Ngaphezu kwe-500,000 izidibaniso zombutho zenziwe kwi-US
Ngokwe-United Network ye-Organisation Sharing (UNOS), phakathi kukaJanuwari 1, 1988, kunye noJuni 30, 2016, ama-669,556 amalungu agxininiswe eMelika. Nangona la manani ayamangalisa ngokuphawulekayo, akukho zixhobo ezaneleyo ezifumanekayo kulabo abazifunayo. Okwangoku, abantu abayi-120,139 banesidingo sokutshintshwa kwesigqeba sokusindisa ubomi.
Nazi ezinye ezithandathu eziqhelekileyo zokufakelwa komzimba ngokulandelelana kwexesha. Ukutshintshwa kwamalungu angatshatyalalwanga kubonisiwe kuba abalwamkeli bequmrhu badla ngokufumana elinye iqumrhu elinye ngexesha elinye. Ngokomzekelo, inani leentso / i-pancreas (21,727) ngeli xesha elikhankanywe ngentla likhulu kunani leepancreas transplants kuphela (8,235).
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ZezintsoInani leentso zeentsholongwane phakathi kweJanuwari 1, 1988 noJuni 30, 2016, yayingama- 395,510
Iinjongo ziqumrhu eliqhelekileyo lokutsalwa. Ngo-2011, bekukho abangu-11,835 abafayo abafayo kunye ne-5772 abaxhamli abaphilileyo.
Ukutshintshwa kweentso kusetyenziswa ukuphatha abantu abanesifo sokuguqulwa kwesigxina, okanye ukungaphumeleli kwezintso. Ngokuqhelekileyo, ukungaphumeleli kwezintso kubangelwa isifo sikashukela okanye uxinzelelo olusenyongweni. Ngokona nxalenye, iimpembelelo eziphambili ziphumelele ngakumbi kune-dialysis kwaye zithuthukise indlela yokuphila kwaye zandisa ixesha lokuphila ngokubanzi kunokuba i- dialysis .
Ngama-1960, iipilisi kuphela zokugonywa kwamagciwane okufuneka sizenzele ukulwa nokulahlwa kwezitho zaba yi-azathioprine kunye ne-prednisone. Ngenxa yokuba sasinemithi emininzi yokugonywa kwamagciwane ngexesha le minyaka yokuqala yokutshala, iinjongo ezithengwa kubaxhasi abaphilileyo ziyakuthi zithathe ngaphezu kweentso ezithengiweyo kubaxhasi abafayo.
Namhlanje, sinemiba eyahlukahlukeneyo yokunceda ukukhusela iimpendulo zomzimba kumntu ofumana ukutshintshwa kweentso. Ngokukodwa, ezi zi yobisi zikhusela iintlobo zezimpendulo ze-immune, eziquka ezo zibangelwa yiibhaktheriya, i-fungus, kunye nezihlamba ezibi.
Amagunya asetyenziswa ukukhupha ukugatywa ahlulwa ngokubanzi njengama- agent okuchithwa okanye ama-agent agcino . Ama-agent acocekileyo anciphisa ithuba lokugatywa ngokukhawuleza kwaye anikwa ngexesha lokutshintshwa. Kubantu abafumana iintso, ezi zenze i-antibodies zibandakanya ukusetyenziswa kwe-steroids okanye i-calcineurin inhibitors (i-cyclosporine kunye ne-tacrolimus) kunye nezobisi ezinxulumene nazo.
Ulwaphulo lwezondlo lunceda ukuthintela ukulahlwa kunye nokulahlekelwa kweengtso. Ngokuqhelekileyo, izigulane zifumana unyango olulandelayo: i-prednisone (steroids), i-calcinurin inhibitor kunye ne-antimetabolite (cinga i-azithioprin okanye, ngokuqhelekileyo, i-mycophenolate mofetil). Ulwaphulo lwezondlo lulungiswa ngokuhamba kwexesha.
Ndiyabulela ukuphuculwa kwonyango lokuguquka kwamagciwane, ukulahlekelwa kweentso eziguqwayo ngenxa yokugatya ngokuqhelekileyo akuqhelekanga. Ngomhla kaDisemba 2012, inani leentso ezifumana ubomi emva kweminyaka emihlanu, okanye i-five-year survival rate, lalingama-83.4 epesenti ngenxa yeentso ezithengwa kubaxhasi abasweleko kunye nama-92 epesenti ngenxa yeentso ezithengwa ngabaxhasi abaphilayo.
Ngexesha elithile, ke, umsebenzi wezintso ezifakwe kwintsikelelo ixhaswa yinkqubo engapheli kakuhle, ebandakanya i-fibrosis ye-interstitial, i-atrophy ye-tubular, i-vasculopathy kunye ne-glomerulopathy. Ngaloo ndlela, ithuba lokuphila lobomi kulabo bafumana iintso ezivela kubanikeli abaphilileyo liyiminyaka engama-20 kwaye okokuba abamkeli bezitho zabaxhamli abafayo yiminyaka eyi-14.
Abaxhasi abavolontiya abaphilayo kufuneka basuswe naluphi na uhlobo lwezonyango ezinzulu, kwaye abaxhasi abasweleyo akufanele babe naluphi na uhlobo lwesifo esingasasazeka kummkeli, njenge-HIV, i-hepatitis okanye umdlavuza we-metastatic.
Abaxhasi bahambelana nabamkeli basebenzisa ama-antigens eqela legazi (cinga uhlobo lwegazi) kunye nama-antigens we-HLA enkulu ye-HT. Abamkeli beentso eziye zihambelana ngokugqithiseleyo neentlobo ze-HLA zihamba bhetele kunezo ezinokungafani neze-HLA. Ngokuqhelekileyo, izalamane zokuqala ziyakwazi ukuvakalisa ama-antigen anxulumana ne-HLA. Ngamanye amazwi, isihlobo sokuqala se-degree sinokuthi sinikeze ilungu elisebenzayo eliza kuthatha elibhetele ngakumbi kuneentso ezivela kumgcini-fileyo oshonile.
Ukuhlinzwa okutshintshiselwa kweentso kungabonakaliyo kunye nequmrhu elibekwe kwi-fusa inguinal ngaphandle kwesidingo sokukhupha i-peritoneal cavity. Ukuba zonke ziyahamba kakuhle, ummeli weentso angalindela ukuba akhululwe esibhedlele kwimeko enhle emva kweentsuku ezintlanu.
Izintso ezithengwa kubaxhasi abasweleko zingagcinwa malunga neeyure ezingama-48 ngaphambi kokutshintshwa. Eli xesha linika abasebenzi abanonophelo ixesha lokwengeza ixesha elifanelekileyo, ukukhetha, ukukhetha nokuthutha ezi ziko.
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IbindiInani lokuhamba kweebindi phakathi kukaJanuwari 1, 1988, kunye noJuni 30, 2016, bekuyi- 143,856.
Njengazintso kunye nokutshintshwa kweengtso, izibindi zivela kubanikeli abaphilayo. Iminikelo enobungozi yecimbiso yesibindi ngokuqhelekileyo ivela kubaxhasi abafikele ebuchosheni abangaphantsi kwama-60. Umnikeli oshonile kufuneka ahlangabezane nemigangatho ethile, ngaphandle kokulimala kwesibindi ngenxa yexinzelelo okanye izifo ezinjenge-hepatitis.
Iingcali ezifanayo nabanikeli abanamkeli abasebenzisa i-ABO ukuhambelana nobungakanani bomntu. Okuthakazelisayo kwiimeko zongxamiseko, isibindi sinokuhlulwa (ukwahlukana kwesibindi) kwaye kunikezelwe kubamkeli ababini. Kwakhona kwimeko yokuxakeka okanye ukuphazamiseka komzimba, uphawu lwe-ABO oluhambelanayo lungasetyenziswa. Ngokungafani neentsholongwane zeengso, izibindi akudingeki ukuba zihlolwe ukuhambelana kwe-HLA.
Isibindi yilungu elilodwa kuphela le-visceral eliza kuba nelungelo elihle lokuvuselela. Ngamanye amazwi, isibindi sikhula. Esi sizathu esinokuvuselela sizathu sokuba kutheni ukunyuka kwesibindi kunokwenzeka. Xa isahlulo okanye i-lobe yesibindi ishintshiwe, iya kuhlaziywa kwakhona.
Ngokufakelwa kwesibindi, i-lobe ephezulu kakhulu ekhethiweyo ikhethwa kwilobe ekhohlo. Ukongezelela, nangona ukunyuka kwesibindi esincinci kunikwe abaxhasi abaphilayo, ngokuqhelekileyo izibindi zithengwa kwii-cadavers. Ngo-2012, kuphela iipesenti ezi-4 zesigxina sesibindi (ii-246 iinkqubo) zithengwa kubaxhasi abaphila.
Ukufakelwa kwesibindi kunikwa njengendlela yokonyango xa zonke ezinye iindlela zikhe zaphela. Inikwe abantu abanesifo esinesibindi esinamandla nesingenakunqandeka apho kungabikho ukhetho olunyango okanye unyango oluthile. Ngokomzekelo, umntu ophethe i- cirrhosis ephezulu ebangelwa yi-hepatitis C okanye utywala unokuba ngumviwa wokufakelwa kwesibindi.
Ngenxa yokufakelwa kwesibindi, ixesha libaluleke kakhulu. Umntu ofumana ukutshintshwa kufuneka agule ngokwaneleyo ukufuna ukutshala kodwa ngokufanelekileyo ukufumana ukuhlinzwa.
Ukutshintshwa kwesibindi, okanye ukufakelwa kwe-orthotopic , kuyindlela enkulu yokuhlinzwa kunye neengxaki-ngokukodwa kubantu abanengcinezelo yengozi ye-cirrhosis. Ukudibanisa kwegazi lomzimba kunye ne-coagulopathy, okanye ukuphazamiseka kwegazi okuphazamiseka okubangelwa ukuhluleka kwesibindi, kunokukhokelela ekulahlekelweni kwegazi ngexesha lokuhlinzwa kunye neemfuno ezinkulu zokuxilongwa kwemveliso yegazi. Ngaphezu koko, ukususa isibindi sonke size sithathe indawo yaso kufuneka kuqala kuqala ukuxubusha (ukusika) kwaye emva koko i-anastomoses (ukujoyina) imithwalo yegazi ebalulekileyo kunye nezinye izakhiwo, ezinjenge-inferior vena cavae, i-veal port, i-hepatic artery kunye ne-bile duct.
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IntliziyoInani lentliziyo ehamba phakathi kukaJanuwari 1, 1988, kunye noJuni 30, 2016, yayingama- 64,085.
Ukutshintsha intliziyo kwakunjalo into ephupha ngabalobi bezesayensi, kodwa senze. Kwathatha iminyaka engaphezu kwama-200 ukuqhubela phambili kokubili ukuqonda kwe-immunology kunye nokuphuculwa kwindlela yokuhlinzwa kunye ne-suture kunye neteknoloji ukuvula umnyango wokutsalwa kwentliziyo. Ngomnyaka we-1967, ukutsalwa kwentliziyo kwenzelwa eKapa, eMzantsi Afrika, ngugqirha ogqirha ogama linguDkt Christiaan Barnard.
Nangona ubuchwephesha bezobuchwephesha, ukuguquka kwenhliziyo kwangaphambili akuzange kwandise ixesha lokusinda nangona nayiphi na indlela ebalulekileyo. Enyanisweni, isigulane sikaBarnard sasihlala iintsuku ezingama-18 emva kokufumana intliziyo entsha. Kuya kuthatha ukuphucula izidakamizwa ze-immunosuppressive kunye nokuthayipha izicubu zokuphucula ukuphucula emva kokuhlinzwa kwentliziyo.
Ngokutsho kweSebe lezeMpilo neSebe lezeMpilo yase-United States, ngo-2012, izinga lokusinda kweminyaka emihlanu, okanye inani labantu abesaphila iminyaka emihlanu emva kokutsalwa kwentliziyo, ngama-76.8 ekhulwini.
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LungUkuhamba kweemiphunga phakathi kweJanuwari 1, 1988, kunye noJuni 30, 2016, bekuyi- 32,224.
Ukususela ngo-1985, kuye kwaqhutyelwa ngaphezu kwe-40,000 ukuphazamiseka kwemiphunga emhlabeni jikelele. Ukufakelwa kwe-lung kwenziwa ngabantu abaphethwe ngesifo sokuphazamiseka kwesifo sengumphunga esingasomdlavuza (ongagqibekanga). Nazi izikhokelo ezine eziphezulu zokufakelwa kwemiphunga:
- Isifo sokuphefumula esingapheliyo (COPD)
- Idiopathic pulmonary fibrosis
- Icystic fibrosis
- U-Alpha-1 u-antitrypsin ukusilela kwe-emphysema
Ngokuqhelekileyo, iimiphunga zithengwa kubaxhasi abasweleko ngokuhluleka kwengqondo (ukufa kwengqondo). Nangona kunjalo, phakathi kwama-15 ne-20 ekhulwini kwabaxhasi abanjalo banemiphepha emaphepheni afanelekileyo wokutshintshwa.
Kwiintlobo ezininzi zezifo eziqinisekisa ukufakelwa kwemiphunga, mhlawumbi enye okanye imiphunga emibili ingafakwa. Nge-cystic fibrosis kunye nezinye iibronchiectasis, nangona kunjalo, zombini imiphunga kufuneka ifakwe. Ukutshintshwa kweemiphunga zombili iimpompo kwenziwa ukuyeka usuleleko ukusasazeka kwimizimba yamaphaphu asekuhlaleni ukuya kutshintshwe izicubu zamaphaphu. Nangona enye okanye imiphunga emibili ingatshintshwa ukunyanga ezininzi iintlobo zesifo, ukutshintshwa kweemiphunga ezimbini kubhetele.
Ilungelo lempompo lihlukaniswe zibe yi-lobes ezintathu, kwaye umphunga wesobunxele uhlukaniswe nge-lobes ezimbini. Ukutshintshwa kwe-lobe efunyenwe kumnikeli ophilileyo kwenziwa kwithuba elidlulileyo kodwa ngoku kungavamile. Ngokuqhelekileyo, ukutshintshwa kwelobar enjalo kwenzelwa abantu abasebancinci kunye nabantu abadala abano-cystic fibrosis ababeza kufa ngokulindela ukutsalwa kwemiphunga emibini (okanye kabini) efunyanwa kumntu oshonile, okanye umgcini.
Ngokuqhelekileyo, umgangatho wobomi uphucula ngokucacileyo kulabo bathola ukuhamba kwemiphunga. Ixesha langempela umntu ohlala kunye nokutshintshwa kwezinto kuhlukahluka ngokubhekiselele kwisifo esifanelekileyo sokutshintshwa kunye nomdala wommkeli-kunye nabamkeli abancinci abaphila ixesha elide. Ngokubanzi, abantu abaninzi abafumana iimpazamo zeemiphunga baphila malunga neminyaka eyi-10 ngaphambi kokungavumi ukugula okungapheliyo.
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PancreasInani leepancreas ezihamba phakathi kukaJanuwari 1, 1988, kunye noJuni 30, 2016, bekuyi- 8 235.
Ukupakishwa kokuqala kwepencre kwenziwa nguWilliam Kelly noRichard Lillehei kwiYunivesithi yaseMinnesota ngo-1966. Kususela ngaloo ndlela, kuye kwaqhutyelwa ama-pancreas angama-25,000 e-United States kunye nama-35,000 kwihlabathi lonke. Ngokuqhelekileyo, ama-pancreases athengwa kubaxhasi abaswelekileyo; Nangona kunjalo, nangona kunjalo kakhulu, abaxhasi abaphilayo banokusetyenziswa.
Ukutshintshwa kwe-Pancreas yinkcazo echanekileyo yexesha elide kubantu abanesifo sikashukela esine-insulin (uhlobo lwesifo sikashukela se-1). Ukufakelwa okunjalo kunokubuyisela i-homeostasis evamile ye-glucose kunye ne-metabolism kunye nokunciphisa umngcipheko weengxaki zexesha elide kwisifo sikashukela.
Ingqalelo, ukuguqulwa kwamapakreas kufana nokuthelekiswa nokutshintshwa kwe-islet , ezingenasiphelo esincinci. Iislet zeIslet ziziqela zeeseli kwiipakreta ezivelisa amahomoni, njenge-insulin kunye ne-glucagon. Nangona ukutshintshwa kwe-islet kuye kwaphucula kakhulu kwiminyaka yamuva nje, ukuhamba kwe-pancreas kusebenza kangcono kunokuba utshintsho lwezilwanyana. Esikhundleni seenkqubo zokukhuphisana, kukulungele ukujonga i-pancreas kunye nokutshintshwa kwezilwanyana njengeenkqubo ezihambelanayo, ezo zombini zinokunceda ummkeli unesidingo.
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AmathumbuInani leemathumbu ezihamba phakathi kweJanuwari 1, 1988, kunye noJuni 30, 2016, bekuyi- 2,733.
Ukutshintshwa kwe-intestine yinkqubo enzima. Kwiminyaka yakutshanje, le nkqubo iye yafumana ukuthandwa kwindlela yokwelashwa kwemfuyo emfutshane, apho abantu abanako ukufumana amanzi aneleyo, iikhalori, iiprotheyini, amafutha, iivithamini, amaminerali njalonjalo. Ngokuqhelekileyo, abantu abafumana izibilini ze-intestine bafumana ukungaphumeleli kwamathumbu kwaye bafuna ukutya okunesondlo se-parenteral (TPN), okanye ukutya okunomsoco.
Phantse ama-80 ekhulwini abantu abafumana isitofu sokutshintshwa kwamathumbu bafumana umsebenzi opheleleyo kwi-graft yamathumbu. Iingxaki ezinxulumene nale nkqubo zibandakanya ukusuleleka kwe-CMV , ukukhanyela okunzima kunye nokungapheliyo, kunye nesifo sokunyuka kwesifo se-lymphoproliferative.
Imithombo:
UAzizi J, uMilford EL, uSayegh MH, uChandraker A. Utshintsho kwiNyango yokuLingela kweRenal. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Iinqununu zeHarrison ze-Internal Medicine, 19e. New York, NY: McGraw-Hill; 2015.
I-AC, i-Jie T, i-Papas K, i-Porubsky M, i-Rana A, i-Smith M, i-Yost SE, uL. Dunn D, i-Gruessner RG. Ukutshintshwa kwezityalo. Ku: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. I-Schwartz Iimigaqo zoPhando, 10e . New York, NY: McGraw-Hill; 2014.
Tavakkoli A, Ashley SW, Zinner MJ. Ndibonise uthando. Ku: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. I-Schwartz Iimigaqo zoPhando, 10e . New York, NY: McGraw-Hill; 2014.
Utshintsho ngohlobo lohlobo lukaJanuwari 1, 1988-Juni 30, 2016. Inethiwekhi yeZizwe eziManyeneyo ze-Organ Sharing https://www.unos.org/data/.
Trulock EP. Ukufakelwa kwezityalo. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Iinqununu zeHarrison ze-Internal Medicine, 19e . New York, NY: McGraw-Hill; 2015.