubva kune vakafa vanokwanisa kuchengetwa kwemaawa anenge makumi maviri zvisati zvashandurwa. Nguva ino inopa vashandi vehutano nguva yakakwana yekufananidza, kupindirana, kusarudza uye kutakura nhengo idzi.
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ChiropaNhamba yechiropa ichiputika pakati peJanuary 1, 1988, uye June 30, 2016, yaiva 143 856.
Sezvo neinso netsvo yekuputika, zviputi zvinogona kubva kune vapenyu vanorarama. Nhengo dzechiropa yezvipikirwa zvinowanzouya kubva kune vanoita uropi-vakafa vari vaduku kupfuura 60. Mupi wakafa anofanira kusangana nemamwe mitero, kusanganisira kusakanganiswa kwechiropa nekuda kwekutambudzika kana zvirwere zvakadai sehepatitis.
Nyanzvi dzinopikisana nevatsigiri nevagashiri vachishandisa kubatirana kwaAbO uye ukuru hwemunhu. Zvinonakidza mumamiriro ekukurumidzira, chiropa chinogona kuparadzaniswa (kupatsanurwa chiropa) uye chinopiwa kune vaviri vanogamuchira vana. Uyewo mumamiriro ekukurumidzira kana kujekeswa kwechirongwa chechirwere, zvipembenene zvinonzi ABO-zvisingabvumirwi zvinogona kushandiswa. Kusiyana neinso dzinochinja, zviputi hazvidi kuongororwa kuti zvienderane neHLA.
Chiropa ndicho choga chechirwere chekushanda chinogona kuva neruzivo rukuru rwekuvandudza. Mune mamwe mazwi, chiropa chinokura zvakare. Izvi zvinogona kuchinja zvakare ndicho chikonzero nei chidimbu chinokonzera chiropa chinokwanisika. Kana imwe nguva chikamu kana chirebe chechiropa chiri kupfuudzwa, chichadzoka zvakare.
Nechiropa chokupemha, iyo yakakura-yakakura yakarurama lobe inoshandiswa kuruboshwe rwelobe. Uyezve, kunyange zvazvo kusarura kwechiropa kunowanikwa kubva kune vanopa zvipenyu vanoitwa, kazhinji zvipembenene zvinowanikwa kubva kune dzimwe nyika. Muna 2012, 4 chete muzana yehuputi yehuputi (246 maitiro) yakatengwa kubva kuvanhu vanorarama.
Chiropa chekuendeswa chinopiwa senzira yekurapa kana dzimwe dzose zvingasapera. Inopiwa kune vanhu vane chirwere chakakomba uye chisingaregereki chechiropa chisina humwe mushonga wezvechiremba kana kuporesa. Somuenzaniso, munhu ane chirwere chakakura chakakonzerwa nehepatitis C kana kudhakwa kunogona kuva mubati wechiropa chekuisa.
Nechiropa chekushandiswa, nguva yakakosha zvikuru. Munhu anogamuchira kuwedzerwa anofanira kunge achirwara zvakakwana kuti adzire kukohwa asi zvakanaka zvakakwana kuti adzoke kubva pakuvhiyiwa.
Zvose zvinokonzerwa nechiropa, kana kuti orthotopic transplantation , inobata chirwere chakakura uye inonyanya kuoma-kunyanya kune vanhu vane hutachiona hwehutachiona hunokonzerwa nechirwere chechirwere. Kubatanidzwa kwehutachiona hwehutachiona uye coagulopathy, kana kukanganiswa kwekuvhara ropa kunokonzerwa nekushaya simba kwechiropa, kunogona kutungamirira ku kurasikirwa kweropa akawanda panguva yekuvhiyiwa uye kuwedzerwa kwekuda kuisira ropa. Uyezve, kubvisa chiropa chose uye kuchinjisa kunoda kutanga kutanga kusanganisa (kudzvora) uye zvakare anastomoses (kujoina) yemiti midzi yakakosha yemaropa nezvimwe zvivako, zvakadai sedoro reva vena cavae, portal vein, hepatic artery, uye bile duct.
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MoyoNhamba yemwoyo inoputika pakati peJanuary 1, 1988, uye June 30, 2016, yaiva 64 085.
Kudzorera mwoyo kwakambove chimwe chinhu chakarota nesayenzi vanyori vezvinyorwa, asi isu takazviita. Zvinotora makore anopfuura mazana maviri ekufambira mberi mukati mese kunzwisisa kwedu kwekudzivirira muviri uye kuvandudzwa kwekuvhiyiwa pamwe netsika ye suture uye teknolojia yekuzarura musuo wekugadzirisa mwoyo. Muna 1967, kukohwa kwekutanga kwemoyo kwakaitwa muCape Town, South Africa, nechiremba chiremba anonzi Dr. Christiaan Barnard.
Kunyange zvazvo teknolojia yakaisvonaka, kuchinja kwepakutanga kwemoyo hakuna kuwedzera kupona munzira ipi zvayo. Ichokwadi, murwere waBarnard akararama mazuva gumi nemasere mushure mokugamuchira moyo mutsva. Zvinotora kunatsiridza muzvirwere zvinoshandiswa mumasikirwo emasikirwo uye mavara ekunyora kunatsiridza kupona mushure mekuvhiyiwa kwemoyo.
Maererano neDhipatimendi reUnited Health & Human Services, muna 2012, makore mashanu ekupona, kana kuti nhamba yevanhu vakanga vachiri vapenyu makore mashanu mushure mekutengesa mwoyo, ndeye 76.8 muzana.
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LungMuto wemapapu unofamba pakati paJanuary 1, 1988, uye June 30, 2016, aiva 32.224.
Kubvira muna 1985, zvinodarika makumi mana zvemapapu zvinoputika zvakaitwa munyika yose. Kugadzirwa kwemafupa kunoitwa nevanhu vane magumo emapapu chirwere chisina kushaya kenza (nonmalignant). Heano pane zviratidzo zvina zvakakwirira zvekugadzirisa mapapu:
- Chirwere chekudzivirira chirwere chepachimona (COPD)
- Idiopathic pulmonary fibrosis
- Cystic fibrosis
- Alpha-1 antitrypsin inoshaya emphysema
Kazhinji, mapapu anowanikwa kubva kune vakafa varipo nehutano hwehutachiona hwekushaya (brain death). Zvisinei, pakati pe15 ne20 muzana yevakapa vakadaro vane mapapu akakodzera kuwedzerwa.
Kune marudzi akawanda ehutano achibvumidza kupemha kwemapapu, kana mapapu maviri kana maviri anogona kuiswa. Ne cystic fibrosis uye mamwe maitiro ebronchiectasis, zvisinei, mapofu ose anofanira kuiswa. Kuiswa kwemapapu maviri kwakagadzirirwa kuvhara utachiona kubva pakupararira kubva kumapfupa emapapu kumapfupa kusvika kune mapapu emapapu. Kunyangwe imwe mapapu imwe kana maviri inogona kuiswa mukati kuti irore marudzi akawanda ezvirwere, kuiswa kwemapapu maviri kunowanzosarudzwa.
Mapapu akanaka akaparadzaniswa kuva matatu, uye mapapu ari kuruboshwe akaparadzaniswa kuva maviri lobes. Kudhindwa kwelobe kunowanikwa kubva kune anopa zvipo kwakaitwa munguva yakapfuura asi ikozvino kusingawanzoitiki. Kazhinji, rakadaro lobar transplantation yakaitwa mumakore ekuyaruka uye vechidiki vane cystic fibrosis avo vangangodaro vachimirira kubatanidzwa kwemapapiro (kana maviri) emapapu akawanikwa kubva kumunhu akafa, kana cadaver.
Kazhinji, hutano hwehupenyu hunovandudzwa zvikuru kune avo vanogamuchira kuputika kwemapapu. Nguva chaiyo munhu inorarama nekutengesa inopesana maererano nezvirwere zvipi zvaidiwa kubatanidzwa pamwe nemakore emupiro-nevagari vaduku vanorarama kwenguva yakareba-uye kugovera nzira. Muchidimbu, vanhu vazhinji vanogamuchira mapapu emapapu vanorarama makore gumi nemakore vasati vagara vachirambwa.
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PancreasNhamba yepascreas iripo pakati peJanuary 1, 1988, uye June 30, 2016, yaiva 8 235.
Iko kutanga kwepascreas transplant yakaitwa naWilliam Kelly naRichard Lillehei paYunivhesiti yeMinnesota muna 1966. Kubvira panguva iyo, zvinopfuura 25 000 makandakiti anoenderera mberi akaitwa muUnited States uye anopfuura 35,000 pasi rose. Kazhinji, zvipembenene zvinowanikwa kubva kune vakafa vanopa; zvisinei, kunyange zvazvo zvisinganyanyozivikanwi, vanorarama vanogonawo kushandiswa.
Pancreas transplant ndiyo inoshandiswa kwenguva yakareba kurapwa kwevanhu vane inshuini-inokonzerwa nechirwere cheshuga mellitus (rudzi rwechirwere cheshuga cheshuga). Kuwedzerwa kwakadai kunogona kudzorera kugadzika kweglucose homeostasis uye metabolism pamwe nekuderedza dambudziko rezvenguva refu zvinetso zvechipiri kune chirwere cheshuga.
Nezvinyorwa, zvipembenene zvinoputika zvinowanzowananiswa nechekuputika , izvo zvisingasviki. Islet masero masumbu emasero mumapancre anobudisa mahomoni, zvakadai se insulin uye glucagon. Kunyange zvazvo chiwi chinoputika chave chichiwedzera zvikuru mumakore achangopfuura, kupisa kwepascora kunoshanda zviri nani kudarika chinoputika. Panzvimbo yekukwikwidza, zvakanakisisa kuona pancreas uye chiwi chinoputika sevamwe mapindiro emitemo, izvo zvose zviri zviviri zvinogona kubatsira mubatsiri mune zvido.
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UtumboNhamba yemukumbo inopindirana pakati peJanuary 1, 1988, uye June 30, 2016, yaiva 2 733.
Kuiswa kwemukati hutsika yakaoma. Mumakore achangobva kupfuura, nzira iyi yakave yakakurumbira mukurapa kwemafupa echidiki mashoma, umo vanhu vasingakwanisi kuwana mvura yakakwana, makorikiti, mapuroteni, mafuta, mavitamini, minerals nezvimwe zvakadaro. Kazhinji, vanhu vanogamuchira matumbo vanofamba vanonzwa kusakundikana uye vanoda chizere chemarenteral chikafu (TPN), kana kudya kwakagadzikana.
Inenge 80 kubva muzana yevanhu vanogadziriswa mumatumbo kutengesa kuwana basa rakakwana mumatumbo. Zvinetso zvinosanganisira izvi zvinosanganisira chirwere che CMV , chirwere chakanyanya uye chisingaperi, uye post-transplant lymphoproliferative chirwere.
Sources:
Azzi J, Milford EL, Sayegh MH, Chandraker A. Kuiswa muTraining of Renal Failure. Muna: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2015.
Gruessner AC, Jie T, Papas K, Porubsky M, Rana A, Smith M, Yost SE, L. Dunn D, Gruessner RG. Transplantation. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e . New York, NY: McGraw-Hill; 2014.
Tavakkoli A, Ashley SW, Zinner MJ. Small Intestine. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e . New York, NY: McGraw-Hill; 2014.
Kuputika Nedzimwe Muviri January 1, 1988 - June 30, 2016. United Network for Organ Sharing https://www.unos.org/data/.
Trulock EP. Lung Transplantation. Muna: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e . New York, NY: McGraw-Hill; 2015.