Starzl, TE

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Julg 1 S. 1996 Chimerism· The Glue 01- Tronsplontot /c.'ln !. Thomas E. Starzl M.D .• Ph.D. The Concept of Mlcr-ochl mer-lsm 1 n Or-gan Recl plents CHII'fERIS/'f.· THE liLUE OF TRANSPLANTATION I I'fI'fUNOL OliY by Thomas E. Starzl. M.D .• Ph.D. Professor of Surg Director of the q~~~!i=:~~~#~~~~~~ Further real growth of transmlantatt=~~~~~~~~;;;;;;;;;;; those from disparate species. This mechanism of organ allograft accep chimerism (1.2). The following tho concept. which wll1 be debated in t nt il 1992. and eyer si nce or organ allograft was enYisioned as a d first seen as unrealistic. eyen after tota in 1950 to be i mmunosuppressi yeo he Billi ngham. Brent. and Medawar Cl a r hiS grim pessimism was lightened in 19 Df acquired tolerance in immunologically hematolymphopoietic donor cells. and wi transplantation. a natural extension of t immune system. made possible by simula Df the neonatal model. As with Medawar' recipients (graft yersus host disease). Drgan allografts. he Enigma of Organ Transplantation resul t i ng one-way paradi gm in whi c mm reaction appeared to explain the SU ..... I .... r ... _ lr_l ... loll .. will ronow In. __ . I .... _f~ o.Im.', f ~ • • 1 ._ ... . . L ... I ... II ......... _ rl .... r_.n _ I_I .. n.",.r.1 .. Jlel l - " onlu l ... . n ... no'ift .. I. _ '" • • natr.nIP' on'.Uan ......... II ..... ,. MiII l " .... ed- . ,. ... ~ af , .. fIIft ' wuli l Ihe _ 1. dI U ,_ P 11M n.e .... .... 1..- Lh. l r "''''' , "'1I,,"ulus • •• Is> . fflp ...... eeltM f'H;-t,.u . 1 ___ WI 11\1&) .. hlch _. La .. p.rUewl.r's ..... l . lIQft f uul.-.,-.d ... f . ...... 1* •• "'.,.... Ih. _ 1.-.' 1 . 1 ... ..... _ b . n _ l i d ., 1J . ...... 'ly . t . . .... ( i6) Ih' .. . _ ;r.e •• i ... 0 .... ~ . mb ...... ...... I •• cul . ' .. I . tr.p I1l.n •• " u ILh _ItFt S t. l m " 11. Ilu h . d t ,... Idtil . btu •• ......,. .... I' _ Ih ... 1.11_ ' PII1 ... " _ Iwl . , Ih ... Ill ... . I I f • ..... !'IIi", •• 11M IUrnllA:AM 6- •• '1 .i ii".. 10'''-, I h i ___ 'ullu _ ,. l .oeul . ' . . ..... rl'_, _ .d.pl ...l"nl'.I., pfa, I,:. ' f KKKKIKf~ fKKKKKKKK-~ Ilu a •• ump. lD'.rMCI IIr 1\ d • • • ' Dp. I L 1 11 ...... n qul ... p ... I ..... I.d _ 1_\1 ••• Tn. u" f~1 qu • • • I ..... It _ . 1 ' _ 1 ,. Z.nl_ I·. humonilid ..... , _lIhumon _ Lhl". ' . u« ........ r ~ n b • • eai..,.-_*," I hl waylli r. ~fDrf Ull tH I ... 1. not be . 1'_l ed _ will _ I . ..... 1 luLIng I. ~yfDDDDDl_ .....,...tn .. ,.1 Foreword Thomas E. Starzl, M.D., Ph.D . . lIVfR lonnpmlnnlnll~n Professor of Surgery Director, Thomas E. Starzl Transplantation Institute The idea (and now the reality) of a continuously updated electronic textbook of liver transplantation goes to the heart of a more general problem in science and medicine. The exponential growth of professional journals and the material published in them has long since outstripped the ability of interested parties to keep up. Even for the diligent reader, the reward may not match the effort. For one thing, the delays engendered by the review, publication, and distribution process conspire to make journal articles obsolete by the time they see the light of day. Consequently, many journals have become no more than renewable incomplete textbooks, which are skimmed to see if familiar concepts are confirmed (almost invariably the case) , or challenged sufficiently to warrant looking at the evidence in detail. The gestational period of textbooks is even more protracted, sometimes lasting so long that the central theme at insemination has disintegrated by the time the finished product appears in the book stores. The best books are, however, more enduring than journals because they provide for their given subject a broader and more even account of the historical experience upon which future progress can be mounted. No one has suggested that journals or books will disappear from the scene However, the University of Strasbourg surgical faculty has taken a step that could shorten the time gap between discoveries and observations and their dissemination. This is particularly important for a field like Unlversite louiS Pasteur ............ y~g-~ Please clict u the loges above for more infl rml Uon about thue i ns t it uti ons . liver transplantation which is undergoing constant change. Instead of organization by classical chapters, the format is based on 160 (or more) recurring questions, problems, or topics. The selection of appropriate subjects requires the dedicated input of people with extensive personal exposure to liver transplantation. The Strasbourg team is well qualified by virtue of their decade's work in the clinical trenches of liver transplantation, and their even longer deep interest in liver disease. It has been said, sometimes critically, that surgeons compete amongst themselves more remorselessly than in any other area of life science. Such remarks betray an ignorance of history. The tradition of surgeons throughout the centuries has been to report triumphs promptly, but there has been an equal emphasis on complications and mistakes. Most importantly, surgeons and those who work with them have ennobled the profession by prompt open disclosure of discoveries and innovations. Advances that might have driven others to secrecy, or to the patent office, have been freely shared with peers. Because the Strasbourg initiative has the core objective of informing and bringing together colleagues internationally, it has a bright future. ow Dill liis Idea Evolve? Jacques Cinqualbre M.D. University Lou is Pasteur Medical School , Strasbourg, France Can we envision another approach ? Definitely we can by using new ( ... ) communications pathways. Here is the world wide web, a marvelous toy for adults, an increasingly efficient tool for commercial purposes, and probably the most important development for the future of mass or individual education. This is how the idea of submitting a project to the transplant community on the Internet came into being: a collaborative, on-line, truly "non-definitive", continuously in-progress book, devoted to liver transplantation. Netsite ; I http://webcom.com/joinq litem201 .html .. --, At its best, this book will also fulfill the prophecy: "knowledge is the only wealth that increases when it is being shared", which appears to be a fair illustration of the web concept ( ... ). .1" samr: bUp:1I www.llllnrIRSpIIRIIIIDR.Drg Editorial board policies : contact D. Jaeck M.D. Item -20 I ,-----3 November 11.1996 l 1 LlVH{ I t{eEr~i~11 ~m IIUII List or Items 905 or 07/ /7/96 Key to Items III Open Items • Fulfilled Items • 425 lrthoto~i c auxiliary trans~lantation K. Boudjema M.D. II 518 Graft-versus-host disease • 702 uenotrans~lantation of the liver P. Wolf M.D. SurgiclIl Anll/om}' of the Liver Oeniel Jeeck Renee Wolfrem Philippe Becheliler The Morphological As pect of the liver Surgi cal Anatomy of th e Liver by Daniel Jaeck Renee Wolfram Philippe Bachellier lhe transplant surgeon. Several topics need to be e ,tion of the liver leading to various methods of hep ,eed to be at the same time well-informed hepatic afts, usually the right liver (segments V-VI-VII-VI for the pediatric recipient (1 , 2, B, 10). Furthermo ent enhanced the need for performing safe he poteet gicel lobes do not correspond to the right end lelt I e glissonien sheoths whi ch leed the portel tried (po -iptlon, more funcUon ol , divi des the liver Into right ,ft side of t he In ferior vene covo posteriorly. This p t complete end the most use ful lo r t he su rg eon. It d 't bronch of the portel vein supplies the left liver e lted by the left portel fissu re. Eech sector Is then d ,ts the fu ncUonel lobetion of the liver end the dl vls coudote lobe (Spige l lobe) : it is eutonomous lor Its lce ives it s vessels from the le ft but elso fro m the , HS n"pOliC vems or" ,naepenae", "no ena a,recllY 'nlo the Inferior vena ceve. summari zes the common hepetectomles foll owing Cou lnelld's nomencl etu re, compered to 

Chimerism: The glue of transplantation immunology

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Chimerism: The glue of transplantation immunology

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