Transplantation of organs, cells and tissues is a modern highly effective method of treatment of a number of serious diseases with end-stage organ failure.
Transplantation is considered an indicator of the quality and level of health care system, as well as the level of the development of the country and society. The absence or undevelopment of transplantology service is considered an evidence of weakness and shortsightedness of state apparatus, the sign of the third world country.
Currently in the United States annually about 26-28 thousand transplants are performed; in Spain – more than 3 thousand;in Poland more than 1,500 transplants per year. Among the post-Soviet countries Estonia is leading due to the number of transplants performed annually – 46.2 transplants per 1 million of population, Latvia – 36,2, and Lithuania – 22.4 per 1 million of population per year.
In Ukraine, the emergence of transplantology can be dated 1912, when VP Filatov performed the first corneal transplant. In 1930, in Ukraine the first kidney transplant was performed in the experiment, and in 1933 – in the clinic. In 1994, in Zaporizhzhya Transplantology Center, Prof. OS Nikonenko performed the first liver transplant in Ukraine from the deceased donor. In 2000, in Ukraine the first bone marrow transplant was carried out. In 2001, prof. VF Sayenko and OG Kotenko for the first time in the country performed a transplantation of a liver part from a living related donor at the Institute of Surgery and Transplantatology n.a. AA Shalimov, and prof. BM Todurov in the same year performed the first heart transplant in Ukraine.
Over the past 10 years in Ukraine 949 transplants of kidney, liver, heart, pancreas were perfomed. Of these, 394 transplants were performed in the Institute of Surgery and Transplantatology n.a. AA Shalimov, what makes 41.5% of all transplants in Ukraine. Also, within the past 10 years in Ukraine 97 liver transplants were done, of which – 94 transplants of a part of the liver from a living related donor in the Institute of Surgery and Transplantatology n.a. AA Shalimov and 3 cadaveric liver transplants in Zaporizhzhya under the direction of A. Nikonenko. Half of the cases of 94 transplants of the liver from a living related donor were carried out in children aged from 5 months to 18 years. The Institute of Surgery and Transplantatology n.a. AA Shalimov performs 12-13 liver transplants per year. However, the need for a liver transplant in Ukraine is from 800 to 1,200 transplants per year. From 2010 to 2014 in Ukraine, 612 organ transplants were done, but the annual demand for organ transplants in the country is hundreds-fold bigger than these numbers.
Actually in the world the increase of the transplantologic activity is being noted as well as progress in the organization of the donor process, optimization of organ preservation, expansion of indications for the donation, new approaches to the surgical technique, extending the range of transplanted organs, new approaches to immunological monitoring, application of new immunosuppressive drugs and protocols.
To date, Spain is considered the country, which managed to organize one of the most successful transplant services in the world. Currently, in Spain more than 90 000 organ transplants were performed, about 300,000 tissue transplants and about 50,000 bone marrow transplants or cord blood transfusions. Residents of Spain, who need organ transplants, have the highest chances among the inhabitants of the planet to get them. Average waiting time for a kidney in Spain is about a year, for a liver – six months, for a heart – three months. Donation and organ transplantation in Spain are regulated at the legislative level. The donation of organs, tissues and cells are totally voluntary and not a way to obtain any economic benefit. A person wishing to pass their organs after death to another person for transplantation signs a card of a donor. But after the death of the donor, the consent of the family members for the removal of organs for transplantation is mandatory. Percentage of vivo consents for organ donation in Spain is 85%. In every hospital in Spain the position of the transplant coordinator is introduced.
Analyzing the development of transplantology in the neighboring countries, the extremely successful experience of the Belarusian colleagues in organization of the transplantology service should be described first of all. In 2013, in the Republic of Belarus, the Law “On Transplantation of Organs and Tissues” was adopted, which allowed to reform the system of organ donation and to ensure 50-fold growth of the number of organ transplants in 2013 compared to 2005. Thus in 2013, the Republic of Belarus took the 10th place in the world due to the number of effective cadaveric donors per 1 million population. In 2013, in Belarus the number of effective cadaveric donors was 18.1 per 1 million inhabitants, while in Ukraine – 0.2, in Poland – 15.5 in Germany – 10.7.
Among the world countries which successfully organized a transplant service, Bangkok and Thailand can also be noted, where the simplification of a model of post-mortem donation allowed to double the number of transplants from postmortem donors in 3 years.
In 2013, in Romania, the introduction of 35 posts of transplant coordinators resulted in the diagnosis of 250 brain death during the 1st year, 135 organ recuperations and subsequently 500 transplantations compared to 2011, when only 100 potential donors were found and only 75 retrievals of organs were performed.
Increased activity of transplantation was noted in recent years also in Cyprus. This is a small country with a multicultural population (1.9 million), where in 2012, 3,000 consents to postmortem organ donation were recorded, whereas already in 2014 30,000 consents were registered. Progress in transplantology in Cyprus was achieved through training of transplant coordinators in Barcelona, information campaigns, rewarding donors.
In modern transplantology organ transplants from aged donors (over 70 years) are increasingly performed and liver transplantation in incompatible blood group.
In September of 2014, in Sweden, the first successful childbirth in woman after transplantation of the uterus occurred.
According to the International Registry of Hands and Tissue Composites Transplantation (Institute of Hand Surgery, Calgary, Italy), from 1998 to 2014 66 transplants of upper limb were performed, 22 transplants of one hand and 22 transplants of two hands.
Since 2005, 20 transplants of face (cheeks, nose, lips, perioral tissues) were performed worldwide.
According to the data of the State of Philadelphia (USA) in the period 1987-2013, 122 pregnancies were reported in 71 women after heart transplantation, 3 pregnancies after 2 heart transplants and 1 pregnancy after 3 heart transplants. 82 pregnancies in heart recipients ended with childbirth. The average weight of infants at birth was 2,550 g. Among children born to mothers with the donor heart, 72 children are healthy and developing normally, their average age is 7,7 ± 5,9 years.
In addition to organ transplantation, in recent years cell and tissue transplantation is being increasingly developed, and Ukraine is in the club of the world countries, where the methods of transplantation of human cells are widely used in clinical practice.
In 2008, the Institute of Cell Therapy became the first medical institution in Ukraine which received the right to conduct clinical trials using stem cells. And 5 years later, in 2012, the Ministry of Health of Ukraine approved the methods of cell therapy of pancreatic necrosis and critical limbs ischemia, developed by the Institute of Cell Therapy.
It is also worth noting that majority of stem cell transplants, which are used in leading research institutes and clinics of Ukraine are produced by the Institute of Cell Therapy.
Currently in Ukraine, biomaterial processed at the Institute of Cell Therapy is the most frequently used in clinical practice.
Significant success in cell transplantation in Ukraine was achieved by the scientists from the State Institution “Institute of Neurosurgery n.a. AP Romodanov”, where 1,043 patients with various neurological disorders were treated using methods of cell neurotransplantation. Improvement was observed in 79% of patients.
Institute of Neurosurgery n.a. AP Romodanov of NAMS of Ukraine in cooperation with the Institute of Cell Therapy developed methods for isolation of chondrocytes and the technology of the treatment of patients with herniated discs using autologous cartilaginous cells. To date, 5 patients have already successfully been treated with the use of this innovative technology. Cultivation of chondrocytes for all patients prior to transplantation was carried out by the Institute of Cell Therapy.
Regenerative therapy is also actively developing in the Republic of Belarus, where 17 cell technologies for the treatment of multiple sclerosis, breast cancer, diabetes, amyotrophic lateral sclerosis, and many other serious diseases have already been approved, and there is an experience of outpatient cell therapy.
Due to the high level of development of modern surgical techniques and biotechnology a prediction can be made that the transplantology of the future will be based on the transplantation of tissue-engineered organs grown from stem cells.The article is based on the materials of the scientific-practical conference “Transplantation – Past, Present and Future”, Kiev, 2014 (reports of Prof. V. Tsymbalyuk, Prof. R. Solyutin, Prof. A. Nikonenko, Prof. O. Rummo, Dr. A. Dzyadzko, Prof. O. Kotenko, Prof. V. Denisova, Prof. R. Zohrabyan, Dr. V. Shabliy and data provided by the Association of Cryobanks http://stemcellbank.org.ua/v-ispanii-proveli-50-000-transplantacij-kostnogo-mozga-i-pupovinnoj-krovi/