Izinguquko ezingaphezu kuka-500,000 zomzimba zenziwe eNingizimu Afrika
Ngokusho kwe-United Network for Organ Sharing (UNOS), phakathi kukaJanuwari 1, 1988, kanye noJuni 30, 2016, izilinganiselwa ezingamakhulu angu-669 566 zafakwa kabusha e-United States. Nakuba lezi zinombolo zihlaba umxhwele ngokuphawulekayo, azikho izitho ezanele ezitholakalayo kulabo abadinga. Njengamanje, abantu abayi-120,139 badinga ukufakelwa kwesilwane esindisa ukuphila.
Nazi ezinye eziyisithupha ezijwayelekile zokuguqula izakhi ukuze kutholakale imvamisa. Ukuguquka komzimba okukodwa kuyacaciswa ngoba abamukeli bezitho ngokuvamile bathola okungaphezulu kwesisodwa ngesikhathi esisodwa. Isibonelo, inani lezinkinga zezinso / i-pancreas (21,727) phakathi nesikhathi esishiwo ngenhla likhulu kunezinombolo zokuhamba kwe-pancre kuphela (8 235).
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IzinsoInombolo yezinso ezihamba phakathi kukaJanuwari 1, 1988 noJuni 30, 2016, yayiyi- 395,510
Izinso yisici esivame ukufakelwa kabusha. Ngo-2011, kwakunezinguquko ezingu-11,835 ezifihliwe ezifayo kanye nezinguquko ezingu-5772 eziphilayo.
Ukufakelwa kwezinso zezinso kusetshenziselwa ukuphatha abantu abanezifo zokuqeda isiteleka sokuphela, noma ukwehluleka kwezinso. Ngokuvamile, ukuhluleka kwezinso ezinjalo kungenxa yesifo sikashukela noma isifo sofuba esinamandla. Ngokuyinhloko, ukuguqulwa kwezinso kuyaphumelela kakhulu kune-dialysis futhi kuthuthukise indlela yokuphila futhi kwandise isikhathi esiphezulu sokuphila esikhathini esingaphezu kwesimo se- dialysis .
Ngama-1960, imithi kuphela yokuzivikela emzimbeni esasiyilwe ukulwa nokulahlwa kwezitho kwakungu-azathioprin ne-prednisone. Ngenxa yokuthi sasinemishanguzo encane yokugonywa kwamagciwane ngesikhathi sale minyaka yokuqala yokufakelwa kabusha, izinso ezitholakalayo ezivela kubanikeli abaphilayo zazivame ukuthatha kunezinso ezitholakale kubanikeli abashonile.
Namuhla, sinemithi ehlukahlukene yokusiza ukuvimbela impendulo yomzimba kubantu abathola ukufakelwa kwezinso zezinso. Ngokuqondile, lezi zidakamizwa zivimbela izimpendulo ezihlukahlukene zokuzivikela ngomzimba, kuhlanganise nalabo abangelwa amagciwane, isikhunta kanye nezicubu ezimbi.
Ama-agents asetshenziselwa ukuvimbela ukwenqatshwa ahlukaniswa ngokubanzi njengama- agent wokungeniswa noma ama-agent wokugcina . Ama-induction agents ayanciphisa ithuba lokulahlwa ngokuqinile futhi anikwa ngesikhathi sokufakelwa. Kulabo abathola izinso, lezi zinhlobo zokufaka izinambuzane zihlanganisa izidakamizwa eziqeda ukusetshenziswa kwe-steroids noma i-calcineurin inhibitors (i-cyclosporine ne-tacrolimus) kanye ne-toxicities ehambisana nayo.
Ukwelashwa kwesondlo kusiza ukuvimbela ukulahlwa okukhulu nokulahlekelwa kwezinso. Ngokuvamile, iziguli zithola ukwelashwa okulandelayo: i-prednisone (i-steroids), i-calcineurin inhibitor ne-antimetabolite (cabanga nge-azithioprin noma, ngokuvamile, i-mycophenolate mofetil). Ukwelashwa kwesondlo kulungiswa ngokuhamba kwesikhathi.
Ngenxa yokuthuthukiswa kwezifo zokuzivikela, ukulahlekelwa izinso ezitshalwe ngenxa yokulahla okuvamile akuvamile. Kusukela ngoDisemba 2012, inani lezinso eziphilile ngemuva kweminyaka emihlanu, noma isilinganiso seminyaka emihlanu yokusinda, kwakungamaphesenti angama-83.4 ngezinsolo ezitholakale kubanikezi abashonile nabangu-92 amaphesenti ngezinsolo ezitholakala kubanikeli abaphilayo.
Nokho, ngokuhamba kwesikhathi, umsebenzi wezinso ezitshalisiwe uphazamiseka nenqubo engavamile engaqondakali, okubandakanya i-fibrosis yangaphakathi, i-atrophy ye-tubular, i-vasculopathy ne-glomerulopathy. Ngakho-ke, isikhathi esiphezulu sokuphila kwalabo abathola izinso ezivela kubanikeli abaphilayo abayiminyaka engama-20 futhi ukuthi abamukeli bezitho zomnikeli oshonile eminyakeni engu-14.
Abanikeli bokuvolontiya abaphilayo kufanele basuswe noma yiziphi izimo zezokwelapha ezimbi, futhi abanikeli abafayo akufanele babe nezinhlobo zezifo ezingasakazeka kumamukeli, njenge-HIV, isifo sofuba noma umdlavuza we-metastatic.
Abaxhasi bafaniswa nabamukeli basebenzisa ama-antigens eqembu legazi (cabanga uhlobo lwegazi) kanye nama-antigens we-HLA enkulu ye-histocompatibility gene gene complex. Abamukeli bezinso abahambisana kakhulu nezinhlobo ze-HLA bahamba kangcono kunalabo abanezinhlobo ze-HLA ezingafani. Ngokujwayelekile, izihlobo zokuqala zikwazi ukuveza ama-antigens e-HLA wokufakelwa kwezitshalo. Ngamanye amazwi, isihlobo esiphezulu sezinga eliphezulu singase sinikeze isitho esisebenzayo esizothatha kangcono kunenso kusuka kumcashi omshonile.
Ukuhlinzekwa kokufakelwa kwezinso kwezinso akuyona into engavumeleki neyilungu elibekwe ku-inguinal fossa ngaphandle kwesidingo sokubhanqa umgogodla we-peritoneal. Uma konke kuhamba kahle, umamukeli wezinso angalindela ukuba akhululwe esibhedlela esimweni esihle kakhulu ngemva kwezinsuku ezinhlanu.
Izinso ezitholakale kumanikeli abashonile zingagcinwa cishe amahora angu-48 ngaphambi kokufakelwa. Lesi sikhathi unikeza abasebenzi bokunakekelwa kwezempilo isikhathi esanele sokuthayipha, ukuhambelana, ukukhetha nokuthutha lezi zitho.
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IsibindiIsibalo sesibindi sebindi phakathi kukaJanuwari 1, 1988, kanye noJuni 30, 2016, sasingu 143,856.
Njengezinso nokufakelwa kwezinso zezinso, ama-livers angabuka kubaxhasi abaphilayo. Iminikelo yesibindi esonakele isivela kubaxhasi abafa ebuchosheni abangaphansi kuka-60. Umnikeli oshonile kufanele ahlangabezane nemigomo ethile, okufaka phakathi ukulimala kwesibindi ngenxa yokuhlukunyezwa noma izifo ezinjenge-hepatitis.
Ochwepheshe balinganisa abanikeli nabamukeli abasebenzisa ukuhambisana kwe-ABO nosayizi lomuntu. Ngokuthakazelisayo ezimweni eziphuthumayo, isibindi singahlukaniswa (sihlukaniswe isibindi) futhi sinikezwe abamukeli ababili bezingane. Futhi lapho kwenzeka ukuphuleka komzimba okuphuthumayo noma okuphawulwe, ama-liver angama-ABO angahambisani nawo angasetshenziswa. Ngokungafani nokuguqulwa kwezinso, ama-liver akudingeki ahlolwe ukuhambisana kwe-HLA.
Isibindi yiyona yodwa inhlangano ye-visceral yokuthola amandla okuvuselela okuphawulekayo. Ngamanye amazwi, isibindi sikhula. Lokhu okungenzeka ukuvuselela kungesizathu sokuthi ukufakelwa kwesibindi esinqunyiwe kungenzeke. Uma ingxenye noma i-lobe yesibindi ishintshiwe, izovuselela.
Ngokufakelwa kwesibindi, i-lobe engaphezulu kakhulu engakwesokudla ikhethwa ku-lobe kwesokunxele. Ngaphezu kwalokho, nakuba ukuguqulwa kwesibindi okuyingxenye okutholakala kubanikeli abaphilayo, ngokuvamile izimbambo zithengwa kusuka ku-cadavers. Ngonyaka ka-2012, amaphesenti angu-4 kuphela okudluliswa komzimba kwesibindi (izinqubo ezingu-246) athengwe ngabanikeli abaphilayo.
Ukufakelwa kwesibindi kunikezwa njengendlela yokwelashwa lapho zonke ezinye izinketho seziphelile. Ihlinzekwa kubantu abanesifo esinesibindi esinzima futhi esingenakugwenywa lapho kungekho khona ukwelashwa okunye noma ukwelapha okunye ukwelashwa. Isibonelo, umuntu ophethe i- cirrhosis ephakeme ebangelwa i-hepatitis C noma utshwala angase abe ngumfundi wesibindi sokufakelwa kwesibindi.
Nge-transplantation yesibindi, isikhathi sibaluleke kakhulu. Umuntu othola ukufakelwa kufanele abe ogulayo ngokwanele ukuze adinge ukufakelwa kodwa kahle ngokwanele ukuze alulame kusukela ekuhlinzekeni.
Ukufakelwa kwesibindi sonke, noma ukufakelwa kwe-orthotopic , kuyindlela enkulu yokuhlinza futhi inselele-ikakhulukazi kubantu abanegazi eliphakeme lokungena komzimba lapho i-cirrhosis yimbangela evamile. Ukuhlanganiswa kwesifo somfutho wegazi kanye ne-coagulopathy, noma ukuphazamiseka kwegazi okwehluleka okubangelwa ukuhluleka kwesibindi, kungaholela ekulahlekelweni kwegazi okuningi ngesikhathi sokuhlinzwa kanye nezimfuneko ezinkulu zokukhishwa komkhiqizo wegazi. Ngaphezu kwalokho, ukususa sonke isibindi bese sithatha indawo kuyadingeka kuqala i-dissection (ukusika) bese i-anastomoses (ijoyina) imithwalo yegazi ebalulekile nezinye izakhiwo, njenge-inferior vena cavae, i-portal vein, i-arter hepatic, ne-bile duct.
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InhliziyoInombolo yokushintsha kwenhliziyo phakathi kukaJanuwari 1, 1988, kanye noJuni 30, 2016, yayingu- 64 085.
Ukubuyisela inhliziyo kwakungenye into ephupha ngabalobi bezesayensi, kodwa senza lokho. Kwathatha iminyaka engaphezu kwengu-200 ukuthuthuka kokubili ukuqonda kwethu kwe-immunology kanye nokuthuthukiswa ekuhlinzeni kanye nethuluzi le-suture nobuchwepheshe bokuvula umnyango wokufakelwa kwenhliziyo. Ngo-1967, ukufakelwa kwenhliziyo yokuqala kwenzeka eKapa, eNingizimu Afrika, udokotela ohlinzayo ogama lakhe linguDkt. Christiaan Barnard.
Yize ubuciko bezobuchwepheshe, ukuguqulwa kwenhliziyo kwangaphambili akuzange kwandise ukusinda nganoma iyiphi indlela enkulu. Eqinisweni, isiguli sikaBarnard saphila izinsuku ezingu-18 kuphela ngemuva kokuthola inhliziyo entsha. Kungathatha ukuthuthukiswa kwezidakamizwa ze-immunosuppressive kanye nokuthayipha kwezicubu ukuthuthukisa ukusinda emva kokuhlinzwa kwenhliziyo.
Ngokomnyango wezeMpilo wezeMpilo nase-Human Services, ngo-2012, isilinganiso seminyaka emihlanu yokusinda, noma inani labantu abesaphila eminyakeni emihlanu emva kokufakelwa kwenhliziyo, ngamaphesenti angu-76.8.
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LungUkuguquka kwamaphaphu phakathi kukaJanuwari 1, 1988, kanye noJuni 30, 2016, kwakungu- 32.224.
Kusukela ngo-1985, kunezinguquko ezingaphezu kuka-40 000 zamaphaphu ezenziwe emhlabeni jikelele. Ukufakelwa kwe-lung kwenziwa kubantu abane-end-stage epulence isifo esingesifo somdlavuza (esingavamile). Nazi izinkomba ezine eziphezulu zokufakelwa kwamaphaphu:
- Isifo se-Chronic obstructive pulmonary (COPD)
- Idiopathic pulmonary fibrosis
- I-cystic fibrosis
- I-Alpha-1 antitrypsin ukuntuleka kwe-emphysema
Ngokuvamile, amaphaphu atholakala kumanikeli abashonile ngokuhluleka kwengqondo ngokuphelele (ukufa kobuchopho). Kodwa-ke, phakathi kwamaphesenti angu-15 no-20 abahlinzeki abanjalo banamapayipi afanele ukufakelwa.
Ngezinhlobo eziningi zezifo eziqinisekisa ukufakelwa kwamaphaphu, noma eyodwa noma amaphaphu amabili angafakwa kabusha. Nge-cystic fibrosis nezinye izinhlobo ze-bronchiectasis, noma kunjalo, zombili amaphaphu kudingeka adluliselwe. Ukufakelwa kwezitshalo zombili amaphaphu kwenziwa ukuyeka ukutheleleka kusuka ekusakazeni kusuka emathangeni amathumbu emaphandleni kuya emathisheni amaphaphu asetshenziswe. Ngisho noma amaphaphu amabili noma amabili angatshalwa kabusha ukuze aphathe izinhlobo eziningi zezifo, ukuguqulwa kwamaphaphu amabili kuvame ukukhetha.
Iphaphu elilungile lihlukaniswe ngama-lobes amathathu, futhi iphaphu lesokunxele lihlukaniswe laba ama-lobes amabili. Ukufakelwa kwesitshalo se-lobe esivela ku-donor ophilayo kuyenziwe esikhathini esidlule kodwa manje sekuvamile. Ngokuvamile, ukufakelwa kokungenwa kwe-lobar kwenzelwa intsha kanye nabantu abadala abasha abane-cystic fibrosis okungenzeka bafe ngenkathi balindele ukufakelwa kwamaphaphu amabili (noma kabili) okufakwe kumuntu oshonile, noma i-cadaver.
Ngokuvamile, ikhwalithi yokuphila iyathuthuka ngokuphawulekayo kulabo abathola ukuguqulwa kwamaphaphu. Isikhathi sangempela umuntu ahlala nokufakelwa ukutshala ngokusho ukuthi yisiphi isifo esidinga ukufakelwa kanye neminyaka yomamukeli-nabamukeli abancanyana abaphila ngenqubo ende. Ngamagama amaningi, abantu abaningi abathola ukuguqulwa kwamaphaphu baphila cishe eminyakeni eyishumi ngaphambi kokungenwa okungapheli.
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I-PancreasInani lokuhamba kwe- pancreas phakathi kukaJanuwari 1, 1988, noJuni 30, 2016, laliyi-8 235.
Ukufakelwa kwe-pancreas yokuqala kwenziwa nguWilliam Kelly noRichard Lillehei eNyuvesi yaseMinnesota ngo-1966. Kusukela ngaleso sikhathi, kuye kwaqhutshwa ama-pancreas angaphezu kuka-25 000 e-United States nangaphezu kuka-35,000 emhlabeni jikelele. Ngokuvamile, ama-pancreases atholakala kumanikeli abashonile; Kodwa-ke, nakuba kungavamile kakhulu, abaxhasi abaphilayo bangasetshenziswa futhi.
Ukufakelwa kwe-Pancreas yindlela yokwelapha yesikhathi esigcwele eqondile kubantu abane-diabetes mellitus enesifo sikashukela (uhlobo lwesifo sikashukela 1). Ukufakelwa okunjalo kungabuyisa i-homeostasis evamile ye-glucose kanye ne-metabolism kanye nokunciphisa ingozi yezinkinga zesikhathi eside ezihambisana nesifo sikashukela.
Ngokuphawula, ukuguqulwa kwe-pancreas kuvame ukuqhathaniswa nokuguqulwa kwesisethi , okungekho okungahambi kahle. Ama-Islet amaseli amaqoqo amaseli ema-pancreas akha ama-hormone, afana ne-insulini ne-glucagon. Nakuba ukuguqulwa kwezilwane kuye kwathuthuka kakhulu eminyakeni yamuva, ukuguqulwa kwe-pancreas kusebenza kangcono kunokudlulisa isles. Esikhundleni sezinqubo zokuncintisana, kungcono ukubuka ama-pancreas kanye nokuguqula islet njengezinqubo ezihambisanayo, zombili zombili ezingasiza umamukeli ekudingeni.
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AmathumbuInani lezinambuzane eziphakathi kwamathumbu phakathi kukaJanuwari 1, 1988, kanye noJuni 30, 2016, laliyi- 2,733.
Ukufakelwa kwezitho zangasese kuyinkambinkimbi eyinkimbinkimbi. Eminyakeni yamuva, le nqubo iye yathola ukuthandwa ekwelapheni kwesifo samathumbu esifushane, lapho abantu abakwazi ukuthola amanzi anele, ama-calories, amaprotheni, amafutha, amavithamini, amaminerali njalonjalo. Ngokujwayelekile, abantu abathola izibeletho zamathumbu bahlangabezana nokuhluleka kwamathumbu futhi badinga ukudla okuphelele kokubeletha kwama-parenteral (TPN), noma ukudla okunomsoco.
Abantu abangamaphesenti angaba ngu-80 abathola ukufakelwa kwamathumbu ukuze bathole umsebenzi ogcwele emathunjini emathunjini. Izinkinga ezihambisana nale nqubo zibandakanya ukutheleleka kwe-CMV , ukulahlwa okunamandla nokuhlala njalo, kanye nesifo sokuguqula i-lymphoproliferative.
Imithombo:
I-Azzi J, i-Milford EL, iSayegh MH, i-Chandraker A. Ukufakelwa kwe-Treatment of Faal Failure. Ku: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. I-Harrison's Principals of Internal Medicine, 19e. ENew York, NY: McGraw-Hill; 2015.
Gruessner AC, Jie T, Papas K, Porubsky M, Rana A, Smith M, Yost SE, L. Dunn D, Gruessner RG. Ukufakelwa kwezitshalo. Ku: Brunicardi F, Andersen DK, B Billiar, Dunn DL, Hunter JG, Matthews JB, Pollock RE. ama-eds. Izimiso Zokuhlinza Schwartz, 10e . ENew York, NY: McGraw-Hill; 2014.
Tavakkoli A, Ashley SW, Zinner MJ. Intestine encane. Ku: Brunicardi F, Andersen DK, B Billiar, Dunn DL, Hunter JG, Matthews JB, Pollock RE. ama-eds. Izimiso Zokuhlinza Schwartz, 10e . ENew York, NY: McGraw-Hill; 2014.
Ukuguqulwa Ngohlobo Lwemvelo January 1, 1988 - Juni 30, 2016. Uxhumano Lwe-United for Organ Sharing https://www.unos.org/data/.
I-Trulock EP. Ukufakelwa kwe-Lung. Ku: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. I-Harrison's Principals of Internal Medicine, 19e . ENew York, NY: McGraw-Hill; 2015.