1. SOLID ORGAN TRANSPLANTATION
Prof. ÖZCAN GÖKÇE, MD
Director of the Department of General Surgery
Yeditepe University Hospital

2. Organ Source
Cadaver
Living donor
Other species

3. HLA TYPING A-MATCH…FULL B-MATCH..ONE ANTIGEN DIFFERENT
C-MATCH..TWO ANTIGENS DIFFERENT
…..SO ON
THE MORE CLOSER TO A-MATCH, THE MORE SUCCESSFULL KIDNEY TRANSPLANTATION

4. MAJOR HISTOCOMPATABILITY COMPLEX
Class I - present on almost all nucleated cells (interesting exceptions include sperm and the cells of the trophoblast).
Class II- present on Antigen Presenting Cells (macrophages, B cells, and dendritic cells).
Class III- are not surface molecules, but instead are various proteins typically which have some immunological role (C2,C4,Tumor necrosis factor alpha and beta, various HSPs)
Human HLA region [Highly Simplified version !]
---DP--DQ--DR C4--C2--etc B--C--A---

5. Human MHC genes are highly polymorphic

8. IMMUNUSUPRESSION

9. IMMUNOSUPRESSIVE AGENTS
T-CELL BLOCKERS
GLUCOCORTICOIDS
BIOLOGIC IMMUNOSUPPRESSION
SITOTOXIC AGENTS

10. T-CELL BOCKERS CYCLOSPORINE-A TACROLIMUS SIROLIMUS
CYCLOSPORINE AND TACROLIMUS ARE SELECTIVE CALCINEURIN INHIBITORS
INHIBITION OF Th INDUCTION WHICH IS ACTIVATED BY IL-2

11. NFAT :Nuclear factor of activated T-cells
FKBP: FK Binding protein

12. BIOLOGIC IMMUNOSUPPRESSION
-Antilymphosite globulines(Polyclonal antibodies)
(Atgam, timoglobulin)
-Anti-CD3 monoclonal antibodies
(OKT3, muromonab-CD3)
all -mab, -imab and -umab suffixes
-Anti-Tac, Anti-CD25 monoclonal antibodies
(Basiliximab, daclizumab)
Anti-CD25 Monoclonal Antibodies (Basiliximab and Daclizumab)
Anti-CD52 Monoclonal Antibody Alemtuzumab (Campath-1h)
Anti-CD20 (Rituximab)
Monoclonal Antibodies to Adhesion Molecules
anti–LFA-1 mAb (efalizumab)
anti-CD4 mAb (priliximab)

14. New Agents
1. AEB: This is a new oral compound that effectively blocks early T-cell activation by selective inhibition of protein kinase C. Therefore, it has a different mechanism of action from that of calcineurin inhibitors, and early studies suggest it is not associated with the nephrotoxicity seen with calcineurin inhibitors. This agent is currently in phase II testing.
2. ISA247: This is a novel semisynthetic analogue of cyclosporine that is structurally similar to it except for a modification of a functional group. This agent has not been associated with the nephrotoxicity seen with cyclosporine and currently is in phase II testing.
3. Janus kinase-3 (JAK-3) inhibitors: JAKs are cytoplasmic tyrosine kinases that participate in the signaling of a broad range of cell surface receptors, particularly members of the cytokine receptor superfamily. JAK-3 is found primarily on hematopoietic cells and blocking this may provide a significant degree of selectivity in immunosuppression. It is currently in phase II trials.

15. 16 DECEMBER 2006

17. Hepatocellular diseases
Chronic liver disease
Cholestatic
Biliary atrezia
Primary biliary cirrhosis
Primary sclerozing cholangitis
Familial cholestatic diseases
Hepatocellular diseases
Chronic viral hepatitis (hepatitis B, C, D)
Drud related injury
Alcoholic liver disease
Idiopatic otoimmun liver disease
Vascular diseases
Budd-Chiari syndrome
Veno-occlusive Hepatic Disease 

18. Unresectable hepatic malignancy
Hepatocellular carcinoma Cholangiocarcinoma (Only selected patients)
Epitelial hemangioendotelioma Isolated hepatic metastatic tumor Carcinoid tumor Pancreatic islet cell tumor

19. Metabolic Liver Disease
Alpha-1 antitripsin deficiency Wilson’s disease Homozigot type II hiperlipoproteinemia Crigler-Najjar syndrome type I Eritropoetik protoporfiria Urea cycle disorders Glycogen storage diseases, type I and IV Tyrozinemia Hereditary hemochromatozis

20. Fulminant Liver Disease † Acute viral hepatitis
†Drug related liver toxicity
Halothane Gold Disulfiram(Antabuse) Acetaminophen Mushroom poisoning
Other Metabolic liver disease
Wilson’s disease
Reye syndrome
Organic aciduria

21. Methanol

23. Ethanol
                   
               
                

24. Fomepizole
Fomepizole is a competitive inhibitor of alcohol dehydrogenase

25. HEMODIALYSIS