Zosintha zoposa 500,000 zagwiritsidwa ntchito ku US
Malingana ndi United Network for Organ Sharing (UNOS), pakati pa 1 January 1988, ndi June 30, 2016, ziwalo zokwana 669,556 zidapitsidwira ku United States. Ngakhale kuti nambalayi ndi yodabwitsa kwambiri, palibenso ziwalo zowonjezera zomwe zilipo kwa iwo omwe amazifuna. Pakalipano, anthu 120,139 akusowa kupulumutsidwa kwa thupi.
Nazi izi zisanu ndi chimodzi zomwe zimagwiritsidwa ntchito limodzi kuti zikhale zochepa. Mankhwala osakaniza okha amatchulidwa chifukwa olandira mankhwala nthawi zambiri amalandira zoposa chiwalo chimodzi panthawi yomweyo. Mwachitsanzo, chiwerengero cha zipsyinjo za impso / kapangidwe (21,727) pa nthawi yomwe tatchulidwa pamwambayi ndi zazikulu kuposa chiwerengero cha mphukira zokha (8,235).
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ImpsoChiwerengero cha impso pakati pa January 1, 1988 ndi June 30, 2016, chinali 395,510
Impso ndiwo chiwalo chofalikira kwambiri. Mu 2011, panali 11,835 opatsirana opatsirana pogwiritsa ntchito impso komanso 5772 omwe amapereka moyo wawo.
Kupatsirana kwa impso kumagwiritsidwa ntchito pofuna kuchiza anthu omwe ali ndi mapeto a nthendayi, kapena impso kulephera. Kawirikawiri, impso zoterezi zimachokera ku shuga kapena matenda oopsa kwambiri. Kwa mbali zambiri, impso zokhudzana ndi impso zimapambana kuposa dialysis ndi kusintha moyo ndi kuwonjezera chiyembekezo cha moyo kuposa momwe dialysis imachitira.
M'zaka za m'ma 1960, mankhwala okhawo omwe tinkamenyana nawo kuti tisamane nawo anali azathioprine ndi prednisone. Chifukwa chakuti tinali ndi mankhwala ochepa opatsirana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito mankhwala osokoneza bongo.
Lero, tili ndi mankhwala osiyanasiyana othandizira kuteteza chitetezo cha mthupi mwa anthu omwe amalandira impso. Mwapadera, mankhwalawa amateteza mitundu yambiri ya chitetezo cha mthupi, kuphatikizapo mabakiteriya, bowa, ndi zotupa zoipa.
Agents omwe amaletsa kukanidwa amagawidwa kwambiri ngati mawotchi opangira mavitamini kapena okonza . Otsatsa malonda amachepetsa mwayi wotsutsa kwambiri ndipo amaperekedwa nthawi ya kusamba. Anthu omwe amalandira impso, opanga mavitaminiwa amapezerapo mankhwala omwe amathetsa kugwiritsa ntchito steroids kapena calcineurin inhibitors (cyclosporine ndi tacrolimus) ndi ma toxicities awo.
Thandizo la kusamalira limathandiza kupewa kukana ndi kuperewera kwa impso. Kawirikawiri, odwala amalandira mankhwala awa: prednisone (steroids), calcineurin inhibitor ndi antimetabolite (taganizirani azithioprine kapena, kawirikawiri, mycophenolate mofetil). Thandizo la kusamalira limasinthidwa pakapita nthawi.
Chifukwa cha kusintha kwa mankhwala osamalidwa bwino, kutayika kwa impso zokha chifukwa cha kukanidwa kwachilendo sizodziwika. Kuyambira mwezi wa December 2012, chiwerengero cha impso chomwe chinali ndi moyo pambuyo pa zaka zisanu, kapena kupitirira zaka zisanu, chinali 83.4 peresenti chifukwa cha impso zoperekedwa kuchokera kwa abambo omwe anamwalira ndi 92 peresenti kwa impso zomwe zimaperekedwa kuchokera kwa opereka ndalama.
Komabe, patapita nthawi, ntchito ya impso yofalikira imayambitsidwa ndi njira yosadziwika bwino, yomwe imakhudzana ndi matenda osokoneza bongo, maambukomiro a tubular, vasculopathy, ndi glomerulopathy. Choncho, pafupifupi nthawi imene anthu omwe amalandira impso kuchokera kwa opereka ndalama ali ndi zaka 20 ndipo kuti opezeka operekera ziwalozi ndi zaka 14.
Odzipereka odzipereka ayenera kuchotseratu matenda aliwonse aakulu, ndipo abambo ofa sayenera kukhala ndi matenda omwe angathe kufalikira kwa wolandira, monga HIV, chiwindi cha chiwindi kapena khansa ya mthupi.
Opereka amaphatikizidwa ndi ozilandira pogwiritsa ntchito magulu a antigen (kuganiza za mtundu wa magazi) ndi maantijeni a HLA yaikulu kwambiri. Ophunzira a impso omwe akugwirizana kwambiri ndi ma HLA amakhala bwino kuposa omwe ali ndi ma HLA osagwirizana. Kawirikawiri, achibale oyambirira amatha kufotokoza zofanana ndi ma antigen. Mwa kuyankhula kwina, wachibale wa digirii yoyamba ali ndi mwayi wopereka chida chothandizira chomwe chidzapambana kuposa impso kuchokera ku cadaver wakufa.
Kuchita opaleshoni ya impso ndi yowonongeka ndi limba lomwe likuyikidwa pa inguinal fossa popanda kusowa kwa piritonial cavity. Ngati zonse zikuyenda bwino, wolandira impso akhoza kuyembekezera kuti achotsedwe kuchipatala bwino kwambiri pakatha masiku asanu.
Impso zoperekedwa kuchokera kwa abambo omwe anamwalira zikhoza kusungidwa kwa maola pafupifupi 48 isanafike. Nthawi ino amapereka antchito a zaumoyo nthawi yokwanira kuti ayese, kuwonana, kusankha ndi kutumiza ziwalo izi.
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ChiwindiChiwerengero cha chiwindi cha chiwindi pakati pa January 1, 1988, ndi June 30, 2016, chinali 143,856.
Monga ndi impso ndi kupatsirana kwa impso, ziwindi zingabwere kuchokera kwa opereka moyo. Ndalama zoyipa za chiwindi zimachokera kwa opereka ubongo omwe ali ochepa kuposa 60. Wothandizira wakufa ayenera kukwaniritsa zofunikira zina, kuphatikizapo chiwindi cha chiwindi chifukwa cha kuopsa kwa matenda kapena matenda monga hepatitis.
Akatswiri amatsutsana ndi opereka chithandizo pogwiritsa ntchito ABO kufanana ndi kukula kwa munthuyo. Chochititsa chidwi ndi nthawi yowopsa, chiwindi chimagawanika (kupatukana chiwindi) ndipo chimaperekedwa kwa ana awiri omwe alandira. Komanso pakagwa vuto lachidziwitso kapena kuchepa kwa chiwalo, zivundi zomwe ziri zosiyana ndi ZOYENERA kugwiritsidwa ntchito. Mosiyana ndi impso zosakaniza, ziwindi sizingayesedwe kuti zizigwirizana ndi HLA.
Chiwindi ndilo chokha chokhachokha kuti chikhale ndi mphamvu zowonongeka. M'mawu ena, chiwindi chimakula. Izi zowonjezeretsa ndizo chifukwa chomwe chiwerengero cha chiwindi chazing'ono chimatha. Kamodzi kagawo kapena chiwindi cha chiwindi chimaikidwa, chidzabwereranso.
Kuphimbidwa ndi chiwindi, kukongola kwakukulu kumeneku kumaperekedwa ku lobe lamanzere. Komanso, ngakhale kusintha kwapakati kwa chiwindi kuperekedwa kuchokera kwa opereka amoyo kumachitika, makamaka ziwindi zimapezedwa kuchokera kumadzulo. Mu 2012, ndi 4 peresenti ya ziwalo za thupi (246) zomwe zinaperekedwa kuchokera kwa opereka ndalama.
Kuikidwa kwa chiwindi kumaperekedwa ngati njira yothandizira nthawi ina iliyonse imene mungasankhe. Amaperekedwa kwa anthu omwe ali ndi matenda aakulu a chiwindi omwe sagwiritsidwa ntchito omwe palibe njira zina zothandizira mankhwala kapena opaleshoni. Mwachitsanzo, munthu amene ali ndi matenda a chiwindi oopsa kwambiri omwe amachititsa matenda a chiwindi (C) kapena chiwerewere (alcohol) akhoza kukhala woyenera kuwedza chiwindi.
Ndikulumikizidwa ndi chiwindi, nthawi ndi yofunika kwambiri. Munthu amene akulandirayo ayenera kukhala wodwala mokwanira kuti apeze kupatsa koma bwino kuti athe kuchira.
Kuwombera kwathunthu kwa chiwindi, kapena kutsegula kwa orthotopic , ndi opaleshoni yaikulu komanso yotsutsa-makamaka mwa anthu omwe ali ndi matenda oopsa omwe amachititsa kuti matendawa asokonezeke. Kuphatikizidwa kwa chiwopsezo cha m'mimba komanso coagulopathy, kapena kuwonongeka kwa magazi komwe kumabwera chifukwa cha chiwindi, kumayambitsa magazi ambiri pamene akuchitidwa opaleshoni komanso kufunika kwakukulu koika magazi. Kuwonjezera apo, kuchotsa chiwindi chonse ndikuchichotsa kumafuna choyamba kusokoneza (kenako kudula) ndikuyambitsanso mitsempha yambiri yamagazi ndi zina, monga inferior vena cavae, mitsempha yam'nyumba, mitsempha yapamwamba, ndi ndondomeko ya bile.
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MtimaChiwerengero cha mitima yoyambira pakati pa January 1, 1988, ndi June 30, 2016, chinali 64,085.
Kusintha mtima kunakhalapo chinthu china cholota ndi olemba sayansi, koma tinatero. Zinatengera zaka zoposa 200 kuti tipite patsogolo pakumvetsetsa kwathu kwa thupi komanso kusintha kwa opaleshoni komanso njira zamakono komanso zipangizo zamakono kuti zitsegulire khomo la mtima. Mu 1967, kukonzanso mtima koyamba kunachitika ku Cape Town, South Africa, ndi dokotala wa opaleshoni wotchedwa Dr. Christiaan Barnard.
Ngakhale kuti zogwiritsa ntchito zamakono, kusintha kwa mtima koyambirira sikudapitirize kupulumuka mwa njira iliyonse yodalirika. Ndipotu, wodwala wa Barnard anakhala ndi moyo masiku 18 okha atalandira mtima watsopano. Zingasinthe kusintha kwa mankhwala osokoneza bongo ndi mawonekedwe a minofu kuti apitirize kupulumuka atatha opaleshoni ya mtima.
Malingana ndi Dipatimenti ya Zaumoyo ya Zaumoyo ku United States, mu 2012, zaka zisanu zapakati pa moyo wawo, kapena chiŵerengero cha anthu omwe adakali ndi moyo zaka zisanu pambuyo pa kupuma mtima, ndi 76.8 peresenti.
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MphunguMbalame yamapapu imayenda pakati pa January 1, 1988, ndi June 30, 2016, inali 32,224.
Kuchokera mu 1985, maiko opitirira 40,000 apangidwa m'mapapo padziko lonse lapansi. Kuloledwa kwapopu kumatheka kwa anthu omwe ali ndi mapeto a mapapo a mapeto omwe sali odwala khansa (osadziwika). Nazi zizindikiro zinayi zapamwamba zowonjezera mapapo:
- Matenda osokoneza bongo (COPD)
- Idiopathic pulmonary fibrosis
- Cystic fibrosis
- Matenda a Alpha-1 antitrypsin omwe amapezeka m'mphysema
Kawirikawiri, mapapo amaperekedwa kuchokera kwa abambo omwe anamwalira ali ndi ubongo wokwanira (ubongo wa imfa). Komabe, pakati pa 15 ndi 20 peresenti ya operekawo amakhala ndi mapapu oyenerera kuti awapatse.
Kwa mitundu yambiri ya matenda yomwe imalimbikitsa kupatsa mapapo, mapepala amodzi kapena awiri akhoza kuikidwa. Ndi cystic fibrosis ndi mitundu ina ya bronchiectasis, komabe mapapo onsewa ayenera kuikidwa. Kufalikira kwa mapapo awiri onse kumachitika pofuna kuchepetsa matenda kufalitsidwa kuchokera ku minofu ya m'mapapo ya chifuwa mpaka kumapiko a mapapo. Ngakhale kuti mapapu amodzi kapena awiri akhoza kuikidwa pamtundu kuti athetse mitundu yambiri ya matenda, kuikidwa kwa mapapo awiri kumakonda.
Mapapu abwino amagawidwa malabe atatu, ndipo mapewa a kumanzere amagawidwa awiri awiri. Kusindikizidwa kwa lobe kuchokera ku zopereka zamoyo kwachitika kale koma tsopano sikunali kozolowereka. Kawirikawiri, opaleshoni yotereyi inkachitidwa ali achinyamata ndi achinyamata omwe ali ndi cystic fibrosis omwe mwina amafa pamene akudikirira kuikidwa m'mapapo (kapena awiri) operekedwa kuchokera kwa wothandizira wakufayo.
Kawirikawiri, khalidwe la moyo limakhala bwino makamaka kwa omwe amalandira mapapu. Nthawi yeniyeni imene munthu amakhala ndi kusintha imakhala yosiyanasiyana malinga ndi matenda omwe amafunika kuikapo komanso msinkhu wa wolandila-ndi ocheperapo omwe amakhala ndi moyo wautali komanso wokumbidwa. Mwachidule, anthu ambiri omwe amalandira mapuloteni amatha kukhala zaka pafupifupi 10 asanalandire matenda aakulu.
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PancreasChiwerengero cha mapepala osakanikirana pakati pa January 1, 1988, ndi June 30, 2016, chinali 8,235.
Chomera choyamba cha mphukira chinachitidwa ndi William Kelly ndi Richard Lillehei ku yunivesite ya Minnesota mu 1966. Kuchokera nthawi imeneyo, ku United States kuli zopitirira 25,000 zapakisita komanso zoposa 35,000 padziko lonse lapansi. Kawirikawiri, ziphuphu zimagulidwa kuchokera kwa abambo akufa; Komabe, ngakhale kuti ndi zochepa kwambiri, opereka ndalama angagwiritsidwe ntchito.
Kuika pancreas ndi chitsimikizo cha nthawi yaitali chithandizo cha anthu omwe ali ndi matenda a shuga a shuga (mtundu wa shuga 1). Kuikapo kotereku kumatha kubwezeretsanso mankhwala osokoneza bongo m'magazi komanso kuchepa kwa chiopsezo komanso kuchepetsa chiopsezo cha mavuto aakulu omwe akudwala kwambiri ndi matenda a shuga.
Zindikirani, zokopa zapakiteriya zimakhala zofanana poyerekeza ndi zizindikiro zosungunuka , zomwe zimakhala zochepa kwambiri. Maselo a maselo ndi magulu a maselo m'matenda omwe amachititsa mahomoni, monga insulini ndi glucagon. Ngakhale kusintha kwazilumba kwasintha kwambiri m'zaka zaposachedwapa, kusintha kwa kansalu kumagwira ntchito bwino kusiyana ndi chiwonetsero cha chilumba. M'malo motsutsana ndi njira, ndi bwino kuyang'ana zoperekera ndi zisudzo monga njira zothandizira, zomwe zonse zingathandize wothandizirayo.
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MatumboChiwerengero cha matumbo omwe amatha pakati pa January 1, 1988, ndi June 30, 2016, chinali 2,733.
Kufalikira kwa matumbo kumakhala kovuta. Zaka zaposachedwapa, njirayi yakhala ikudziwika pochiza matenda afupipafupi, omwe anthu sangathe kutenga madzi okwanira, makilogalamu, mapuloteni, mafuta, mavitamini, mchere ndi zina zotero. Kawirikawiri, anthu omwe amatenga matumbo amatha kupweteka kwa m'mimba ndipo amafunikira zakudya zopatsa thanzi (TPN), kapena zakudya zopatsa thanzi.
Pafupifupi 80 peresenti ya anthu omwe amalandira katemera wa m'matumbo amatha kugwira ntchito yonse m'matumbo a m'mimba. Zovuta zokhudzana ndi njirayi zimaphatikizapo matenda a CMV , kukana kwachilendo komanso kwachilendo, ndi matenda omwe amachititsa kuti thupi lizizira matendawa.
Zotsatira:
Azzi J, Milford EL, Sayegh MH, Chandraker A. Kusindikiza mu Chithandizo cha Kulephera Kuthandizira. Mu: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Mfundo za Harrison za Internal Medicine, 19e. New York, NY: Hill ya McGraw; 2015.
Gruessner AC, Jie T, Papas K, Porubsky M, Rana A, Smith M, Yost SE, L. Dunn D, Gruessner RG. Kusindikiza. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Mfundo za Schwartz za Opaleshoni, 10e . New York, NY: Hill ya McGraw; 2014.
Tavakkoli A, Ashley SW, Zinner MJ. Utumbo Wang'ono. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Mfundo za Schwartz za Opaleshoni, 10e . New York, NY: Hill ya McGraw; 2014.
Kusinthasintha Ndi Mtundu Wanyama January 1, 1988 - June 30, 2016. United Network for Organ Sharing https://www.unos.org/data/.
Trulock EP. Kupaka Mapira. Mu: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Mfundo za Harrison za Internal Medicine, 19e . New York, NY: Hill ya McGraw; 2015.