Kidney Transplant Program for Children
Since 1980 a haemodialysis program for children patients is available at Motol University Hospital. Dr. Špatenka had for many years provided monopoly management of access to circulation of children, especially for haemodialysis.
The kidney transplant program for children opened in 1977. In 1981 it was on request of IKEM (prof. MUDr. V. Kočandrle, DrSc.) moved from IKEM to Motol University Hospital (UH). In 1981 the first childhood kidney transplantation was performed. The program was provided by 1st Children´s Clinic, Children Cardiology Centre, Clinic of Children Surgery and Clinic of Anaesthesiology and Resuscitation. Since 1982 Dr. Špatenka had been invited to all meeting of so-called “Transplant Commission”. The commission was formed of the Czechoslovakian heads of transplant centres and was in charge of a transplant program in the country. Transplant commission was summoned by Prof. Kočandrle, senior consultant of IKEM Transplant Centre and head of international transplant organization “Intertransplant”, which gathered renal transplant programs of former CSSR, GDR and Hungary.
Establishment of Children Centre
In the 80´s, due to proposal of Doc. Janda and Dr.Špatenka the Ministry of Health of CSSR granted accreditation to the Children dialyses and transplant centre within the 1st Children´s Clinic. In 1991 the Ministry of Health of CSR appointed the new Transplant commission consisting of all Transplant centres´ senior consultants. In the same year Dr. Kryl, the head of Motol University Hospital founded the “Transplant Centre for Children” within our hospital and Dr. Špatenka was appointed its head. The centre at that time provided only organ taking within Motol UH and program of renal transplantation for children of whole Czechoslovakia. This program has been successful up to the present. Small children from Slovakia have been transplanted here even after the division of Czechoslovakia.
In 1992, the Head of Motol UH opened the Cryobank for homotransplants of cardiac valves within the Children Transplant Centre. The Bank was financed partly by grant Z 112 “Production and Preservation of Cardiac Valves and Vessels for Cardiovascular Surgery” which took place in 1991 – 1994. Programme freezing of valves and vessels is from the very beginning ensured by the Institute of Haematology and Blood Transfusion (MUDr. Petr Kobylka, CSc.). Own cryo storage with nitrogen management was opened at 1-D children ward. Later, in 2003 the new Motol UH Cryo Storage was built within HB3 premises. One out of three chambers is available for the Transplant Centre. Valve and vessel grafts are stored there in liquid nitrogen under conditions that are in compliance with accreditation rules of EC.
Bank of Musculoskeletal Tissue
In 2004, a group of specialists from 1st Orthopaedic Department of Motol UH joined under the leadership of MUDr. Jan Hrach the Transplant Centre in order to build up the Bank of Musculoskeletal Tissues. Grafts have been stored also in the new cryo facility. In 2004 the Ministry of Health of the Czech Republic issued a decision in accordance with Transplantation Law and granted a permission to establish Specialized Tissue Bank with registration number STB85. This bank is recently authorised to take, process, to store in the long term and to distribute cardiovascular tissues of the dead donors and musculoskeletal tissues of the living donors.
Lung Transplant Program
The Transplant Centre of Motol UH had taken part in preparation of the Lung Transplant Program at 3rd Clinic of Surgery before this department was moved to Motol University Hospital. In 1997 the Transplant Centre of the General University Hospital (headed by Prof. Pafko) was formally united with the Transplant Centre for Children Motol UH. Thus the Children Transplant Centre lost its specific paediatric focus and is called the Transplant Centre of Motol University Hospital. The cooperation with AHK Vienna was deepened. Many employees of 3rd Department of Surgery obtained training led by Prof. Klepetko. In December 1997 the first lung transplant operation in the Czech Republic was performed. This program has been developing successfully further.
Program of Taking Organ and Tissue
Organs and tissues´ taking has been performed in Motol University Hospital since 1977. As the Transplant Centre for Children (in comparison with the rest of transplant centres) did not have a catchment area, the number of annual performances was very low.
Our Prominent Specialists
After the Czech Transplant was dissolved in 1998, its former head MUDr. Vojtěch Martínek, CSc. and his deputy, Prof. MUDr. Karel Matoušovic, DrSc. have joined the University Hospital Motol. Both are nephrologists of European level with wide professional experience in abroad. Both of them work at the Internal Clinic. The Transplant Centre makes use of their expert knowledge and also international contacts in transplant medicine, especially within the branch of organs and tissue taking. MUDr Martínek, CSc. has been very successful in managing the program of organs and tissues´ taking. The number of hospital beds within the Anaesthesiology and Resuscitation Department has increased recently as well as the number of the Intensive Care Unit beds where the ill are ventilated. We managed to rise the number of takings to the standards of other transplant centres in the country (calculated per a million of inhabitants). After Dr. Martínek, CSc. left Motol University Hospital, Prof. MUDr. Karel Matoušovic, DrSc. has become the head of this program since 1st January 2005.
Motol University Hospital offers optimal conditions for organ and tissue transplantation especially thanks to its comprehensive personnel and device equipment. The interdisciplinary co-operation between Motol UH and 2nd Faculty of Medicine UK has become traditional. The citizens´ association “EATB.CZ” (reg. no.: CZ26660148, www.eatb.cz, account no.: 0138861399 / 0800) has been working within the program of cardiovascular tissue taking, processing and transplantation since 2004 with MUDr. Jaroslav ŠPATENKA, CSc. as its head.
Program of Taking Organ and Transplant
TC of Motol University Hospital maintains a close co-operation with the Coordination Centre of Transplantations (KST – www.kst.cz) when taking and transplanting organs and tissues.
Selection of Donors
Potential donors of organs and tissues are in Motol University hospital indicated above all by hospital staff of inpatient wards of the Clinic of Anaesthesiology and Resuscitation and so far also exceptionally by specialists of some Intensive Care Units. Taking of organs and tissues is supervised by transplant coordinators and is performed at central operating theatres within children´s hospital or hospital for the adults. The department still does not have its own catchment area.
The Coordination Centre is also fully responsible for coordination of lung taking, especially of the remote ones performed by the taking team of 3rd Clinic of Surgery including urgent transport towards recipients. We also participate in coordination of lung transplant of children.
Kidney Transplant of Children
Kidney transplant program for children is provided mainly by the Department of Paediatrics which indicates patients for the program, prepares chronic haemodialysis and peritoneal dialysis and it admits patients for transplantation. The kidney transplant itself is performed at central operating theatres of the children hospital part and are supervised by the chief physician of the TC and paediatric surgeons of the Clinic of Paediatric Surgery. The immediate postoperative care is provided at inpatient children ward of the Clinic of Anaesthesiology and Resuscitation in co-operation with the children nephrologist. After the state of health is stabilised, the patient returns back to the Clinic of Paediatrics which provides further postoperative care and long-term monitoring.
Lung Transplantation program
Lung transplant program is provided especially by 3rd Clinic of Surgery of 1st Faculty of Medicine which indicates patients for transplant and together with pneumatologists prepare them for the operation. The taking team of clinic ensures lung taking (including remote lung taking). The transplant itself is performed at the Central operating theatres of 3rd Clinic of Surgery equipped with heart surgery device. The Clinic of Cardiac Surgery provides device as well as extracorporeal circulation. The immediate postoperative care is provided at inpatient ward for the adults of the Clinic of Anaesthesiology and Resuscitation. After the state of health is stabilised, the patients return back to the 3rd Clinic of Surgery which ensures in co-operation with pneumological experts also the long-term monitoring of the transplanted.
Program of Tissue Taking and Transplant – Special Tissue Bank – STB 85 (No. of the Ministry of Health CZ)
Our Tissue Centre deals only with taking and preparation of cardiovascular tissues and osseous tissues from the living donors – therefore STB 85.
Cardiovascular Tissue Bank
Program of taking, preparation and transplantation of cardiovascular issues (cardiac valve and vessels) is provided mostly by Transplant Centre staff. Taking of hearts and vessels is most often performed within multi organ taking of the organ transplant program in the Czech Republic if for some reasons the donor heart can not be transplanted and vessels were not taken at the same time as organ grafts (livers, pancreas and kidney). Heart taking from the deceased children (especially neonates and infants) is performed by Transplant Centre professionals at Intensive Care Units.
How It Works
KST service offers the potential donor of heart or vessels and offer is received by the transplant coordinator of TC Motol UH. If the donor is accepted, KST service informs the coordinator about the result of serologic screening of the deceased donor. Transport of the taken grafts and their further preparation are organised by the transplant coordinator, the acute surgical preparation of heart is ensured by heart surgeons of the Clinic of Heart Surgery Clinic of Motol UH. Microbiological tissue examination during preparation is provided by the Institute of Medicine Microbiology. Cryo preservation is available in ÚHKT Prague so far, because the Cardiovascular Bank has not been finished yet in UH Motol.
Use of Grafts
The grafts allocation and approval for their utilization fall within the competence of the chief physician. Distribution of valve and vessel grafts is provided by coordinators in accordance with the requests of cardiovascular surgeons. The highest number of grafts is used directly in UH Motol (Heart Centre for Children and Clinic of Heart Surgery). The grafts are regularly used by heart surgeons from many Czech departments of heart surgery. In acute demand and after export approval are the valve grafts transported and also regularly used abroad. Every year the Bank renews import and export permission of the Ministry of Health CZ (valid for all countries WHO).
Bone Tissue Bank
Program of taking, preparation and transplantation of musculoskeletal tissue from the living donors, has been for many years provided by procedures of various quality at many orthopaedic departments. In 2004 the Bone Tissue Bank from living donors was founded within the Transplant Centre of Motol UH and the Ministry of Health of the Czech Republic granted accreditation to the Bank activity (see history).
Activity of the tissue facility STB 85 is in compliance with effective rules, i.e. Law No. 285/2002 as subsequently amended (so-called „Transplant Law“) and above all Law No. 296/2008 Coll. (So called “Law about human cells and tissues”) as subsequently amended. Its activity is therefore in accordance with the Directive of European Parliament and Council 2004/23/EC, 2006/17/EC and 2006/86/EC.
Audit of Legislation Implementation
In April 2009 the director of UH Motol (in accordance with § 17 Law 296/2008 Coll.) asked SÚKL for the permission to open STB 85. In March 2010 we were asked to remove deficiencies in the original request within 60 days which we had fulfilled. At the present, the Tissue Bank has been expecting the SÚKL inspection which will consider the implementation of effective legislation into facility operation.