50 years Anniversary of First Kidney Transplant at Manchester Royal Infirmary

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1 50 years Anniversary of First Kidney Transplant at Manchester Royal Infirmary Consultant Transplant Surgeon Clinical Lead for Manchester /North west Paediatric Transplantation & Abdominal National Organ Retrieval (NORS)

2 Manchester Transplant Unit Where we were Where we are & Where we are going

3 Kidney Transplantation in Manchester Manchester 1 st Transplant 22 nd March 1968 Manchester 1 st Paediatric 18 th March year old male

4 Manchester Royal Infirmary

5 Manchester University Hospitals

6 Near Future

7 Near Future

8 A Vision for Future Manchester Organ Transplant Centre

9 I was excited to come to busiest transplant unit in UK at the time (2000). The unit was doing approximately transplant a year

10 Opportunity to work with

11 Opportunity to work with

12 Transplant Consultants not in Manchester

13 Transplant Consultants in Manchester

14 New Addition to Manchester Consultants Team

15 Paediatric Team in Manchester

16 Nursing Figures

17 Transplant Office, Gayle and Maria

18 Transplant Laboratory

19 Some of many Nephrologists

20 The Origin and Development of Renal Failure Services in Manchester and the North Western Health Region. RWG Johnson MS;FRCS; FRCS Ed

21 Kidney transplantation in context ARF due to acute tubular necrosis was first described by English physicians during the blitz in WW II dialysis was initially developed in the 1940 s to support patients with ARF 1 st dialysis machine: Kolff rotating drum, 1943

22 Home Haemodialysis

23 Future Implantable Renal Assist Device (IRAD)

24 Paris 1951

25 Kidney Transplantation The modern approach to kidney transplantation

26 Perfusion and Preservation

27 Organ Packaging & Preservation

28 Cold Perfusion and Preservation

29 Cold Machine Perfusion & Preservation

30 Warm perfusion -Kidney

31 Tissue Typing

32 The first two kidney transplants in the UK from a donor who had registered her wishes on a computer register were carried out at MRI. This was in March 1985 It was called the 'Kidney Lifeline' Ruth Shrigley

33 Tissue Typing

34 The remaining challenges closing the gap between supply and demand maximizing long-term graft function and survival diagnosis and management of chronic rejection new immunosuppressive strategies to reduce the burden of toxicities;?development of tolerance premature cardiovascular disease new onset diabetes post-transplant and dyslipidemia infections malignancies

35 Manchester Transplant Activity

36 Source: Annual Report on Kidney Transplantation 2014/15, Afshin 2016/17, Tavakoli NHS NHS Blood Blood and and Transplant

37 UK Strategy Taking Organ Transplantation to 2020 Targets for deceased donors and transplants Target figures to 2020

38 UK Strategy Taking Organ Transplantation to 2020 Targets for deceased donors and transplants Target figures to 2020

39 National Organ Retrieval Scheme (NORS)

40 Manchester Abdominal NORS Retrieval Attendance in 2016/17 n = 305

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42 Number of Transplants Manchester Renal Transplant Activity Adult and paediatric transplants at CMFT, Adult Paediatric Calendar Year V Bowman, Renal Transplant Data & Audit Manager, CMFT

43 Manchester Paediatric Transplantation n = n = 13 Alder Hey = 5 Mancheste r = n = 22 Alder Hey = 6 Manchester = 15 Belfast = n = 21 Alder Hey = 10 Manchester = n = 25 Alder Hey = 6 Manchester = 16 Leeds = 2 Cardiff = n = 24 Alder Hey = 7 Manchester = 16 Leeds = Cadveric 11 Living

44 What does it translate into? 9 year old twins Congenital kidney disease 1 live donor (father) can t give to both.

45 Identical Twin Transplant from same Cadaver Donor European 1 st done in Manchester

46 Family's transplant plea to save Salford girl, 5, born with no kidneys

47 Living donor types Related Non related : directed Altruistic (anonymous nondirected) ABO incompatible Desensitisation Paired pool

48 Number of living kidney transplants in 2014 by transplant centre

49 Number of living Donors Paired exchange Altruistic Unrelated (directed) Related 20 0

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51 Manchester 50 Years milestone Manchester 1 st Transplant 22 nd March 1968 Manchester 1000 Transplant 17 th March 1988 Manchester 2000 Transplant 23 rd May 1995 Manchester 3000 Transplant 15 th February 2002 Manchester 4000 Transplant 12 th November 2008 Manchester 5000 Transplant 31 th May 2013 Manchester 6000 Transplant 26 th September 2016 Manchester 6500 Transplant 21 th March 2018

52 Future

53 Stem Cell engineering (Karolinski Institute)

54 Mechanical Organs Syncardia UCLA Implantable Renal Assist Device (IRAD)

55 Biological Immunosupression (MGH)

56 Immuno-tolerance

57 Robotic

58 3D Printing organs

59 Manchester in March 50 Years on Manchester 1 st Transplant 22 nd March 1968 Manchester 1 st Paediatric 18 th March 1969 Manchester Computerised WL 29 th March 1985 Manchester 1000 Transplant 17 th March 1988 Manchester 6500 Transplant 21 th March 2018

60 Source: Annual Report on Kidney Transplantation 2014/15, Afshin 2016/17, Tavakoli NHS NHS Blood Blood and and Transplant

61

62 Over the years transplantation has grown in MANCHESTER TRANSPLANT UNIT. From hundreds of patients on the waiting list we have nearly 1000 patient on the waiting list. That means we are reaching large population and able to help a lot of patients. We are the biggest and busiest kidney transplant unit in UK We are transforming our community and surrounding community who are under our umbrella ( children Alder Hey, Adult The whole idea that Manchester is a major player in UK and Europe and transplant world makes us proud. It is something that we have done a lot of commitment toward. I am delighted to watch this increasing complexity being taken up. Multiple organs at the time, organs that we did not think we could transplant before. all becoming part of future.

63 50 years Anniversary of First Kidney Transplant at Manchester Royal Infirmary