Der Einfluss der norditalienischen Universitäten auf die Entwicklung der Chirurgie in Innsbruck R. Margreiter Univ.-Klinik für Visceral-, Transplantations-

Der Einfluss der norditalienischen Universitäten auf die Entwicklung

der Chirurgie in Innsbruck

R. MargreiterR. Margreiter

Univ.-Klinik für Visceral-, Transplantations- und ThoraxchirurgieUniv.-Klinik für Visceral-, Transplantations- und Thoraxchirurgie

Department für Operative MedizinDepartment für Operative Medizin

Medizinische Universität InnsbruckMedizinische Universität Innsbruck

Tirolisch-Venezianisch-Lombardische Chirurgenvereinigung, Schloss Maretsch, 26.6.2008Tirolisch-Venezianisch-Lombardische Chirurgenvereinigung, Schloss Maretsch, 26.6.2008

Hippolytus Guarinonius (1571-1654)

1. namhafter Arzt in Tirol

1593-1597: Medizinstudium in Padua1598: Hausarzt am Damenstift in Hall1601: Stadtmedikus in Hall1609: Arzt der Bergwerkstrupppen

Hieronymus Leopold Bacchettoni

1724/25: Medizinstudium in Padua und Bologna

1726: Promotion zum Doktor der Medizin in Innsbruck

1736: 1. Lehrstuhl für Chirurgie in der Habsburger Monarchie

Karl Anton Gerstner

(1713-1797)

Medizinstudium in Padua bei Giovanni

Battista Morgani

1741: 1. Lehrstuhl für Pathologie und Praxis

Die Geschichte der Transplantationsmedizin

Tirolisch- Venezianisch- Lombardische Chirurgenvereinigung, Schloss Maretsch, 26.6.2008Tirolisch- Venezianisch- Lombardische Chirurgenvereinigung, Schloss Maretsch, 26.6.2008

Experimental

~1895 A.v. Lexer first attempt

1899 A.v. Decastello-Rechtwehr

partial success

1902 E. Ullmann first successful renal Tx

1905 A. Carrel, C.C. Guthrie

vascular anastomoses

1907 R. Stich uretero-neocystostomy

The history of renal transplantationThe history of renal transplantation

Alfred von Lexer ~1895

Vienna

Early vascular thrombosis?Lesky E: Münch. Med. Wschr. 116, 1081 (1974)

Alfred von Decastello-Rechtwehr 21.12.1899

Vienna

1200 cc urine, died after 40 hours (hemorrhage)Decastello Av: Wien. Klin. Wschr. 15, 317 (1902)

ExperimentalExperimental



partial success






Emerich UllmannVienna

7 March 1902: Report on first successful kidney

transplantautotransplant to neck-vessels (dog)cuff techniquefunction for 5 days

Ullmann E: Wien. Klin. Wschr. 11,281 (1902)

ExperimentalExperimental



partial success





1924 Avramovici preservation


Alexis Carrel

1905

renal transplants with vascular anastomoses

Carrel A: Science 22, 473 (1905)

Experimental



partial success






R. Stich

1907

autotransplants

uretero-neocystostomy

Stich R: Arch. Klin. chir. 83, 494 (1907)

History of Kidney Transplantation

1906 M. Jaboulay 1st Xenotransplantation

1910 E. Unger monkey kidneys en bloc

1923 H. Neuhof sheep kidneys

1933-1949 Y. Voronoy 1st allotransplantation

1945 Landsteiner, Hufnagel acute kidney failure

1950 R.H. Lawler partial success

1951 R. Küss Iive donors

1951 C. Dubost iliac implantation

1951 U. Servelle cutaneous ureterostomy

1952-1953 D.M. Hume 16 months function

1953 L. Michon living donation

1954 J. Murray 1st long-term survivor

M. Jaboulay

24.01.1906: pig kidney > 48y female

09.04.1906: goat kidney > 50y female

Implantation site: elbow

function: no

died after 3 and 9 days

Jaboulay M: Lyon Med. 107, 575 (1906)














Ernst Unger

1910 en bloc subhuman primate kidneys > female 21yimplantation site: tighfunction: nooutcome: died after 32 hours

Unger E: Berl. Klin. Wschr. 573: 13 (1910)














M. Neuhof

1923sheep kidney > 48y malefunction: nooutcome: died day 9

Neuhof H: Transplantation of tissues, Appleton, New York (1923)














Yuri Voronoy

1933donor: trauma victim, blood group „B“recipient: 37y male, blood group „0“

mercury poisoningwarm ischemia: 6 hoursimplantation site: tighfunction: nooutcome: died after 48 hours4 further transplants

Hamilton D.N.H., Reid W.A: YoYo Voronoy and the first human kidney allograft: Surg. Gyn. Obst. 159,289 (1954)














Landsteiner, Hufnagel

1945

recipient: 36y female, acute renal failure

implementation site: elbow

function: no

outcome: survived

graft removed after 48 hours

Cited: Hume D.M.: J. Clin. Invest. 34, 327 (1955)














R.H. Lawler et al

17.6.1950donor: woman 49y – blood group: „AB“ hemorrhages from esophageal varicesrecipient: woman 44y – blood group: „AB“ polycystic kidney disease (Cr. 1.8 mg%)implantation site: orthotopic, left ureteroureterostomyfunction: yesoutcome: Cr. 1.2 mg% no function at month 9

R.H. Lawler et al: JAMA 144, 844 (1950)














R. KüssC. DubostU. Servelle

1951 live donors implantation site: iliac fossa function: partial outcome: no longterm survivor

Küss R. et al: Mem. Acad. Chir. 77, 755 (1951)Dubost C. et al: Bull. Soc. Med. Hop. Paris 67, 1372 (1951)Sevelle U. et al: Bull. Soc. Med. Hop. Paris 67, 99 (1951)

„The „free kidneys‘ in those days came

from children with hydrocephalos, who

had one kidney removed (Matson‘s

procedure) to use the ureter from

drainage of the catheter from the brain.“














D.M. Hume (1917-1973)

1952-1953

10 transplants

implantation site:tigh

life sustaining function for 6 months

Hume D.M. et al: J. Clin. Invest. 34, 327 (1955)














L. Michon

1953

donor: mother

recipient: male 16y

function: 22 days

outcome: died day 23

Michon L et al: Presse Med. 61: 1419 (1953)














J. Murray

23/12/1954donor: monozygotic twin

implantation site: iliac fossa

uretero-neocystostomy

function: excellent

outcome: died at 8 years

(myocardial infarction)

First Successfull Kidney Transplant

December 23rd, 1954

History of pancreas transplantation

Year Author Type of TX

1852 Minkowski Pancreatic tissue

1927 Gayet, Giullaumie Pancreas (dog)

27.12.1967 Kelly, Lillehei Pancreas (clinical)

1973 Gliedmann Urinary tract drainage

1978 Dubernard Duct occlusion

1982 SollingerSutherland

Bladder drainageinternational registry

Minneapolis 2006

Mrs Lillehei 2006

History of Liver Transplantation

1955 Welch experimental, auxiliary

1958 StarzlMoore

experimental, orthotopic

1963 Starzl clinical orthotopic

1983 Margreiter combined liver-kidney

1984 Bismuth segmental transplantation

1989 Pichlmayr splitting

1989 Raia living donor

1990 Pichlmayr APOLT

1st Liver Transplantation

March 1st 1963

TE. Starzl

1st Liver Transplantation in Europe

R. Calne

May 2nd 1968

46-year old female with HCC

survived for 11 weeks (HAT)

Combined Liver and

Kidney TransplantationMargreiter R, Kramar R, Huber C,

Steiner E, Niederwieser D, Judmaier G,

Vogel W

Lancet, 330: 1077-1078, 1984

Innsbruck

First combined Liver-Kidney Transplant

December 5th 1983

Hannover

Liver Splitting

Hannover Auxiliary Partial Orthotopic Liver Transplantation

History of Heart Transplantation

Year Author Type of TX

1905 Carrel, Guthrie first experiments

1933 Mann exp. heterotopic

1949 Demikhov Experimental

1959 Cass, Brock atria remain with recipient

1960 Lower, Shumway first long term surviving dogs

23.1.1964 Hardy J. clinical – xeno

2.12.1967 Barnard clinical – allo

1969 Barnard clinical-heterotopic

Vladimir Demikhov

(1916-1998)

First Human Heart Transplant

January 27, 1964

1st Heart Allotransplantation

First Heart Allotransplant

Philipp Bleiberg

1st long-term survivor

History of Lung and Heart-Lung Transplantation

1949 Demikhov heart-lung experimental

1951 Junelle lung auto experimental

1963 Hardy single lung clinical

1968 Cooley heart-lung clinical

1968 Derom single lung

1981 Reitz heart-lung clinical successful

June 1963

1st Lung Transplant Recipient

14.11.1968

Fritz Derom

1st successfull Lung Transplant

1981

Joel Cooper

March 9, 1981

1st successfull Heart-Lung Transplant

History of Intestinal Transplantation

1959 Lillehei small bowel experimental

1960 Starzl multivisceral experimental

1967 Lillehei small bowel clinical

1983 Starzl multivisceral clinical

1988 Deltz 1st successful small bowel

1989 Margreiter 1st successful multivisceral

1990 Grant 1st liver intestine

• Starzl, Calne MGT in reith

First Combined Liver-Intestinal Transplantation

13.11.1988 London (Ontario) D. Grant 41 year-old woman with short-gut syndrome due to antithrombin III

deficiency IS: OKT3-CyA-Aza-Ster

Grant D, Wall W, Mimerault R et al: Succesful small bowel-liver transplantation.

Lancet 1990; 335, 181-184.

Year Centre Age Sex Patient Survival

Cause of Death

1983 Pittsburgh 6,8 f 30 hours exsanguination

1986 Chicago 1,4 m 4 days exsanguination

1987 Pittsburgh 3,5 f 192 days lymphoma

1988 Chicago 0,7 m 109 days lymphoma

26.12.1989 Innsbruck 49 m 9 months tumor recurrence

1990 London, Ont 27 f 6,5 months

lymphoma

History ofMultivisceral Transplantation

First Successfull Multivisceral Transplantation

History of Composite Tissue Transplantation

1965 Colombia single hand

Sept 1998 Dubernard first successfull single hand

Jan 2000 Dubernard double hand

17.02.2003 Innsbruck double forearm

30.11.2005 Devauchelle Dubernard

partial face

1st Successfull Hand Transplantation

1st Double Forearm Transplant

1st Partial Face Transplant

Documents

Der Einfluss der norditalienischen Universitäten auf die Entwicklung der Chirurgie in Innsbruck R. Margreiter Univ.-Klinik für Visceral-, Transplantations-