{"id":955,"date":"2013-04-15T14:53:45","date_gmt":"2013-04-15T12:53:45","guid":{"rendered":"http:\/\/digipathblog.wordpress.com\/?p=6"},"modified":"2021-01-11T14:43:14","modified_gmt":"2021-01-11T12:43:14","slug":"borrowed-organs","status":"publish","type":"post","link":"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/","title":{"rendered":"Borrowed organs"},"content":{"rendered":"<div id='gallery-1' class='gallery galleryid-955 gallery-columns-3 gallery-size-thumbnail'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/chacma-baboon\/'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/chacma-baboon-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-72\" \/><\/a>\n\t\t\t<\/div>\n\t\t\t\t<figcaption class='wp-caption-text gallery-caption' id='gallery-1-72'>\n\t\t\t\t<a href=\"http:\/\/www.flickr.com\/photos\/arnolouise\/with\/409875964\/#photo_409875964\" target=\"_blank\">Papio Ursinus Arno Meintjies Wildlife<\/a>\n\t\t\t\t<\/figcaption><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/chimp-national-geographic-2\/'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/chimp-national-geographic1-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-74\" \/><\/a>\n\t\t\t<\/div>\n\t\t\t\t<figcaption class='wp-caption-text gallery-caption' id='gallery-1-74'>\n\t\t\t\t<a href=\"http:\/\/animals.nationalgeographic.com\/animals\/photos\/chimps\/#\/chimp-frodo_5808_600x450.jpg\" target=\"_blank\">Pan troglodytes Michael Nichols, National Geographic<\/a>\n\t\t\t\t<\/figcaption><\/figure>\n\t\t<\/div>\n\n<p>For our opening post I\u2019ve homed in on some specimens that are interesting because of their place in medical history, specifically the history of <span style=\"color: #808080;\">xenotransplantation.<\/span><\/p>\n<p>After his exceedingly well known first human heart transplant in 1967, Dr Chris Barnard continued experimenting. The rationale for the \u201cpiggy-back heart transplant\u201d or heterotopic cardiac transplant is clear from this excerpt:<\/p>\n<p>\u201cIn 1973, Barnard performed a heart transplant and the donor heart failed to function satisfactorily, so the patient died in the operating theatre. When Barnard came out to break the sad news, he was asked why he could not put the old heart back, as at least it had kept the patient alive. This struck Barnard as a distinct possibility. If the patient\u2019s own heart had been left in place, and the transplant was inserted as an auxiliary pump, failure of the donor heart may not have caused the patient\u2019s demise. Furthermore, during severe rejection episodes, which were common in those early days and a major cause of the poor results at the time, the native <i>(i.e. patient\u2019s own)<\/i> heart might be able to maintain the circulation while rejection was reversed by increased therapy.\u201d<sup>1<\/sup><\/p>\n<p>One thing led to another:<\/p>\n<p>\u201cOn two occasions in 1977, when a patient\u2019s left ventricle failed acutely after routine open-heart surgery and when no human donor organ was available, Barnard transplanted an animal heart heterotopically. On the first occasion, a baboon heart was transplanted, but this failed to support the circulation sufficiently, the patient dying some six hours after transplantation. In the second patient, a chimpanzee heart successfully maintained life until irreversible rejection occurred four days later, the recipient\u2019s native heart having failed to recover during this period. Further attempts at xenotransplantation were abandoned and even now, more than 30 years later, xenotransplantation remains an elusive holy grail despite decades of research.\u201d<sup>1<\/sup><\/p>\n<p>These are those two ragged-looking but seminal xenotransplants, preserved in the UCT pathology teaching collection:<\/p>\n<div id='gallery-2' class='gallery galleryid-955 gallery-columns-3 gallery-size-medium'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/ppm_21_b\/'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"188\" src=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_21_b-300x188.jpg\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_21_b-300x188.jpg 300w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_21_b-768x482.jpg 768w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_21_b-1024x643.jpg 1024w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_21_b.jpg 1115w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/ppm_42_b\/'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"198\" src=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_42_b-300x198.jpg\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_42_b-300x198.jpg 300w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_42_b-768x507.jpg 768w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_42_b-1024x676.jpg 1024w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/ppm_42_b.jpg 1060w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n\n<p>Barnard\u2019s own report of these two cases makes fascinating reading<sup>2<\/sup>.<\/p>\n<p>In a similar vein, and from a similar time, this liver specimen dated 1968 is from a patient who suffered severe (sub)acute liver failure and went into coma. The catalogue description reads:&nbsp;\u201cThe liver is seen to be markedly reduced in size (885g), with the bulk of the surviving regenerated liver present as a large mass in the right lobe with occasional smaller nodules present elsewhere; the left lobe is shrunken, and slightly congested.\u201d<\/p>\n<div id='gallery-3' class='gallery galleryid-955 gallery-columns-3 gallery-size-medium'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/xviii_vii_30_rb\/'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"249\" src=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/xviii_vii_30_rb-300x249.jpg\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/xviii_vii_30_rb-300x249.jpg 300w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/xviii_vii_30_rb-768x636.jpg 768w, https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/xviii_vii_30_rb.jpg 845w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n\n<p>But what is notable about this case is that a&nbsp;<span style=\"color: #808080;\">baboon liver perfusion<\/span>&nbsp;had been performed, though unfortunately without response. The objective would have been to try to tide the patient over the acute liver failure, giving their own liver a chance to regenerate enough to resume functioning &#8211; analogous to the use of transient renal dialysis in acute kidney failure.<\/p>\n<p>Between 1964 and 1970, one hundred and thirteen patients who had received extracorporeal liver perfusion or ECLP were reported (this case not among them). By 2000 the number reported was 270. Pig livers were most often used, but on review, baboon or human livers gave better long term survival (\u224840% vs. \u224820%). But during this period the <i>overall<\/i> survival of acute liver failure patients receiving ECLP was no better than that of patients receiving conventional intensive care (\u224825% for both)<sup>3<\/sup>.&nbsp;Today, artificial and bioartificial liver support can be part of the intensive care for acute liver failure, often as a bridge to liver transplantation, the optimal treatment. &nbsp;ELCP using whole human livers (not suitable for transplant) or transgenic pig livers is still an option for temporary liver support in this context, despite the technical challenges and concerns about the risk of transmission of infectious agents<sup>4<\/sup>.<\/p>\n<p style=\"text-align: left;\"><span style=\"color: #808080;\">The availability of non-human primates for medical research is now far more limited than it was in the second half of the 20th century from when these cases date, but aside from non-human primates, other animals appear to remain &#8220;fair game&#8221; in the modern field of xenotransplantation.<\/span><\/p>\n<p><strong>See also<\/strong><\/p>\n<p><strong>&nbsp;<a href=\"http:\/\/www.humanxenotransplant.org\/home\/index.php\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.humanxenotransplant.org<\/a><\/strong><\/p>\n<p><a href=\"http:\/\/qjmed.oxfordjournals.org\/content\/93\/12\/831.full.pdf+html\" target=\"_blank\" rel=\"noopener noreferrer\"><strong>Benatar D. Duty and the beast: animal experimentation and neglected interests. Q J Med 2000: 93:831-835<\/strong><\/a><\/p>\n<p>References<\/p>\n<ol>\n<li><a href=\"http:\/\/blues.sabinet.co.za\/WebZ\/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&amp;\/AdvancedQuery?&amp;format=F&amp;next=images\/ejour\/cardio1\/cardio1_v20_n1_a7.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Brink JG, Hassoulas J. The first human heart transplant and further advances in cardiac transplantation at Groote Schuur Hospital and the University of Cape Town. Cardiovasc J Afr.&nbsp;2009; 20(1):31-5<\/a><\/li>\n<li><a href=\"http:\/\/archive.samj.org.za\/1977%20VOL%20LI%20Jul-Dec\/Articles\/12%20December\/3.5%20HETEROTOPIC%20CARDIAC%20TRANSPLANTATION%20WITH%20A%20XENOGRAFT%20FOR%20ASSISTANCE%20OF%20THE%20LEFT%20HEART%20IN%20CARD.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Barnard CN,&nbsp;Wolpowitz A,&nbsp;Losman JG. Heterotopic&nbsp;cardiac&nbsp;transplantation&nbsp;with a&nbsp;xenograft&nbsp;for&nbsp;assistance&nbsp;of the&nbsp;left&nbsp;heart&nbsp;in&nbsp;cardiogenic&nbsp;shock&nbsp;after cardiopulmonary&nbsp;bypass. S Afr Med J.&nbsp;1977; 52(26):1035-8.<\/a><\/li>\n<li>&nbsp;<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1034\/j.1399-3089.2002.01076.x\/pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Pascher A, Sauer IM, Hammer C, Gerlach JC, Neuhaus P. Extracorporeal liver perfusion as hepatic assist in acute liver failure: a review of world experience. Xenotransplantation 2002: 9: 309\u2013324&nbsp;<\/a><\/li>\n<li><a href=\"http:\/\/link.springer.com\/content\/pdf\/10.1007%2Fs00595-004-2980-5.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Naruse K, Nagashima H, Sakai Y, Kokudo N, Makuuchi M.&nbsp;Development and perspectives of perfusion treatment for liver failure.&nbsp;Surg Today. 2005; 35:507\u2013517<\/a><\/li>\n<\/ol>\n<div><a title=\"QJM : monthly journal of the Association of Physicians.\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11110591#\">&nbsp;<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>For our opening post I\u2019ve homed in on some specimens that are interesting because of their place in medical history, specifically the history of xenotransplantation. After his exceedingly well known [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"ngg_post_thumbnail":0,"footnotes":""},"categories":[16,4],"tags":[9,10,12],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Borrowed organs - digital pathology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Borrowed organs - digital pathology\" \/>\n<meta property=\"og:description\" content=\"For our opening post I\u2019ve homed in on some specimens that are interesting because of their place in medical history, specifically the history of xenotransplantation. After his exceedingly well known [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/\" \/>\n<meta property=\"og:site_name\" content=\"digital pathology\" \/>\n<meta property=\"article:published_time\" content=\"2013-04-15T12:53:45+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2021-01-11T12:43:14+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.uct.ac.za\/digipathblog\/wp-content\/uploads\/2013\/04\/chacma-baboon-150x150.jpg\" \/>\n<meta name=\"author\" content=\"Jane Yeats\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jane Yeats\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/\",\"url\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/\",\"name\":\"Borrowed organs - digital pathology\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/#website\"},\"datePublished\":\"2013-04-15T12:53:45+00:00\",\"dateModified\":\"2021-01-11T12:43:14+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/#\/schema\/person\/b64f90534c98e29d1d01afd05ac7edbc\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Borrowed organs\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/#website\",\"url\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/\",\"name\":\"digital pathology\",\"description\":\"This is the blog for www.pathologylearningcentre.uct.ac.za\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/#\/schema\/person\/b64f90534c98e29d1d01afd05ac7edbc\",\"name\":\"Jane Yeats\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/0920f1cb82472658499b8a8b4f0f2d67?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/0920f1cb82472658499b8a8b4f0f2d67?s=96&d=mm&r=g\",\"caption\":\"Jane Yeats\"},\"url\":\"https:\/\/blogs.uct.ac.za\/digipathblog\/author\/01406484\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Borrowed organs - digital pathology","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.uct.ac.za\/digipathblog\/2013\/04\/borrowed-organs\/","og_locale":"en_GB","og_type":"article","og_title":"Borrowed organs - digital pathology","og_description":"For our opening post I\u2019ve homed in on some specimens that are interesting because of their place in medical history, specifically the history of xenotransplantation. 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