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D Fries

Publications and source records attributed to D Fries.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Arterial stenosis in the renal graft. Indication for endoluminal dilatation].

One hundred and thirty eight patients with renal transplant artery stenosis were reported in a series of 1200 renal transplants. These cases included 47 patients in whom hypertension was well controlled by means of hypotensive drugs, 39 patients treated by surgical repair (SR) and 49 treated by percutaneous angioplasty (PTA). The long-term success rate was 81.5 percent in the SR group compared with 40.8 percent in the PTA group. PTA morbidity was greater than that of SR, and we believe that after the initial optimism, the results of this technique should be reevaluated according to the anatomical pattern of the renal artery stenosis.

Adolescent↗
PubMed1991

[Arterial stenosis in the renal graft. Spontaneous evolution in 40 cases].

From January 1976 to June 1989, 138 renal artery stenoses (RAS) occurred in a population of 1,200 renal transplantations in a single center (11.5 percent). An interventional procedure was performed in 89 patients: surgery in 39 and transluminal angioplasty in 50. Six other patients were excluded from the study because of complications and RAS spontaneously disappeared in 3 patients. Finally, 40 patients were treated medically with a mean follow-up of 57.6 months (range 12 to 116 months). In this group, the actuarial graft survival rate did not significantly differ from that of the 2 other groups. One patient only lost his graft from renal artery thrombosis. The mean serum creatinine level at the time of RAS diagnosis (140 +/- 8.6 mumol/l) was not significantly different from the mean serum creatinine level at the last follow-up (146 +/- 14.6 mumol/l). The degree of hypertension, graded on the number of anti-hypertensive drugs, was not different at the time of diagnosis and at the end of follow-up. In conclusion, in our experience, the spontaneous course of RAS does not result in an increased rate of graft failure or impaired long-term renal function.

Adult↗
PubMed1991

EBV cell-lines (LCL) and E- cells as stimulator cells for limiting dilution analysis (LDA) of alloreactive IL-2-secreting cells (IL-2-SC) and cytotoxic precursors (CTLp). Comparison of their stimulator capacity and ability to generate specific alloreactivity.

The choice of stimulator cells is crucial in determining the frequency of alloreactive cells by limiting dilution analysis (LDA). In humans, E- cells or EBV-lymphoblastoid cell lines (LCL) are available for this purpose. The E- cells have been mostly used until now, but they appear to stimulate much less than LCL in other models. Consequently, we undertook a systematic comparison of the efficiency of both types of cell for the LDA of alloreactive IL-2-secreting cells (IL-2-SC) and cytotoxic precursors (CTLp). We show that LCL are stronger stimulator cells both for IL-2 secretion and for cytotoxicity induction. However, high levels of non-allogeneic reactivity were also induced. Therefore, to measure the frequency of specific alloreactive IL-2-SC and CTLp, T cells were depleted of such irrelevant reactive cells by a suicide technique: culture with autologous LCL in the presence of BUDR and use of the remaining live cells as responding effectors in LDA. Using this methodology, no non-allogeneic reactive T cells remain in the responding cells: after restimulation by autologous LCL, no IL-2-SC could be seen and no cytotoxic activity could be observed against autologous, irrelevant or LAK sensitive targets. In contrast, the number of IL-2-SC and CTLp against allogeneic targets was preserved. Therefore with this methodology, the strong stimulator capacity of LCL could be used whereas non-specific activation could be avoided in order to assess the frequency of allo-specific IL-2-SC and CTLp.

Bromodeoxyuridine↗
PubMed1991

Decrease in renal vascular resistance in University of Wisconsin solution preserved kidney transplants.

Renal vascular resistance was compared in 2 groups of renal grafts: group 1-16 kidneys perfused with University of Wisconsin solution and group 2-16 kidneys perfused with Euro-Collins solution. Both groups had comparable donors and recipient criteria. Renal blood flow was measured by a miniaturized pulsed Doppler probe fixed on the graft renal artery. Renal vascular resistance was calculated either according to the formula: renal vascular resistance (mm. Hg/ml. per second) = systemic arterial pressure (P)/renal blood flow or through the renal vascular resistive index (RVRI): RVRI = systolic flow velocity - diastolic flow velocity/systolic flow velocity = (S-D)/S. Renal vascular resistance estimation seems to be more contributory than renal blood flow in assessment of renal graft reperfusion disorders. Our results show that University of Wisconsin solution seems to preserve intrarenal arterial caliber better with a decrease in intrarenal vascular resistance, thus, allowing for a higher arterial graft perfusion flow.

Adenosine↗
PubMed1991

Acute renal thrombosis induced by angiotensin-converting enzyme inhibitors in patients with renovascular hypertension.

Acute reversible renal failure is a widely recognized potential complication of angiotensin-converting enzyme inhibitor (ACEI) administration in renovascular hypertension, particularly in bilateral artery stenosis or stenosis involving a solitary kidney. We report herein 2 cases of a rare but severe complication, i.e., acute renal artery thrombosis. Whereas marked hypotension does not seem to be necessary to trigger acute renal failure following ACE inhibition, by contrast, the fall in blood pressure could play an important role in our patients. Since single-dose ACEI has been advocated in order to improve the predictive value of renal scintigraphy or plasma renin activity measurements in the diagnosis of renovascular hypertension, the potential risk of this approach should be stressed.

Acute Disease↗
PubMed1990

Persistence of donor-specific IL-2-secreting cells and cytotoxic T lymphocyte precursors in human kidney transplant recipients evidenced by limiting dilution analysis.

The low reactivity to donor alloantigens reported in PBL from kidney transplant recipients might be related to clonal deletion and/or suppression of donor-specific alloreactive cells. To discriminate between these two hypotheses, we quantified the number of IL-2 secreting cells (IL-2-SC) and of cytotoxic precursors (CTLp) in the T cells from tolerant recipients when stimulated with either donor specific or nonrelated third-party LCL. To eliminate the irrelevant reactivity, we used as responding cells high-density T cells that had been depleted of such reactivity by 4 days preculture with autologous lymphoblastoid cell line in the presence of bromodeoxyuridine. Thus, frequencies of IL-2-SC and CTLp specifically directed at alloantigens could be measured. In 11 recipients, there was no strong decrease in the frequency of donor-reactive T cells when compared to the frequency of those directed at a third-party lymphoblastoid cell line, either for IL-2-SC (tested in 11 patients) or for CTLp (tested in 6 patients). In three cases of seven, a suppression was observed only when T cells were stimulated by donor cells. These data suggest that donor-reactive cells are still present in PBL of kidney-transplant recipients tested from 6 mo to 4 y posttransplantation. Moreover, suppression of donor-specific cells can be demonstrated in peripheral T cells of some recipients, which may account in part for the absence of rejection.

Histocompatibility↗
PubMed1990

Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty.

One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n = 49) or surgical repair (SR; n = 39). The immediate success rate was 92.1% for SR and 69% for PTA. The long-term success rate was 81.5% for SR and 40.8% for PTA, with a follow-up period of 56.7 +/- 22.4 months (SR group) and 32 +/- 28.1 months (PTA group). PTA morbidity reached 28%, compared to 7.6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.

Adolescent↗
PubMed1990

Decreased lymphokine-activated killer cells in kidney transplant recipients. Correlation with a diminished number of CD3-/NKH1+ cells.

The activity of lymphokine-activated killer cells, measured either by a clonal or polyclonal technique, was assessed in 30 kidney transplant recipients (TX), in 13 hemodialyzed patients (HD-CRI), and in 18 normal (N) controls. A highly significant decrease of the LAK activity in TX in comparison with HD-CRI or N (P = 0.0001) was observed. Moreover, the percentage of CD3-/NKH1+ cells was decreased in TX in comparison with N (P = 0.01). LAK activity was strongly correlated (r = 0.72; P = 0.0001) with the percentage of CD3-/NKH1+ cells and not with that of double-positive CD3+/NKH1+ cells. Multivariate analysis showed that the sole independent variable that determined the LAK activity was the percentage of CD3-/NKH1+ cells: the pathological status (TX, HD-CRI, and N) variable was statistically not significant. On the other hand, two T cell-specific functions (IL-2 secretion and specific cytotoxic activity) were, on the whole, preserved in TX. Altogether, these results suggest that TX are LAK deficient predominantly because they have a decreased number of CD3-/NKH1+ cells. The normality of T cell functions suggests that the high rate of malignancies seen in TX is related to this LAK deficiency. Moreover, our study indicates that, in vivo, CD3+ cells do not significantly contribute to the LAK precursors.

Antigens, CD↗
PubMed1990

[Autosomal dominant polycystic kidney in adults and transplantation].

Seventy-six patients with polycystic kidneys were followed in the Bicêtre renal transplantation unit. Fifty four were transplanted. Fifty two nephrectomies were performed in these patients essentially because of the size of the kidney and for renal infections. Fifty four patients were transplanted at a mean of 44 years. The actuarial survival of the patients at one year and at three years was 92% and 88% and the actuarial survival of the grafts at one year and at five years was 87% and 71%. These results are comparable to those obtained in other patients transplanted in the unit. Pre-transplantation nephrectomy and the patient's age do not aggravate the prognosis. Nephrectomy may be justified in these patients when they must be transplanted as transplantation currently gives very good results.

Adult↗
PubMed1990

[Harvesting multiple organs].

The development of organ transplants is limited by the shortage of organs. The improvement of this situation depends on two factors: increased awareness by the general public that refraining from refusing the removal of organs from the body of a patient with brain death is the most modern form of solidarity; and increased awareness by the medical profession that removal of organs should be proposed for every patient with brain death and that adequate resuscitative techniques should be used to preserve the organs in these patients. When the decision to harvest organs is taken, the transplant specialists must decide whether an organ should be used or not. Advances have been made in preservation techniques but are still insufficient to allow a reduction in immunosuppression. The UW solution is a major advance for liver, kidney and pancreas transplants. During harvesting, the separation of the vascular pedicles requires a good knowledge of surgical anatomy. Furthermore, the needs of the other surgical groups should be taken into account and concessions made to allow the harvesting of the greatest possible number of organs and consequently the treatment of the largest number of patients awaiting organs.

Brain Death↗