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Biomedical subjects

C F Shield

Publications and source records attributed to C F Shield.

At least 55 records · Page 3Linked to original sources
PubMed1992

Factors affecting the waiting time of cadaveric kidney transplant candidates in the United States.

UNLABELLED: OBJECTIVE--To evaluate the relative impact of various factors that could account for differences in waiting time of cadaveric kidney transplant candidates (eg, black and sensitized patients). DESIGN: --A cohort study using multivariate analyses to identify associations between 36 patient, donor, and center factors with waiting time for all US cadaveric kidney transplant candidates listed between October 1, 1987, and June 30, 1990. SETTING--All US kidney transplant centers. PATIENTS--The study included 23,468 cadaveric renal transplant candidates on active waiting status. RESULTS--The patient characteristics most significantly associated with increased waiting time (adjusted for all other variables) were immunologic and included presensitization to HLA antigens, O or B blood type, candidacy for a repeat transplantation, and expression of rare HLA-A or HLA-B antigen phenotypes. Nonimmunologic factors also affected waiting times, which were significantly shorter for patients younger than 15 years vs those aged 15 through 44 years (8.4 vs 12.9 months, respectively; P less than .0001), for those listed at multiple centers vs one center (7.0 vs 13.3 months, respectively; P less than .0001), or for white vs black patients (11.9 vs 15.4 months, respectively; P less than .0001). Local transplant center characteristics associated with a significantly shorter waiting time included a small number of transplantation candidates, a high (greater than 35 per million population) local kidney organ recovery rate, and an approved variance from the Organ Procurement and Transplantation Network allocation algorithm. CONCLUSIONS--The time renal transplant candidates must wait for kidney transplantation is influenced by several factors in addition to those expected due to immunologic reasons of donor incompatibility, the algorithms used for organ distribution, or the effectiveness of local kidney recovery. The impact of these factors should be considered as the current US system for allocating scarce donor organs for kidney transplantation is modified.

Black or African American↗
PubMed1992

Current experience with renal transplantation across the ABO barrier.

Solid organ transplantation has traditionally been governed by the rules of blood group compatibility. Thus, it has been demonstrated that crossing the ABO blood group barrier generally results in hyperacute rejection. However, the A2 subtype of the blood group A is a weaker antigen. Under certain circumstances, organs from donors with blood group A2 can be transplanted across the ABO blood group barrier into recipients of O or B blood type. Since 1986, 33 patients including 24 blood group O and 9 blood group B patients received A2 (30) or A2B (3) donor kidneys. Both cadaver donor (31) and living-related grafts (2) have been undertaken. The mean follow-up since transplantation for the 21 patients with functioning grafts is 36 months, with a 67.2% current graft survival. Immunosuppression for these transplants consisted of azathioprine, prednisone, and cyclosporine, often in combination with prophylactic OKT3 or antilymphocyte globulin as protocol dictated. Special immunosuppressive protocols such as splenectomy or plasmapheresis were not used. The serum of the potential recipient was analyzed for immunoglobulin G (IgG) and immunoglobulin M (IgM) forms of antibody against A1 and A2 red blood cells. There is a strong correlation between a low (less than or equal to 1:8) anti-A1 IgG titer and both early and long-term graft function. Recipients with an IgG titer greater than 1:8 in the pretransplant serum had a much higher incidence of early graft failure. We no longer recommend transplantation of A2 kidneys into O or B recipients with a pretransplant titer of greater than 1:8 but found that recipients with low titers have graft function rates essentially equal to those of ABO-compatible patients. Patients with blood group B have, over time, lower anti-A IgG titers than do blood group O patients. In addition, the graft survival among blood group B patients is 89% compared with 58% among group O recipients. This may be due to the generally low titers found in blood group B recipients. Since instituting a policy in 1988 of not transplanting the kidney when the anti-A IgG titer is greater than 1:8, the survival in O patients is 88%. We recommend the screening of all organ donors with blood group A for the A2 subgroup and believe that transplantation can be safely and successfully performed in certain patients with blood group O or B.(ABSTRACT TRUNCATED AT 400 WORDS)

ABO Blood-Group System↗
PubMed1992

Inguinal herniorrhaphy in the continuous ambulatory peritoneal dialysis patient.

Inguinal hernia repair in the patient on continuous ambulatory peritoneal dialysis (CAPD) is complicated in theory by an increased potential for recurrence. In addition to the constant increased intraabdominal pressure, chronic renal failure has been shown to impair tissue healing. Controversy exists regarding the waiting period before resuming CAPD postoperatively. A retrospective review of all CAPD patients undergoing inguinal herniorrhaphy was performed. The patient's age, type of repair, duration of renal failure preoperatively, length of time on CAPD postoperatively, and date of resumption of CAPD were recorded. An inpatient and outpatient chart review was performed on all patients. Telephone follow-up was performed on surviving patients. From April 1981 to June 1989, 30 patients underwent 36 inguinal herniorrhaphies while on CAPD. One immediate postoperative death occurred due to underlying cardiac disease. The mean follow-up for surviving patients was 34 months (range, 16 to 91) and for those deceased was 25 months (range, 1 to 60). No recurrent hernias were identified either by extensive inpatient and outpatient chart review, or by direct patient telephone contact in all surviving patients. We conclude that inguinal herniorrhaphy can be safely performed in CAPD patients. Peritoneal dialysis can be initiated immediately after repair in this high-risk group of patients. There is a low risk of recurrence; however, long-term patient survival is not expected due to concurrent underlying medical problems.

Adult↗
PubMed1992

Hygroma renalis: two cases within a family and a literature review.

Hygroma renalis is an unusual benign tumor of the kidney. Only 24 cases have been reported previously in the world literature; 22 of these patients underwent nephrectomy. Two sisters, with the first known occurrence in siblings, are discussed and the world literature is reviewed. Our first patient underwent nephrectomy for complications of hygroma in the face of a concern for a renal malignancy, but a high index of suspicion for hygroma enabled the second sibling to undergo a less radical operation, with sparing of the renal parenchyma and function. Both patients have been followed up for more than 3 years, with no evidence of recurrence of the neoplasm. Computed tomography was effective in delineating the nature and extent of disease in both patients and was instrumental in allowing conservative management of the second patient. Renal hygroma is a benign neoplasm treated adequately with conservative management and can be identified by its characteristic appearance on computed tomography. Operation should be reserved for the complications of hygroma. When operation is undertaken, resection of the hygroma without nephrectomy is adequate; radical operation is contraindicated in the management of these patients.

Adult↗
PubMed1990

Effective induction immunosuppression for cadaver renal transplantation at the St. Francis Regional Medical Center.

The OKT3 induction protocol, when compared to a conventional drug protocol, resulted in an improvement in both short- and long-term patient and graft survival, especially in patients receiving a primary transplant. The 1-year allograft survival in primary transplants receiving OKT3 induction was 91% and the T1/2 of 13.5 years. This was accomplished while still being able to minimize the total drug dose of Aza, Pred, and CsA, thereby minimizing clinical complications. The use of OKT3 did not increase infections or malignant complications. This resultant significant improvement supports the passenger leukocyte theory of stimulation for allograft rejection. Further graft survival improvement in histodisparate allografts might be accomplished by OKT3 induction in concert with other methodologies that can control this cell type. The HLA antigens may not be as large an obstacle to grafting as previously suggested.

Antibodies, Monoclonal↗