Der Einfluss der norditalienischen Universit

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Der Einfluss der norditalienischen Universitäten
auf die Entwicklungder Chirurgie in Innsbruck

• R. Margreiter
• Univ.-Klinik für Visceral-, Transplantations- und
  Thoraxchirurgie
• Department für Operative Medizin
• Medizinische Universität Innsbruck

Tirolisch-Venezianisch-Lombardische
Chirurgenvereinigung, Schloss Maretsch, 26.6.2008
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• Hippolytus Guarinonius
• (1571-1654)
• namhafter Arzt in Tirol
• 1593-1597 Medizinstudium in Padua
• 1598 Hausarzt am Damenstift in Hall
• 1601 Stadtmedikus in Hall
• 1609 Arzt der Bergwerkstrupppen

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• 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

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• Karl Anton Gerstner
• (1713-1797)
• Medizinstudium in Padua bei Giovanni
• Battista Morgani
• 1741 1. Lehrstuhl für Pathologie und Praxis

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Die Geschichte der Transplantationsmedizin
Tirolisch- Venezianisch- Lombardische
Chirurgenvereinigung, Schloss Maretsch, 26.6.2008
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The history of renal transplantation
Experimental Experimental 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
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• 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)

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The history of renal transplantation
Experimental Experimental 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
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• Emerich Ullmann
• Vienna
• 7 March 1902 Report on first
  successful kidney
• transplant
• autotransplant to neck-vessels (dog)
• cuff technique
• function for 5 days
• Ullmann E Wien. Klin. Wschr. 11,281 (1902)

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The history of renal transplantation
Experimental Experimental 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
1924 Avramovici preservation
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• Alexis Carrel
• 1905
• renal transplants with vascular anastomoses
• Carrel A Science 22, 473 (1905)

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The history of renal transplantation
Experimental Experimental 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
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• R. Stich
• 1907
• autotransplants
• uretero-neocystostomy
• Stich R Arch. Klin. chir. 83, 494 (1907)

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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

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• M. Jaboulay
• 24.01.1906 pig kidney gt 48y female
• 09.04.1906 goat kidney gt 50y female
• Implantation site elbow
• function no
• died after 3 and 9 days
• Jaboulay M Lyon Med. 107, 575 (1906)

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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

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• Ernst Unger
• 1910
• en bloc subhuman primate kidneys gt
• female 21y
• implantation site tigh
• function no
• outcome died after 32 hours
• Unger E Berl. Klin. Wschr. 573 13 (1910)

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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

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• M. Neuhof
• 1923
• sheep kidney gt 48y male
• function no
• outcome died day 9
• Neuhof H Transplantation of tissues,
  Appleton, New York (1923)

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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

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• Yuri Voronoy
• 1933
• donor trauma victim, blood
  group B
• recipient 37y male, blood group
  0 mercury poisoning
• warm ischemia 6 hours
• implantation site tigh
• function no
• outcome died after 48 hours
• 4 further transplants
• Hamilton D.N.H., Reid W.A YoYo Voronoy and the
  first human kidney allograft Surg. Gyn. Obst.
  159,289 (1954)

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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

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• 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)

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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

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• R.H. Lawler et al
• 17.6.1950
• donor woman 49y blood group AB
• hemorrhages from esophageal
  varices
• recipient woman 44y blood group AB
• polycystic kidney disease (Cr.
  1.8 mg)
• implantation site orthotopic, left
• ureteroureterostomy
• function yes
• outcome Cr. 1.2 mg
• no function at month 9
• R.H. Lawler et al JAMA 144, 844 (1950)

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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

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The free kidneys in those days came from
children with hydrocephalos, who had one kidney
removed (Matsons procedure) to use the ureter
from drainage of the catheter from the brain.

• R. Küss
• C. Dubost
• U. 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)

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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

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• D.M. Hume (1917-1973)
• 1952-1953
• 10 transplants
• implantation sitetigh
• life sustaining function for 6 months
• Hume D.M. et al J. Clin. Invest. 34, 327 (1955)

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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

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L. Michon 1953 donor mother recipient male
16y function 22 days outcome died day
23 Michon L et al Presse Med. 61 1419 (1953)












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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

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J. Murray 23/12/1954 donor monozygotic
twin implantation site iliac fossa
uretero-neocystostomy function
excellent outcome died at 8 years
(myocardial infarction)












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First Successfull Kidney TransplantDecember
23rd, 1954












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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












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Minneapolis 2006
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Mrs Lillehei 2006
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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












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• 1st Liver Transplantation
• March 1st 1963
• TE. Starzl

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• 1st Liver Transplantation in Europe
• R. Calne
• May 2nd 1968
• 46-year old female with HCC
• survived for 11 weeks (HAT)

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InnsbruckFirst combined Liver-Kidney Transplant
December 5th 1983

• Combined Liver and
• Kidney Transplantation
• Margreiter R, Kramar R, Huber C,
• Steiner E, Niederwieser D, Judmaier G,
• Vogel W
• Lancet, 330 1077-1078, 1984

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Hannover Liver Splitting
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Hannover Auxiliary Partial Orthotopic Liver
Transplantation
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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
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• Vladimir Demikhov
• (1916-1998)

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First Human Heart TransplantJanuary 27, 1964
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1st Heart Allotransplantation












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First Heart Allotransplant












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Philipp Bleiberg

• 1st long-term survivor

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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












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1st Lung Transplant Recipient

• June 1963

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1st successfull Lung Transplant

• 14.11.1968

Fritz Derom
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Joel Cooper

• 1981

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1st successfull Heart-Lung Transplant
March 9, 1981
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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
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• Starzl, Calne MGT in reith

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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.

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History ofMultivisceral Transplantation
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
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First Successfull Multivisceral Transplantation
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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
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1st Successfull Hand Transplantation
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1st Double Forearm Transplant
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1st Partial Face Transplant
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