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Biomedical subjects

E E Hodge

Publications and source records attributed to E E Hodge.

At least 37 records · Page 2Linked to original sources
PubMed1995

Changing demographics in renal transplant recipients: the 30 year Cleveland Clinic experience.

While it does appear that the most recent era of transplantation has not resulted in significant improvement in long-term allograft function, this appears to be due, at least in part, to the transplantation of increasing numbers of high-risk patients. It is noted that the improved results accomplished over prior eras of transplantation have been maintained despite the inclusion of these high-risk patients. Patients currently undergoing transplantation are more likely to be older, diabetic, obese or African American. All of these subgroups have poorer patient survival in the most recent transplant era and thus, death with a functioning graft has become a significant contributor to graft loss. Recipients were more likely to receive kidneys from cadaveric donors in the most recent era and within the live-donor groups, sibling donation has decreased. Hopefully, the recent trend of increased live-donor transplants (especially living, unrelated transplants) will continue. Cadaveric recipients were at higher risk for posttransplant ATN which, for the first time in the current era, had a significant adverse impact on graft survival. Long-term survival appeared to be associated with particular characteristics (optimal age at transplantation, optimal donor age, live donor, etc.), and can be achieved despite known risk factors, such as rejection or delayed graft function.

Adolescent↗
PubMed1994

Epidemiologic and clinical comparison of renal artery stenosis in black patients and white patients.

PURPOSE: This study was undertaken to compare the epidemiologic and clinical features of renal artery stenosis (RAS) in black patients and white patients. METHODS: Data on all patients identified with 50% or greater RAS from 1984 to 1990 were collected and analyzed. The study was conducted at the Cleveland Clinic Foundation, which is a referral center for patients with renal artery disease. Eight hundred nineteen patients with RAS were identified from an institutional registry that records information on patients with this disease. This group comprises 40 black patients (4.9%) and 779 white patients (95.1%). The presence of RAS was determined by abdominal aortography in all patients. Black patients and white patients with RAS were compared with respect to their age, sex, presence and severity of hypertension, renal function, type and extent of renal artery disease, extrarenal vascular disease, and risk factors such as history of smoking, diabetes, and hyperlipidemia. RESULTS: The mean age of black patients and white patients was 62 years; however, a greater proportion of black patients were women (p = 0.01). RAS was due to atherosclerosis in 95% and 92% of blacks and whites, respectively. Although the extent and severity of RAS were equivalent in black patients and white patients, more blacks were diagnosed with severe (p = 0.01) or refractory (p = 0.05) hypertension. Extrarenal vascular disease was present in 95% and 70% of blacks and whites, respectively (p < 0.01). The incidence of coronary artery disease (p < 0.01), cerebrovascular disease (p < 0.01), and peripheral vascular disease (p < 0.01) was greater among black patients. A history of smoking was more common among black patients (p < 0.01). Serum total cholesterol and low-density lipoprotein cholesterol levels were equivalent among black patients and white patients; however, black patients had higher high-density lipoprotein cholesterol (p = 0.03) and lower triglyceride (p < 0.01) levels. CONCLUSIONS: There are significant differences between black patients and white patients with RAS. The basis for these findings and their relationship to the cause and true prevalence of RAS in blacks requires further study.

Adult↗
PubMed1994

Long-term results of renal transplantation into the valve bladder.

Between 1970 and 1990 renal transplantation was performed in 16 patients with a history of posterior urethral valves. While 10 patients had undergone supravesical urinary diversion before the development of end stage renal disease, all but 1 transplant were drained to the unaugmented native bladder. The 2 and 5-year graft survival rates were 70% and 59%, respectively. Of the 15 surviving patients 11 have allografts that are functioning at a mean of 86 months after transplantation with a mean serum creatinine of 2.0 mg./dl. Urological complications occurred in 19% of the transplants. No detrimental effect of the valve bladder on long-term allograft survival or function was apparent. With appropriate treatment of vesical dysfunction, these patients can be expected to have graft function comparable to the general transplant population despite use of the unaugmented native bladder.

Adolescent↗
PubMed1994

Use of the thoracic aorta for renal arterial reconstruction.

PURPOSE: Thoracic aortorenal bypass is a new technique for surgical renal revascularization in patients with severe atherosclerosis of the abdominal aorta. In such cases, the thoracic aorta is often free of disease. METHODS: From 1989 to 1992, thoracic aortorenal bypass was performed in 23 patients with hypertension, abdominal aortic atherosclerosis, and celiac artery stenosis; in 21 patients, renal artery stenosis was present bilaterally or in a solitary kidney. RESULTS: There was one operative death. Among the remaining 22 patients, hypertension was cured or improved after operation in 19 (86%), and renal function was improved or stable in 21 (95%). CONCLUSIONS: Thoracic aortorenal bypass has several advantages and is a useful alternative to abdominal aortic replacement in selected older patients who require renal arterial reconstruction.

Aorta, Abdominal↗
PubMed1993

Use of kidneys from older cadaver donors for renal transplantation.

From 1971-1990, 51 patients underwent renal transplantation with a kidney from a cadaver donor more than fifty-five years of age. Following transplantation, 19 kidneys (37%) functioned immediately while initial nonfunction occurred with 32 kidneys (63%). The one-year graft survival rate for kidneys with immediate function versus initial nonfunction was 84 percent and 63 percent, respectively. Graft survival was significantly impaired by increased recipient weight (p < 0.05) and by an elevated donor serum creatinine level (p < 0.05). We conclude that well-functioning kidneys from older donors can be safely and successfully used for renal transplantation. Such kidneys appear to be more susceptible to ischemic damage and should not be used when the donor serum creatinine level is elevated.

Adolescent↗
PubMed1993

Extra-anatomic renal revascularization in patients with renal artery stenosis and abdominal aortic occlusion.

Thirteen patients with atherosclerotic renal artery stenosis and total abdominal aortic occlusion underwent extra-anatomic surgical renal revascularization without aortic replacement. Renal artery stenosis was present unilaterally (n = 2), bilaterally (n = 7), or in a solitary kidney (n = 4). Surgical renal revascularization was indicated for treatment of severe hypertension in all patients and for preservation of renal function in 10 patients. The level of abdominal aortic occlusion was suprarenal (n = 3), perirenal (n = 2), or infrarenal (n = 8). All patients had extensive collateral vascular supply to the lower extremities with absent (n = 7) or mild (n = 6) claudication. Surgical renal revascularization was achieved with hepatorenal bypass (n = 6), mesenterorenal bypass (n = 4), or splenorenal bypass (n = 3). None of the patients underwent concomitant aortic replacement. There were no operative deaths. Postoperatively, hypertension was improved in 10 patients, unchanged in 2 patients, and worse in 1 patient. Renal function was improved in 8 patients, stable in 2 patients, and worse in 3 patients. After surgical renal revascularization, no patient required aortic replacement, while 1 patient underwent extra-anatomic revascularization of the lower extremities. We conclude that some patients with renal artery stenosis and abdominal aortic occlusion can be managed by surgical renal revascularization alone without a more extensive and potentially hazardous aortic replacement. In these patients, extra-anatomic techniques can allow safe and successful surgical renal revascularization while avoiding surgery on the diseased aorta.

Adult↗
PubMed1993

Improved success of living unrelated renal transplantation with cyclosporine immunosuppression.

Kidney transplantation with a living unrelated donor was performed in 13 patients. The donors comprised 10 spouses, 2 brothers-in-law and 1 stranger. All donor-recipient pairs were red blood cell compatible with a negative T cell crossmatch. Five patients underwent transplantation before 1984 without cyclosporine immunosuppression; the 1-year patient and graft survival rates in this group were 40% and 20%, respectively. Eight patients have undergone transplantation since 1985 with cyclosporine immunosuppression. The 1-year patient and graft survival rates in this group were 100% and 88%, respectively (p = 0.03). Currently, 6 patients in the latter group have a well functioning graft with serum creatinine levels of 1.2 to 2.0 mg./dl. (mean 1.5 mg./dl.) and with followup of 1 to 6 years (mean 2.9 years). Excellent graft survival results can now be achieved with living unrelated donors and their expanded use can provide an important additional source of organs for transplantation.

Cyclosporine↗
PubMed1992

Clean intermittent catheterization and urinary diversion in the management of renal transplant recipients with lower urinary tract dysfunction.

Renal transplant recipients with lower urinary tract dysfunction may be managed by urinary diversion or clean intermittent catheterization. To evaluate the comparative problems associated with each mode of therapy we studied 13 patients managed by clean intermittent catheterization (group 1, 6 patients) or urinary diversion (group 2, 7 patients). All 6 and 2 of 7 recipients in groups 1 and 2, respectively, had a neuropathic bladder. Mean followup was 3.7 +/- 1.5 (group 1) and 5.7 +/- 4.9 (group 2) years. Three allografts were lost in group 2 due to rejection (2) and death (1). Two patients each in groups 1 and 2 had febrile urinary tract infections requiring hospitalization and intravenous antibiotics. Complications related to urinary diversion developed in 4 patients in group 2. The serum creatinine at 1 and 3 years, number of hospital days per patient, total number of rejection episodes and number of patients employed in a full-time job following transplantation were similar in both groups. In summary, clean intermittent catheterization appears to have more morbidity in immunosuppressed transplant versus nontransplant patients but it may be preferable in renal transplant recipients due to the overall simplicity, positive psychological effect and comparable morbidity to other forms of management.

Adult↗
PubMed1990

Surgical treatment for isolated dissection of the renal artery.

From 1974 to 1989, 18 patients underwent surgical treatment for isolated dissection of the renal artery causing high grade stenosis, including 2 patients with bilateral renal involvement. The causes of renal artery dissection were blunt trauma (1 patient), unsuccessful percutaneous transluminal angioplasty (5) and atherosclerosis (5) or intimal fibroplasia (7) of the renal artery. The most common presenting signs or symptoms of a dissection were hypertension (94%), an abdominal bruit (44%), headache (44%), minimal proteinuria (44%), microscopic hematuria (38%) and flank pain (38%). Renal artery dissection led to segmental or total renal infarction in 8 of 20 involved kidneys (40%). Seventeen patients underwent unilateral surgical revascularization with amelioration of hypertension and preservation of renal function. Three kidneys were lost due to irreversible ischemic damage from an occlusive dissection. Isolated renal artery dissection is an uncommon lesion that can cause hypertension and threaten renal function.

Adult↗
PubMed1989

Evaluation of pediatric cadaver kidneys transplanted into adult recipients receiving cyclosporine.

The major problem in clinical transplantation is the imbalance between the need for cadaveric organs and the available numbers of donors. If pediatric kidneys were transplanted into adult recipients when no pediatric recipient was available, the potential number of renal donors would be increased by 15 to 20%. Some centers are reluctant to use pediatric kidneys for adult recipients because of recent reports indicating poorer patient and allograft survival, increased delayed graft function, increased post-transplant hypertension and increased technical complication. (There also has been concern that the nephrotoxic effect of cyclosporine A would retard the organ growth that is necessary to provide normal renal function in adults.) A retrospective analysis was performed on 18 adult recipients who received kidneys from cadaver donors 14 months to 12 years old (group 1). These patients were compared to 106 adult recipients who received kidneys from donors greater than 12 years old (group 2). Actuarial patient survival at 1 year was 85% for group 1 and 95.8% for group 2 (p equals 0.13), while 1-year actuarial allograft survival was 83.1% for group 1 and 81.1% for group 2 (p equals 0.87). There was no significant difference between groups 1 and 2 in the frequency of delayed graft function, serum creatinine at 1, 3 and 6 months after transplantation, incidence of post-transplant hypertension or frequency of surgical complications. It is of interest that the pediatric kidneys had significant growth during the initial post-transplant month. Sonographic examination at postoperative days 1 and 30 demonstrated a mean increase in size from 80.7 to 143.5 cm. (p less than 0.001). In this series pediatric kidneys were safe and effective donor organs in adult recipients, and increased the available number of organs by 15%.

Adolescent↗
PubMed1989

Conventional immunosuppression after deliberate third party transfusions versus cyclosporine in living related renal transplant recipients.

A total of 93 recipients of either HLA-identical (34) or 1-haplotype matched (59) living related donor renal transplants was assigned prospectively into immunosuppressive treatment groups on the basis of transfusion histories obtained at the initial evaluation for transplantation. Patients who received 0 to 2 third party transfusions were given no further transfusion, and received cyclosporine and prednisone immunosuppression after transplantation (cyclosporine group). Patients who received 3 or 4 third party transfusions were given additional transfusions until 5 had been received, and were managed with azathioprine and prednisone after transplantation (azathioprine group). Patients who already received 5 or more third party transfusions had no additional transfusions and were assigned to the azathioprine group. No patient had a positive crossmatch to the potential donor after initial evaluation and confirmation of a negative crossmatch. The number of rejection episodes per patient after transplantation was significantly higher in the azathioprine group for HLA-identical (p equals 0.001) and 1-haplotype (p equals 0.003) recipients. One-year patient survival rats for the HLA-identical cyclosporine and azathioprine groups were 100 and 94 per cent, respectively, with respective 1-year allograft survivals of 100 and 89 per cent in the 2 groups. In the 1-haplotype group 1-year patient survival rates were 95 and 94 per cent for the cyclosporine and azathioprine groups, respectively; allograft survival was 81 per cent for the cyclosporine group and 91 per cent for the azathioprine group. None of the observed differences in graft or patient survival between the 2 groups was statistically significant. Deliberate third party transfusions with conventional immunosuppression and cyclosporine immunosuppression are effective methods to treat recipients of living related donor renal transplants.

Adult↗
PubMed1989

Renal transplant calculi. A reevaluation of risks and management.

Between January 1977 and March 1988, 10 of 892 renal transplant recipients formed urinary tract calculi posttransplantation. The presenting symptoms were predominantly those of azotemia due to obstruction and/or hematuria. Factors predisposing to stone formation included a reconstructive urologic procedure at the time of transplantation (n = 4) or a surgical complication (n = 4), necessitating the placement of a ureteral stent and/or nephrostomy tube, secondary hyperparathyroidism (n = 5), hyperuricosuria (n = 4), and hypercalciuria (n = 1). Four patients passed their stones spontaneously; 1 patient underwent ureterolithotomy, 3 patients underwent endourologic stone extraction, 1 patient was treated with a combination of surgical and endourologic procedures, and 1 patient underwent extracorporeal shock wave lithotripsy as monotherapy. While the management of these patients can be challenging, awareness of predisposing factors, proper application of all currently available urologic techniques, and attention to certain guidelines of management can aid in minimizing morbidity from this rare urologic complication of renal transplantation.

Adolescent↗