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Biomedical subjects

B Koneru

Publications and source records attributed to B Koneru.

At least 55 records · Page 3Linked to original sources
PubMed1988

Orthotopic liver transplantation for alcoholic cirrhosis.

Fifteen patients with Laennec's cirrhosis underwent orthotopic liver transplantation between 1963 and the end of 1979. The first eight patients died perioperatively or within two months, but four of the next seven patients had long survival; three are still alive after 11 to 14 years. After the introduction of cyclosporine therapy, 41 more patients with alcoholic cirrhosis were treated with liver transplantation from 1980 to June 1987. The one-year survival is 73.2%, and, after one to three years, 28 (68%) of the recipients are living. Of the 35 patients in the combined old and new series who lived for six months or longer, only two returned to alcohol abuse. Social and vocational rehabilitation has been the rule in these recipients who were selected primarily because of urgency of need, because they or their families insisted on treatment, and because they and their families thereby committed themselves to long-standing programs of alcoholism care.

Adult↗
PubMed1988

Recurrent cholangiocarcinoma in the biliary tree after liver transplantation.

Four liver transplant recipients with recurrent cholangiocarcinoma (CCA) within the allograft biliary tree are described. One patient received a transplant for known CCA and three received transplants for end-stage primary sclerosing cholangitis, in which CCA was found within the hepatectomy specimen. All four developed biliary obstruction due to malignant stricture at the bile duct anastomosis 9-15 months after transplantation. Diagnosis of recurrent CCA was made by means of transhepatic brush biopsy in two patients. Recognition that the biliary tract, especially the anastomosis, is a site of recurrence of CCA should facilitate prompt diagnosis by means of transhepatic brush biopsy in patients with biliary obstruction due to stricture. In addition, because of an association between CCA and primary sclerosing cholangitis, preoperative bile duct biopsy should be considered for liver transplantation candidates with the latter condition. Positive biopsy findings may preclude transplantation.

Adult↗
PubMed1988

Liver transplantation for malignant tumors.

As reviewed herein, the current results of liver transplantation for malignant tumors are suboptimal. Progress depends on development of other modalities of adjunctive therapy.

Biliary Tract Neoplasms↗
PubMed1988

Liver transplantation in the treatment of bleeding esophageal varices.

From March 1980 to July 1987, 1000 patients with various end-stage liver diseases received orthotopic liver transplants. Of the 1000 patients, three hundred two had definite histories of bleeding from esophageal varices before transplantation. There were 287 patients with nonalcoholic liver diseases and 15 patients with alcoholic cirrhosis. All patients had very poor liver function, which was the main indication for liver transplantation. One- through 5-year actuarial survival rates of the 302 patients were 79%, 74%, 71%, 71%, and 71%, respectively. These survival rates are far better than those obtained with other available modes of treatment for bleeding varices when liver disease is advanced. Long-term sclerotherapy is the treatment of primary choice for bleeding varices. Patients in whom sclerotherapy fails should be considered for liver transplantation unless clear contraindications exist.

Esophageal and Gastric Varices↗
PubMed1988

Cadaveric renal transplantation at the University of Pittsburgh: a two and one-half-year experience with the point system.

From January 1, 1986 to July 30, 1988, 530 consecutive cadaver kidney transplantations were performed with patient selection by a point system that took into account time awaiting an organ, donor-recipient matching, degree of presensitization, and some less important factors. The effect of the system was to diminish judgmental factors in case selection which in the past, had probably operated to the disadvantage of "undesirable" potential recipients, including older ones. Primary 1-year graft survival (74%) and graft survival after retransplantation (71%) were lower than in the earlier time. However, the results with triple-drug therapy using CsA, AZA and P demonstrated 88% 1-year graft survival for primary graft recipients and 74% in highly sensitized patients, with comparable patient mortality. These latter observations provide some assurance that the concepts of equitable access and efficient utilization of a scarce resource are not mutually exclusive.

Actuarial Analysis↗
PubMed1988

Diagnostic and interventional radiology in liver transplantation.

Diagnostic and interventional radiology play major roles in the evaluation and management of liver transplant patients. This article begins with a discussion of imaging techniques used in the preoperative evaluation of transplant candidates. Surgical approaches and normal posttransplant anatomy are presented. An in-depth discussion of the radiologic evaluation of posttransplantation complications follows, with numerous illustrative cases. Finally, the role of interventional radiology in the nonoperative management of certain complications, especially biliary problems, is discussed.

Humans↗
PubMed1988

Postoperative surgical complications.

Results of liver transplantation have dramatically improved since the introduction of cyclosporine. Most deaths occur within the first 3 postoperative months. Morbidity and mortality can be minimized by early diagnosis and aggressive management of postoperative surgical complications.

Biliary Tract Diseases↗
PubMed1987

Indications for pediatric liver transplantation.

Two hundred fifty pediatric (less than 18 years of age) patients underwent orthotopic liver transplantation because of end-stage liver disease and were given combination therapy with cyclosporine and prednisone. The most common indications for transplantation in decreasing order of frequency were biliary atresia, inborn errors of metabolism, and postnecrotic cirrhosis. The 5-year actuarial survival for the entire group was 69.2%. Age and diagnosis did not influence survival. Infections were the most common cause of death, followed by liver failure and cerebrovascular accident. The impact of retransplantation on survival depends on the indication. The survival is better when retransplantation is carried out after rejection than because of technical complications, and the latter has a better survival than does primary graft nonfunction. The difference in survival among these groups is statistically significant. The quality of life for 164 of 173 survivors is good to excellent; only nine children are currently experiencing medical problems. A persistent problem in pediatric transplantation is the scarcity of small donors.

Adolescent↗
PubMed1987

Liver transplantation before 1 year of age.

Since 1981, 20 infants younger than 1 year of age received 26 orthotopic liver transplants. Immunosuppression was with cyclosporine and corticosteroids. Thirteen (65%) of the recipients were discharged from the hospital. To date, 12 (60%) of the 20 recipients are surviving, with follow-up of 1 to 56 months (average 14 months). The 5-year actuarial survival is 53.8%. The allograft liver function in the majority of surviving infants is excellent. The predominant causes of mortality were primary nonfunction of the allograft (three patients) and sepsis (three). Major morbidity was caused by hepatic artery thrombosis (five patients), gastrointestinal complications (six), biliary tract complications (five), and bacterial and viral infections (13). Six patients underwent retransplantation; three of these six survived. Results could be improved by prevention of hepatic artery thrombosis, by decreasing the incidence of sepsis, and by procurement of more and better suited pediatric donors.

Actuarial Analysis↗