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PREOPERATIVE PLANNING The decision regarding the type of transplant to be performed is dependent on a variety of patient factors. Intraoperative flexibility is necessary and may change the type of transplant undertaken. A robust plan for adequate venous acce...

SUMMARY Multivisceral and intestinal transplantation remains a complex and uncommon treatment, however it can be life-saving. The risks are high but with improvements in surgical techniques, - especially the introduction of preoperative embolisation, the int...

THE TRANSPLANT Multivisceral/intestinal transplants are almost invariably performed with organs donated from deceased brain dead donors. A small number of living donor intestinal transplants have been performed. In intestinal and multivisceral transplant proc...

TRANSPLANTATION Complications from PN for irreversible intestinal failure are the most well-established indications for intestinal transplantation - ( Table 91.1 ). Short bowel syndrome (SBS) is the most frequent cause for the need for PN. The aetiologies of ...

TYPES OF TRANSPLANT Multivisceral or intestinal transplant covers a number of di ff erent ‘cluster’ transplants, as shown in Table 91.2 and Figure 91.1 . Full multivisceral transplant Liver and small bowel transplant Figure 91.1 Types of intestinal transplant. ...

FURTHER READING Miller L, Birks E, Guglin M et al . Use of ventricular assist devices and heart transplantation for advanced heart failure. Circ Res 2019; 124 (11): 1658–78. - Vieira JL, Mehra MR. Heart transplantation candidacy . Curr Opin Organ Transplant 2...

Future perspectives Contemporary immunosuppressive therapies and modern surgical and perioperative techniques have all contributed to improved outcomes. The principal innovations being investi gated for the future are aimed at increasing donor availability and...

HEART TRANSPLANTATION The incidence of heart failure is increasing as the population ages and coronary artery disease, hypertension and obesity rise. Current medical therapy , including resynchronisation pacemakers and implantable defibrillators, is e ff ective...

Heart retrieval After exposing the heart by median sternotomy and opening - the pericardium the organ is thoroughly inspected for contrac - tility and coronary artery disease. Heparin is administered (300 /uni00A0 U/kg) and a cannula placed into the aorta. The...

Heart–lung transplantation Combined heart–lung transplantation is an excellent treat ment for PAH ( Figure 92.10 ). However resolution of right ventricular dysfunction has been observed consistently after bilateral lung transplantation, making it the favoured...

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LUNG TRANSPLANTATION Pulmonary transplantation has made significant advances since the first human lung transplant performed by James Hardy in 1963 in Mississippi, USA. Mortality and morbidity remain high, in part because lungs remain exposed to the environment ...

Learning objectives To recognise and understand: The indications and contraindications to transplantation of • the heart and lungs The selection of recipients •

Lung retrieval Flexible bronchoscopy is first performed to clear mucopuru - lent secretions or aspiration. After median sternotomy and exposure of the lungs in each pleural space, detailed inspection is carried out for masses, consolidation or contusion. Unifo...

Operative technique Coordination between the retrieval team and the implanting team is of paramount importance to minimise ischaemic time and the duration of cardiopulmonary bypass. A median sternotomy incision is performed and the aorta, SVC and IVC are enc...

Outcomes and complications Survival has dramatically improved with advances in immuno - suppression and perioperative care, with 1-year post-transplant survival of over 90% and a median post-transplant survival of Pump Aorta Pulmonary artery Right ventricle a...

Recipient selection The primary indication for transplantation is prolonged advanced heart failure despite optimal medical management, often typified by repeated admissions or acute deterioration. Vladimir Demikhov , 1916–1998, Russian pioneer of organ transpl...

SUMMARY As the population ages and coronary artery disease, hyperten sion and obesity increase in prevalence the incidence of heart failure continues to rise. Current medical therapy is e ff ective in improving symptoms and survival but man y continue to devel...