Abdominal Organ Transplantation II
Study Course Implementer
Residency Speciality
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About Study Course
Objective
Learning Outcomes
Knowledge
1.During the rotation discipline, the resident acquires basic knowledge and competences in the transplantation of kidneys and other abdominal organs - selection of patients for transplantation, preparation for transplantation, finding and transplanting a suitable donor organ, post-operative immunosuppression and treatment, and prevention and treatment of complications.
Skills
1.As a result of learning the rotation discipline, the resident will be able to examine a patient with terminal abdominal organ failure and prepare for transplantation, find and transplant a suitable donor organ, treat the patient in the post-transplantation period, diagnose and treat post-transplantation complications.
Competences
1.Determination of indications for abdominal organ transplantation, selection of recipients and donors, organ transplantation, prescription and management of induction and maintenance immunosuppression, management of the postoperative period. Surgical provision of renal replacement therapy.
Assessment
Individual work
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Title
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% from total grade
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Grade
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1.
Individual work |
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The student independently acquires theoretical knowledge, prepares and conducts seminars on transplantology issues:
-organization of transplantation service: legislation and ethical aspects in transplantation; principles of organ allocation; non-immunological bases of determining the donor/recipient pair (organ sizes, body weight of the recipient, age); transplant combinations and their role in improving transplant results, organ exchange;
immunological criteria for transplantation; immunological bases of determining the donor / recipient pair (ABO match, HLA match, cross-match), rejection mechanisms of transplanted organs;
-immunosuppression: basic groups of immunosuppressants, mechanism of action, pharmacokinetics; use of immunosuppressive drugs, level monitoring, complications, side effects; preservation of organs and tissues, ischemia, cell biochemistry and physiology during ischemia and preservation, preservation with hypothermia, preservation solutions of organs and tissues, properties of preservation of various organs, complications of reperfusion in cases of preservation of organs; taking kidney, part of liver, part of pancreas for transplantation from living donors;
-kidney transplantation: indications and contraindications, examination of patients and preparation for transplantation, kidney transplantation surgery, features of anesthetic provision, complications of reperfusion and possible prevention, protocols of immunosuppressive therapy, early postoperative complications, immediate and delayed function of the graft and patient management tactics; kidney transplant rejection, its diagnosis and treatment; the early postoperative period, complications of infections and their treatment and prevention, radiological examination of patients with transplants; kidney transplant pathologies, puncture biopsy in the diagnosis of dysfunctions; re-transplantation – peculiarities of preoperative preparation and management of the postoperative period; tactics of management and preparation of hypersensitized patients, choice of immunosuppression and its peculiarities; kidney transplantation in children;
-pancreas transplantation: indications and contraindications, transplantation from living and deceased donors, surgical technique, early and late postoperative complications, immunosuppression, retransplantation.
-liver transplantation: indications and contraindications, transplantation from living and deceased donors, surgical technique, early and late postoperative complications, immunosuppression, retransplantation.
-small intestine transplantation: patient selection, donor selection, technique, immunosuppression technique;
basics of obtaining and transplanting other organs – heart, lung, uterus, vascularized composite tissue, etc. transplantation: indications, selection of patients, transplantation technique, postoperative period;
outpatient follow-up of post-transplantation patients, complications of the late period, quality of life of patients;
xenotransplantation and the use of new technologies: opportunities and perspectives, limitations, immunological and non-immunological problems.
Must learn practical skills in transplanting abdominal organs from living and deceased donors. Must be able to provide qualified transplantological assistance to organ transplant recipients, providing pre-transplantation preparation, operative assistance and post-transplantation treatment.
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Examination
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Title
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% from total grade
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Grade
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1.
Examination |
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Teacher evaluates the practical skills in a 10-point system, recording it in the resident's book.
The test of theoretical knowledge is conducted in writing and is graded in a 10-point system.
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Study Course Theme Plan
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Preparation of a kidney graft for transplantation - dissection of the renal hilum, blood vessel preparation and reconstruction options, ureter preparation and reconstruction options, excision of formations, etc.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Kidney transplantation - retroperitoneal approach, technique. Recipient vascular reconstruction, positioning and adaptation for the graft, variants of urinary tract reconstruction and ureter placement, variants of retroperitoneal graft positioning. Use of intraoperative ultrasound diagnostics. Transplantation technique for complicated graft anatomy.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Kidney transplantation Intra-abdominal approach, technique. Recipient vascular reconstruction, positioning and adaptation for the graft, variants of urinary tract reconstruction and ureter placement, variants of intra-abdominal graft positioning. Use of intraoperative ultrasound diagnostics.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Kidney transplantation for pediatric patients – recipient selection and organ allocation, surgical technique, peculiarities of surgical management. Recipient vascular reconstruction, positioning and adaptation for the graft, urinary tract reconstruction and ureter placement options, graft positioning options. Use of intraoperative ultrasound diagnostics.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Kidney re-transplantation – recipient selection and organ allocation, patient preparation for surgery, features of immunosuppression, surgical techniques and management features. Repeated re-transplantations (third, fourth and subsequent). Peculiarities of post-transplant management of patients. Results of re-transplants.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Management of recipients after kidney transplantation - surgical, immunological and nephrological aspects. Patient monitoring after surgery, drug therapy.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Complications after kidney transplantation: immunological complications (hyperacute, acute, "silent" rejection), diagnosis and treatment.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Complications after kidney transplantation: vascular complications (hemorrhage, thrombosis, stenosis), diagnosis and treatment.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Complications after kidney transplantation: surgical and urological complications (infection, ureteral stenosis and necrosis, urine extravasation, lymphocele formation, etc.), diagnosis and treatment.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Kidney transplantation from extended criteria and non-standard risk donors - indications, risks, complications, features of recipient management after transplantation from such donors.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Simultaneous pancreas and kidney transplantation: indications, recipient selection, preparation, waiting list.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Pancreas preparation for transplantation and possible variants of vascular reconstruction.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Simultaneous pancreas and kidney transplantation: transplantation technique, peculiarities of operation management. Pancreas transplantation after kidney transplantation ("pancreas after kidney"), transplantation of the pancreas as a single organ ("pancreas alone").
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Complications after pancreas transplantation: surgical, immunological complications, graft dysfunction, outcomes.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Liver transplantation: recipient selection, preparation, waiting list.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Liver transplantation: whole-organ classical and piggy-back techniques. Possibilities and limitations of split-liver and organ part transplantation, more frequently used techniques. Use of intraoperative ultrasound diagnostics.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Management of recipients after liver transplantation – surgical, immunological and hepatological aspects. Patient monitoring after surgery, drug therapy. Liver transplantation from extended criteria and non-standard risk donors - indications, risks, complications, features of recipient management after transplantation from such donors.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Intestinal transplantation - recipient selection, preparation, waiting list, recipient surgery technique, peculiarities of post-operative period management.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Multivisceral transplantation - types, recipient selection, preparation, recipient surgery technique, peculiarities of postoperative period management.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Heart transplantation - recipient surgery, management of the post-transplantation period, complications.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Lung transplantation - recipient surgery, management of the post-transplantation period, complications. Combined thoracic organ transplantation.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Transplantation of other (non-vital) organs and vascularized composite tissues - selection and preparation of recipients, operation, post-transplantation period.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Transplantation of pancreatic islet cells - options and types, recipient selection, preparation, recipient surgery technique, features of postoperative period management
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Tissue transplantation: features of recipient and donor selection, preparation, waiting list, recipient surgery technique.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Cell transplantation: recipient selection, preparation, waiting list, recipient surgery technique.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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New opportunities in predicting post-transplant outcomes and monitoring results - biomarkers and other technologies with potential for diagnostics.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Use of new technologies in transplantation – xenotransplantation, "3D printing" of organs, artificial cultivation of organs, transplantation of artificial organs, etc.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Vigilance in transplantation – serious adverse and unexpected events and side effects, documentation, monitoring and traceability. Monitoring the results of transplantation and the use of living donors. Transplant registries.
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Seminar
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Modality
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Location
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On site
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Auditorium
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Topics
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Variants of the organization of the transplant service, activity and efficiency, results. Effects of various medical and non-medical factors on outcomes. Transplant 'myths' and their implications for organ donation and transplantation. The medical and economic importance of transplantation in modern medicine, alternatives.
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Bibliography
Required Reading
Textbook of organ transplantation, vol 1, 2. (edit. Allan D. Kirk). Willey Blackwell, Oxford, 2014.
Gabriel M.Danovich. Handbook of Kidney Transplantation Sixth Edition. Lippincott Williams & Wilkins, Philadelphia, 2017.
Abhinav Humar, Mark L. Sturdevant. Atlas of Organ Transplantation, 2nd ed. 2015.
Carol E.H.Scott-Conner. Essential operative techniques and anatomy. 4th editioin. Wolters Kluwer | Lippincott Williams and Wilkins, Philadelphia, 2014.
Guide to the quality and safety of organs for transplantation. 7th edition. EDQM, Strasbourg, 2018.
Nieru transplantācija (red. R.Rozentāls, I.Folkmane). Nacionālais Apgāds, Rīga, 2008.
Rekomendācijas nieru transplantācijā. (autoru kolektīvs, R.Rozentāla vad.). Medicīnas Apgāds, Rīga, 2015.
Additional Reading
Dialysis Access. A multidisciplinary approach. (edit. Richard J. Gray, Jeffrey J. Sands). Lippincott Williams & Wiulkins, Philadelphia, 2002.
Hemodialysis vascular access: practice and problems. (edit. Peter J.Conlon, Steve J Schwab, Michael L. Nicholson). Oxford University Press, Oxford, 2000.
Living donor organ transplantation. (edit. Rainer W.G.Gruessner, Enrico Benedetti). MCGrawHill Medical, New York, 2008.
Ķirurģija. (red. J.Gardovskis). Rīgas Stradiņa Universitāte, rīga, 2013
Transplantation of the liver. 2nd edition. (edit. Ronald W Busuttil, Goran K. Klintmalm). Elsevier Saunders, Philadelphia, 2005.
Рафаил Розенталь. Получение органов, тканей и клеток для трансплантации. Nacionālais Apgāds, Rīga, 2005.
Other Information Sources
Periodika: Transplant International, Nephrology Dialysis Transplantation, Transplantation Proceedings, Transplantation, JAMA, Lancet, NEJM, Transplant Newsletter, American Journal of Transplantation, cita transplantoloģijas periodika