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Biomedical subjects

D B Evans

Publications and source records attributed to D B Evans.

At least 19 recordsLinked to original sources
PubMed1979

Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers.

34 patients treated with cyclosporin A received 36 cadaveric organ allografts (32 kidneys, 2 pancreases, and 2 livers), 26 kidneys are still supporting life, 3 after more than a year; the pancreases and livers are also functioning. 20 patients are not receiving steroids, and 15 of these have not had any additional immunosuppressive agents. In these patients infectious complications have not been severe, but a gastroduodenal lymphoma has developed in 1 patient. 6 patients were given 'Cytimum' (a cyclophosphamide derivative) and steroids in addition to cyclosporin A: 5 of these died of infections and 1 also had a lymphoma. 11 patients received additional steroids: 1 of these died from septicaemia and lymphoma. Nephrotoxicity can be avoided by perioperative hydration and forced diuresis. Cyclosporin A is effective on its own and is a very potent immunosuppressive drug. Additional immunosuppressive agents may lead to severe complications.

Adult↗
PubMed1979

Renal disease in pregnancy.

In this review the need for early antenatal assessment of renal disease is stressed as is the need to follow-up all patients in the puerperium in whom renal dysfunction has been suspected during pregnancy. A variety of renal disorders and their effect on the outcome of pregnancy are discussed.

Collagen Diseases↗
PubMed1979

Longitudinal study of circulating immune complexes in a patient with Staphylococcus albus-induced shunt nephritis.

The direct measurement and partial characterization of circulating immune complexes has been performed in a longitudinal study of a patient with Staphylococcus albus-induced shunt nephritis. The high levels of immune complexes were associated with cryoglobulinaemia and hypocomplementaemia. The activation of complement was found to be via the classical pathway, but the functioning of the alternative pathway may have been impaired in vivo due to very low levels of C3. The host response to the infection was also characterized by the production of a marked macroglobulinaemia, high titres of rheumatoid factor and a typical acute phase increase in the C-reactive protein level. Immune complex levels were persistently elevated many months after the removal of the focus of the infection. A possible explanation for this surprising finding may lie in the nature of the antigens in the immune complexes. It was found that the immune complexes contained both antibodies to and antigens from Staphlococcus albus. In particular, glycerol teichoic acid and staphylococcal nuclease were identified as components of the immune complexes present during the acute phase. Glycerol teichoic acid was also identified in the immune complexes found later although other Staphylococcus albus antigens as yet unidentified were also present and persisted in the circulation for several months.

Adult↗
PubMed1979

Is it really worth re-transplanting patients?

Increasingly patients whose first renal transplant fails are being re-transplanted. A study of patients in one unit was undertaken to assess whether second kidney grafts were as successful as first allografts and whether certain factors determined the outcome of secondary transplants. Second and subsequent grafting can be performed with confidence of a successful outcome provided a careful selection of patients is made. The outcome of subsequent grafts should show no significant difference from the overall results of first renal allografts.

Graft Rejection↗
PubMed1978

Rupture of the allografted kidney--is repair possible?

Allograft rupture after transplantation is an uncommon but serious complication. A review of the literature suggests a significant mortality and very high incidence of graft loss. Data will be presented which suggests that conservative management of the allograft rupture is possible.

Adult↗
PubMed1978

Acute renal failure.

Acute renal failure even today carries a high mortality, which is related directly to the aetiology of the condition and the age of the patient. Modern radiological techniques have added considerably to the early diagnosis of obstructive factors and acute tubular necrosis. Early treatment and correction of prerenal factors can frequently forestall the development of established acute renal failure but if this is inevitable total patient care and full supportive measures including dialysis should be available.

Acute Kidney Injury↗
PubMed1977

Differential kidney graft survival associated with interaction between recipient ABO group and pretransplant blood transfusion.

In 1973 we reported significantly superior survival of kidneys transplanted to blood group O recipients compared with recipients of those from blood groups A, B, and AB taken together. In this extended series, the difference between these categories was less prominent and no longer significant. In the present study, blood transfusion significantly improved the survival of kidney grafts in patients of blood group O, but not of combined A, B. and AB groups. The difference between the graft protecting effect of transfusion in group O and combined groups A, B, and AB recipients was also significant. This suggests that the improvement in subsequent graft survival after transfusion is either confined to blood group O recipients, or is much stronger in them than in recipients of other groups. Our previous policy of restriction of blood transfusion is seen as one of the causes of the reduced superiority of group O over other groups in this extended series in comparison with our 1973 series. It seems that transfusion of group O recipients can markedly improve the prognosis of a subsequent first kidney graft.

ABO Blood-Group System↗
PubMed1977

Percutaneous needle biopsies of renal allografts: the relationship between morphological changes present in biopsies and subsequent allograft function.

In the Cambridge renal transplant unit percutaneous needle biopsies of renal transplants have been extensively used to help identify the cause of impaired allograft function. During the period 1966--1973, 154 of the 269 renal allografts transplanted were biopsied at least once during the first 90 days after transplantation. In this survey the relationship between morphological changes in these biopsy specimens and allograft function 1, 3 and 5 years after transplantation is assessed. A highly significant direct relationship exists between early graft failure and the presence of medial necrosis of arteries, acute glomerular lesions and interstitial haemorrhage. Less than 10% of grafts with one or more of these changes and none in which all three types of lesion were present were capable of supporting life at 1 year. There is a significant association between poor subsequent graft function and mononuclear cell infiltration of the intima of arteries. No clear relationship exists, however, between the function of grafts at 1 and 3 years and the degree of mononuclear cell infiltration of the interstitial tissue. Tubular necrosis was frequently observed and future graft performance is related to the extent and cause of the tubular damage.

Adolescent↗