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D C Dafoe

Publications and source records attributed to D C Dafoe.

At least 109 records · Page 6Linked to original sources
PubMed1987

Pancreas transplantation with pancreatico-duodeno-cystostomy for exocrine drainage: cystographic findings.

Pancreatic transplantation is becoming accepted therapy for a select subset of patients with type 1 insulin-dependent diabetes. At many centers, whole-organ transplants with pancreatico-duodeno-cystostomy for drainage of exocrine secretions is the preferred surgical procedure. We obtained 21 cystograms in nine patients who underwent this procedure who were suspected of having anastomotic leaks and possible abscess. Positive findings included extrinsic bladder compression (nine patients), filling of the transplanted duodenal segment (three patients), edematous bladder wall (four patients), intraperitoneal (two patients) and extraperitoneal (four patients) leaks, and fistulae (two patients). Intraperitoneal extravasation resulted in abscess formation and cutaneous fistulae, and these transplants were subsequently removed. We conclude that cystography is a useful technique in evaluating the site and extent of anastomotic leaks and fistulae.

Diabetes Mellitus, Type 1↗
PubMed1987

Percutaneous transluminal angioplasty. The procedure of choice in the hypertensive renal allograft recipient with renal artery stenosis.

A retrospective review of 547 renal transplants performed over a six-year period revealed allograft renovascular hypertension secondary to RTAS in 39 (7.1%) patients. Percutaneous transluminal angioplasty (PTA) resulted in immediate cure or improvement in 76% of the patients, increasing to 83% in patients with functioning kidneys at a mean follow-up period of 30 months (1-72 months). The renal artery stenosis (RTAS) was equally distributed between living-related and cadaver kidney recipients and did not appear to be more prevalent in end-to-end or end-to-side anastomoses. The blood pressures fell from pre-PTA levels of 167 +/- 22 mmHg systolic to 141 +/- 23.7 post-PTA and 102 +/- 11 mmHg diastolic pre-PTA to 88 +/- 12 mmHg post-PTA (P less than 0.01). Of 25 cured or improved patients, 24 are on significantly less hypertensive medication. Two patients died of causes unrelated to the PTA and only one patient lost a kidney because of the procedure. Compared with operation, PTA is a safer and more effective procedure for the initial treatment of RTAS.

Adult↗
PubMed1987

Pediatric renal transplantation with an emphasis on the prognosis of patients with chronic renal insufficiency since infancy.

In this report recent experience with renal transplantation in 43 children who were 17 days to 16 years old was reviewed. One-year patient survival rate was 98%, and overall one-year graft survival rate was 68%. One-year graft survival rate was 73% for cyclosporine-treated patients and 78% for recipients of related donor kidneys. A subpopulation of patients affected with renal insufficiency since infancy was analyzed separately to evaluate the prognosis of these patients, who have previously been reported to be a high risk for permanent neurologic, developmental, and growth retardation. All 16 such patients underwent transplantation. Gross motor delay that was noted in 31% of patients before surgery resolved in all patients after transplantation. No evidence of severe developmental delay was noted after transplant and seven of 11 patients with successful transplants had evidence of catch-up growth. Overall renal transplantation is a safe and effective procedure for children with renal failure, and even the patients at highest risk for growth and developmental failure caused by renal insufficiency show potential for rehabilitation after transplantation.

Adolescent↗
PubMed1986

Ultrasound evaluation of uncommon renal transplant complications.

Twenty-five patients who had undergone renal transplants developed uncommon complications that were detected and followed serially with sonography. Two patients developed renal calculi, which produced hydronephrosis in both instances. Other uncommon causes of postoperative hydronephrosis occurred in 5 cases; the causes included ureteral necrosis, ureteral stricture, and a renocutaneous fistula. Eight cases of renal infarction, manifesting 3 different sonographic appearances, were encountered. The presence and disappearance of postoperative gas in the collecting system were documented in 3 patients. The other unusual abnormalities detected involving the transplanted kidney include tuberculosis, pyonephrosis, 3 solitary cysts, a corpus lutem cyst simulating a perinephric fluid collection, and massive urinary ascites.

Adolescent↗
PubMed1986

Simultaneous pancreatic-renal transplant scintigraphy.

99mTc-DTPA scintigraphy was evaluated in seven patients as a technique to assess perfusion of the transplanted pancreas and kidney. Such scans provide high-quality images of both organs in both the flow phase and later phases. The radionuclide is readily available and its brief effective half-life allows repeated evaluations at short intervals. 131I-hippuran, the major radiopharmaceutical for renal transplant scintigraphy, does not allow visualization of the transplanted pancreas or evaluation of its blood supply. Although the blood glucose is a gross indicator of the function of the pancreatic allograft, pancreatic scintigraphy with 99mTc-DTPA in one case was capable of detecting graft dysfunction before elevation of the blood glucose occurred. While additional studies will be necessary to determine the predictive value of this test, 99mTc-DTPA is valuable for pancreatic-renal transplant evaluation.

Adult↗
PubMed1986

Detrimental effects of four hours of cold storage on porcine pancreaticoduodenal transplantation.

Transplantation of the pancreaticoduodenal allograft (PDA) has recently been advocated as a technique that is superior to the use of the segmental allograft. However, the effect of simple cold storage preservation on the PDA has not been studied. We investigated the effect of 24 and 4 hours of cold storage in Eurocollins solution on porcine PDA function after transplantation in pancreatectomized pigs. A regimen of cyclosporine and prednisone was used, which prevented rejection for at least 28 days after transplantation. Cold storage preservation for 24 hours uniformly resulted in PDA failure. Compared with recipients of immediately transplanted PDA, recipients of PDA cold stored for 4 hours had marked plasma hyperamylasemia (10,000 U/L versus 1932 U/L), relative glucose intolerance (K value -2.15 versus -2.66), hypoinsulinemia (peak immunoreactive insulin 11.0 microU/ml versus 34.7 microU/ml), and an abnormal pattern of insulin secretion as demonstrated with intravenous glucose tolerance testing. There was also a higher incidence of technical complications in the group transplanted with cold-stored PDAs. Our results suggest that there is a detrimental effect on porcine PDA function after only 4 hours of cold storage in Eurocollins solution.

Amylases↗
PubMed1986

Immunoreactive anionic and cationic trypsins in serum after experimental porcine pancreatic transplantation.

Immunoreactive anionic and cationic trypsins (irAT and irCT) were measured in blood samples taken daily from 20 pigs during 60 days after whole organ pancreatic transplantation. Immunosuppression was discontinued on the twenty-eighth day after transplantation. IrAT concentrations showed three distinct peaks, the first immediately after operation, the second around the seventh day after operation, and the third irAT peak was seen 2 to 9 days after discontinuation of immunosuppression therapy. IrCT levels paralleled the irAT levels only in the first peak immediately after transplantation. After this there was a dissociation between the concentrations of the two immunoreactive trypsins, with low irCT levels and high irAT levels. Increased irAT levels heralded rejection of the pancreatic allograft by 4 to 30 days (median 20 days) in 13 of the 16 rejecting animals (80%). In addition, low irCT levels preceded hyperglycemia in 13 of the 16 rejecting pigs by 2 to 47 days (median 21 days). The first postoperative peak of immunoreactive trypsins is thought to be related to the operative and storage trauma, whereas the second and third peaks are thought to reflect a rejection process. The results suggest that immunoreactive trypsins can be used as markers for pancreatic allograft rejection.

Animals↗
PubMed1985

Association of inclusion of the donor spleen in pancreaticoduodenal transplantation with rejection.

Clinical pancreas transplantation (txp) using a pancreaticoduodenal allograft (pda) and the donor spleen has been applied as treatment for insulin-dependent diabetes mellitus. Inclusion of the spleen in the pda is purported to protect against thrombosis and may be of possible immunological benefit. In pancreatectomized pigs, we compared the results of pda txp with (n = 8) and without (n = 10) the donor spleen. Animals were maintained on cyclosporine (6 mg/kg/day i.v.) and prednisolone (1.5 mg/kg/day i.v. tapered over 7 days to a maintenance dose of 0.5 mg/kg/day i.v.). Pancreatic exocrine enzyme replacement was administered daily. In 10 recipients of the technically successful pda without the spleen, rejection (blood glucose greater than 150 mg/dl) was not seen in the 28 days after txp. Mean daily blood glucose was 95 +/- 8 mg/dl during this period. In contrast, 5 of 8 recipients of the technically successful pda with the donor spleen rejected their grafts an average of 13 days (range 7-16) after txp (P less than 0.01). Mean daily blood glucose was 88 +/- 21 mg/dl prior to the declaration of rejection and increased to 275 +/- 59 mg/dl after rejection (P less than 0.0001). Rejection was histologically confirmed in all cases. None of the recipients of the pda with the donor spleen developed signs of graft-versus-host disease. Glucose tolerance testing carried out 28 days after transplantation in normoglycemic pigs from both experimental groups demonstrated no difference between the groups. In the porcine pda model used in this study, the inclusion of the spleen in the pda was associated with rejection of the transplant.

Animals↗
PubMed1984

Towne-vaccine-induced prevention of cytomegalovirus disease after renal transplants.

91 renal transplant candidates were randomised to receive Towne strain cytomegalovirus (CMV) vaccine or placebo at least 8 weeks before transplantation. The vaccine was well tolerated and there was no vaccine virus excretion. Serological and cellular immune responses developed in most vaccines but were lower in the transplant patients than in healthy volunteers and some of the seronegative patients failed to mount responses. CMV infection occurred in most of the seronegative vaccine-treated or placebo-treated patients who received kidneys from seropositive donors, but the illnesses were less severe in the vaccines than those in similarly exposed placebo-treated patients. Vaccine-treated patients who received kidneys from seronegative donors did not excrete virus, and therefore the vaccine virus was not reactivated from a putative latent state despite immunosuppression at the time of transplantation.

Antibodies, Viral↗
PubMed1984

Influence of breast feeding on subsequent reactivity to a related renal allograft.

In a previous report the hypothesis that exposure of the neonate to maternal allogeneic cells via the process of breast feeding would result in hyporesponsiveness to a subsequent maternal donor-related renal transplant was examined. Support for this hypothesis was obtained after correlating results of maternal donor-related renal transplantation with the breast feeding status of the transplant recipient. In the present report this observation has been expanded upon and it was asked if a history of breast feeding was associated with improved results in a different patient population (HLA semi-identical sibling donors). Breast-fed patients showed dramatic improvements in graft function rates compared to non-breast-fed counterparts at all intervals studied (P less than or equal to 0.001). Because a history of breast feeding correlated with improved results after sibling donor as well as maternal donor transplantation, it was concluded that the breast feeding effect is not entirely specific for maternal antigens. These observations underscore the importance of breast feeding as a variable in clinical-related renal transplantation.

Adult↗