L'albero della vita di Gustav Klimt
Attivit� dell�Azienda Ospedale di Circolo - Varese
Un po� di storia...
Il 12 settembre 1973 Christian Barnard, cardiochirurgo del "Groothe Schuur" di Citt� del Capo, partecipava ad un congresso della Societ� dei Trapianti tenutosi a Villa Ponti a Varese.
Il Prof. Barnard il 3 dicembre 1967 a Citt� del Capo (Sud Africa) esegu� il primo trapianto di cuore ed apr� cos� un nuovo capitolo della trapiantologia, che in breve coinvolse numerosi scienziati di tutto il mondo.

Da allora molto � cambiato: grazie a nuove tecniche chirurgiche e a farmaci immunosoppressivi pi� evoluti si � potuto dare una svolta alla strada aperta da Christian Barnard negli anni 60. Il trapianto � ormai una terapia consolidata in grado di migliorare numerose insufficienze d'organo e, spesso, rappresenta una terapia salvavita. Gli organi da trapiantare provengono da donatori in morte cerebrale, cio� soggetti deceduti nei quali moderne tecniche rianimatorie permettono di mantenere una adeguata ossigenazione degli organi.

Gi� dal novembre 1975 nell'Azienda di Varese si effettuano prelievi di organi e tessuti. Rene e cornee dal 1986, poi il prelievo multiorgano. Dall'Ottobre 1996 nella nostra Azienda si eseguono i trapianti di rene.



La storia dei trapianti d'organo in realt� inizia nel 1902, quando Alexis Carrel mise a punto la tecnica per congiungere due vasi sanguigni. Per mezzo di questa tecnica furono eseguiti i primi trapianti di cuore e di rene su animali. Il primo ostacolo da affrontare fu il rigetto: l'organismo ospite non accettava i tessuti e gli organi estranei.

Negli anni '40 gli esperimenti del Dottor Peter Medawar, che esegu� innesti cutanei, dimostrarono che l'incompatibilit� era di origine genetica. I suoi studi per la prima volta suggerirono l'importanza della compatibilit� tissutale tra donatore - ricevente (istocompatibilit�).

Tali studi aprirono la strada al primo trapianto di rene fra gemelli identici portato a termine con successo da Murray e Merrill nel 1954. Il ricevente era stato pretrattato con irradiazione totale (TBI) ed il trapianto per la prima volta sopravvisse pi� a lungo di quanto osservato in modelli sperimentali in animali.

Successivamente si procedette a sperimentare trapianti da donatore cadavere con interessanti risultati tanto che a met� degli anni '60 in tutto il mondo erano presenti molti centri di trapianto renale. Da allora questi interventi furono effettuati in numero sempre maggiore e con sempre migliori risultati, fino a diventare operazioni di routine. Il risultato ottenuto stimol� numerosi ricercatori ad attraversare questa nuova frontiera della medicina, e se da una lato si ottennero sempre pi� incoraggianti risultati, dall'altro si comprese il ruolo importante che rivestiva la relazione immunologica tra il donatore ed il ricevente: nacque cos� la branca dell'immunologia dei trapianti e le terapie immunosoppressive, cio� l'uso di farmaci che evitano il rigetto dell'organo trapiantato.

Il trapianto nacque in Italia verso la fine degli anni 60 ad opera di tre scuole chirurgiche: Stefanini a Roma, Malan a Milano, Confortini a Verona che a quell'epoca effettuarono i primi trapianti di rene da cadavere. I professori Malan, Confortini e Sirchia diedero vita nel 1974 ad un programma collaborativo tra Lombardia e Veneto e fu formalizzata, nel 1976, un'associazione di operatori del prelievo e del trapianto che prese il nome di Nord Italia Transplant (NITp), che recentemente ha festeggiato il trentennale.

In Italia il primo trapianto di rene fu eseguito a Roma nel 1966 dal Prof. Paride Stefanini e dai suoi aiuti Prof. Raffaello Cortesini e Prof. Carlo Umberto Casciani. In quella occasione, un rene prelevato da una signora abruzzese venne impiantato in una ragazza romana di diciassette anni. I tre chirurghi sono stati effettivamente "pionieri" nella storia della medicina italiana: va ricordato infatti che quello del '66 era il terzo trapianto effettuato in Europa. Carlo Umberto Casciani, ricorda ancora con emozione il viaggio avventuroso che condussero lui e i suoi due colleghi dall'Abruzzo a Roma nel tempo record di due ore e un quarto.

Per quanto riguarda il trapianto di fegato, il primo ad eseguire l'operazione fu il Prof. Starzl a Pittsburg (USA) nel 1968; in l'Italia si dovettero aspettare ben quindici anni perch� si eseguisse il primo trapianto, che fu eseguito a Roma nel 1983 dal Prof. Raffaello Cortesini, e solo nell'ottobre del 1985, in Italia fu eseguito il primo trapianto di cuore a Padova. Vigan� a Pavia trapianta il primo cuore artificiale nel 1987 ed esegue il primo trapianto combinato cuore-polmone nel 91. Nel dicembre 1985 viene effettuato il primo trapianto di cuore pediatrico a Roma dal Prof. Benedetto Marino.

Il Prof. Fritz Derom (Belgio) nel 1968 esegu� il primo trapianto di polmone singolo, ma solo dopo l'introduzione nell'uso clinico della ciclosporina come farmaco immunosoppressivo i risultati ottenuti divennero soddisfacenti, a tal punto che questo tipo di trapianto ebbe un importante sviluppo. Il primo trapianto di polmone in Italia, invece, fu eseguito a Roma nel 1990 al Policlinico Umberto I dal Prof. Costante Ricci.

La legge in vigore d� a tutti noi la possibilit� di esprimere la propria volont� in merito alla donazione di organi dopo la morte: questa pu� essere notificata alla propria A.S.L. o pu� essere segnalata ai propri familiari, che vengono sempre interpellati quali testimoni della volont� del congiunto deceduto.

Per saperne di pi�:
www.trapianto-giornatanazionale.it
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Questioni etico-deontologiche, medico-giuridiche e sociali

Dal 4 al 11 Maggio 2008
Ministero della Salute
Regioni e Provincie Autonome
Attivit�
Un po' di storia
Il 12 settembre 1973 Christian Barnard, cardiochirurgo del �Groothe Schuur� di Citt� del Capo partecipava ad un congresso della Societ� dei Trapianti tenutosi a Villa Ponti a Varese...
Attivit� di donazione e trapianto Anno 2007
Negli ultimi 10 anni l�Italia � il Paese europeo dove si � realizzato il pi� grande incremento in termini di donatori utilizzati ed oggi...

La parola all'esperto
Il rischio infettivo nel donatore d'organi
La carenza di donatori d�organo rappresenta un serio problema in tutto il mondo. Nonostante il notevole incremento del numero di donatori registrato nel nostro paese negli ultimi anni...

Il ruolo dell'infermiere
I dati della Regione Lombardia in materia di trapianti sono stati positivi per il 2007. I donatori utilizzati nel corso dello scorso anno sono stati 195, 2 in pi� rispetto all'anno precedente...

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