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E Pohanka

Publications and source records attributed to E Pohanka.

At least 73 records · Page 4Linked to original sources
PubMed1988

ATG overdose in a kidney-grafted patient. Clinical course and possible implications.

During antirejection treatment with antithymocyte globulin (ATG), a 48-year-old male kidney graft recipient was erroneously given 30 mg/kg ATG on day 5 of the treatment course. Clinically, the patient presented with abdominal pain, profuse diarrhea, and fever. Initially, the platelet count dropped to 94 x 10(3)/microliters and showed a further decrease to 65 x 10(3)/microliters 2 days thereafter. Plasmapheresis carried out about 12 h after the end of ATG infusion resulted in a decrease in serum levels of total rabbit immunoglobulin as well as the antibody fraction reactive with human T lymphocytes. Within 10 days after the discontinuation of ATG treatment, the relative and absolute number of the T-cell subpopulations, which had disappeared from the circulation at the time of antirejection therapy, returned to normal values. In addition, at this time both platelet and lymphocyte counts were again found to be in the normal range. Kidney function had recovered from the rejection crisis such that the patient could be discharged 26 days posttransplantation.

Antilymphocyte Serum↗
PubMed1988

Cytomegalovirus infection after kidney transplantation using cyclosporin A and low-dose prednisolone immunosuppression.

The incidence and clinical relevance of cytomegalovirus (CMV) infection has been investigated in 120 consecutive renal allograft recipients receiving cyclosporin A and low-dose steroid (CsA/LDS) immunosuppression. Forty patients (33.3%) showed serological evidence of recent CMV infection; 21 patients (17%) developed clinically symptomatic infection. A seronegative recipient status and an aggressive additional immunosuppressive therapy were significant risk factors for the development of serological infection. There was, however, no difference with regard to these or any other relevant parameters (HLA matching; pretransplant history) between the symptomatic and asymptomatic group. Furthermore there was no influence of CMV infection, whether symptomatic or not, on graft outcome. During the study CMV infection prophylaxis consisted of single-shot CMV hyperimmunoglobulin in 72 patients immediately before grafting, recombinant interferon alpha 2 in 28 patients, and placebo in 20 patients. There was no beneficial effect of either interferon or hyperimmunoglobulin on the incidence and severity of CMV infection. However, steroid-resistant vascular rejections were much more common in the interferon group. We conclude that the incidence of CMV infection after kidney transplantation using CsA/LDS immunosuppression is lower when compared to kidney grafting with conventional immunosuppression. Prophylactic treatment with single-shot hyperimmunoglobulin is not effective, and recombinant interferon alpha 2 prophylaxis may even exert deleterious effects on graft survival by inducing steroid-resistant vascular rejection.

Adult↗
PubMed1988

Adverse effect of low-dose prophylactic human recombinant leukocyte interferon-alpha treatment in renal transplant recipients. Cytomegalovirus infection prophylaxis leading to an increased incidence of irreversible rejections.

Since infections with Herpetoviridae after kidney transplantation still remain a major clinical problem, we conducted a double-blind, placebo-controlled trial using low-dose recombinant interferon-alpha-2C (rIFNa2C) prophylaxis in 50 renal graft recipients immunosuppressed with cyclosporine and methylprednisolone. Ten patients were excluded from further analysis because of graft loss due to surgical complications, side effects of rIFNa2C, and because of lack of compliance. There was a significant difference in graft loss due to irreversible rejections between the verum and the placebo group (6 vs. 0; P less than 0.05), whereas no difference was observed with regard to the occurrence of viral infections. We conclude, that low-dose rIFNa2C prophylaxis is harmful in renal allograft recipients treated with cyclosporine in view of the high incidence of irreversible transplant rejections without beneficial effects on the occurrence of viral infections.

Adult↗
PubMed1986

Effect of a single pentoxifylline administration on platelet sensitivity, plasma factor activity, plasma-6-oxo-PGF1 alpha and thromboxane B2 in healthy volunteers.

In eight male healthy volunteers aged 25-38 years 300 mg pentoxifylline (Trental, Hoechst AG, Frankfurt/M., Germany) were administered intravenously by a short term infusion for 10 minutes. Blood was withdrawn before as well as 30, 60, 90 and 120 minutes after the infusion. Throughout the entire investigation the volunteers were kept in an upright sitting position in a comfortable chair. Plasma levels of 6-oxo-PGF1 alpha and thromboxane B2 (TXB2), PGI2 release stimulating plasma factor (PF) activity and the platelet sensitivity to PGE and PGI respectively were evaluated at each interval. Plasma levels of 6-oxo-PGF1 alpha exhibited a significant (p less than 0.001) increase in mean values after pentoxifylline administration, reaching the maximum at 60 minutes after infusion. Only a trend (p less than 0.05) was detectable for a decrease in plasma TXB2 values. The PF activity did not change throughout the follow-up period. The platelet sensitivity to PGI2, however, exhibited a significant (p less than 0.01) increase as did sensitivity to PGE1 (p less than 0.005). These results are in accordance with earlier data showing that pentoxifylline is able to increase PGI formation by various tissues. The findings suggest, that the beneficial effects reported for this compound in clinical use might in part be due to its positive effects in local hemostatic regulation.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Relationship of interferon-gamma and neopterin levels during stimulation with alloantigens in vivo and in vitro.

We have recently shown that interferon-gamma is capable of activating the key enzyme of pterin biosynthesis in macrophages. This leads to excretion of the stable degradation product neopterin. In this article we present experimental evidence suggesting that stimulation of T cells by alloantigens is associated with release of interferon-gamma--which, in the case of rejection, is locally restricted and not always detectable in the bloodstream. Neopterin induced by this lymphokine, however, readily penetrates tissue barriers and is detectable in the serum. This conclusion is based on two different sets of observations: (1) If supernatants of MLCs are compared with sera from patients with documented acute rejection episodes for their interferon-gamma and neopterin levels, a marked gradient is observed to exist between interferon levels measured in vitro and in vivo; this is not the case for neopterin for which comparable levels were seen. (2) Detection of interferon-gamma in sera of allograft recipients invariably precedes an increase of neopterin; on the other hand, increasing neopterin counts are also seen in the absence of detectable interferon-gamma levels in the serum. It thus appears that although interferon-gamma release during allograft rejection is primarily restricted to the tissue, evaluation of certain metabolites of interferon-dependent metabolic pathways enables definition of its endogenous release. Whereas interferon gamma represents a less reliable marker in the monitoring of rejection episodes, it might offer an additional means to differentiate rejection from systemic infections. Such a discrimination can not be achieved with the neopterin marker.

Acute Disease↗
PubMed1985

[Individual dialysis using computer-controlled prescription].

The use of urea kinetics as basis for optimization and individualization of renal replacement therapy has become quite popular over the last decade. The rationale underlying the use of blood urea nitrogen for monitoring or targeting dialysis therapy is based on the report of an American multicentre cooperative dialysis study showing that blood urea nitrogen concentrations are closely correlated to the occurrence of morbidity and complications in dialysis patients. In order to further optimize the accuracy of dialysis prescription we have developed a new algorithm for estimation of the dialysis time needed to reach a certain blood urea nitrogen concentration, which--in contrast to all methods employed so far--enables accurate calculation of ultrafiltration during haemodialysis and of weight changes in the interdialytic period.

Blood Urea Nitrogen↗
PubMed1984

[111-Indium-labeled thrombocytes in the diagnosis of acute kidney transplant rejections and in monitoring the therapy of rejection reactions with prostacyclin].

33 patients were examined daily under a gamma camera after weekly injections of 111-In-labelled autologous platelets over a period of at least 4 weeks after transplantation. A group of 33 patients with long-term stable and well-functioning grafts served as controls. By means of a computerized recording technique, platelet trapping in the graft was measured and expressed as platelet-uptake index (PUI). The method worked well for the early diagnosis of acute rejection signified by an increase in PUI, accompanied by a shortening of platelet half life (t/2). 6 patients suffering from acute rejection received infusions of prostacyclin in addition to conventional high-dose methylprednisolone therapy. In 4 cases the PUI decreased again and an improvement in graft function was observed. Prostacyclin infusion treatment was applied also in 12 patients with histologically-proven chronic transplant rejection. Decreased platelet consumption by the graft and a temporary improvement in transplant function were achieved. We suggest that prostacyclin could enrich the possibilities of anti-rejection treatment by providing a tool for the suppression of platelet trapping in the graft. The platelet scan served as a useful method for the early detection of acute rejection, as well as the monitoring of prostacyclin anti-rejection treatment.

Acute Disease↗
PubMed1983

Radiolabelled platelets and prostacyclin in diagnosis and treatment of transplant rejection.

The trapping of 111Indium-oxine labelled autologous platelets by the transplant was recorded by means of a computerised gamma camera and expressed as platelet uptake index (PUI). Eighty-five patients were studied. The PUI increased in acute rejection from 1.13 +/- 0.11 to 1.74 +/- 0.17, and decreased again when rejection was reversed. In chronic rejection PUI was significantly lower than in acute rejection, but still higher than in long term stable grafts. Prostacyclin infusions were given to six cases of acute rejection and 12 of chronic rejection. In the majority of patients an improvement in transplant function and a decrease in platelet trapping could be demonstrated.

Adolescent↗
PubMed1982

Increased deposition of 111Indium labelled platelets in chronically rejected kidney transplants.

Increased deposition of 111In-oxine labelled autologous platelets in chronically rejected kidney transplants was demonstrated using a gamma-camera and by measurement of a platelet uptake index (PUI). In this group of patients the PUI correlated indirectly with the platelet half-life and was statistically different from the PUI found in stable transplant patients who acted as controls. It is therefore suggested that platelets may play a key role in chronic rejection by the release of a mitogenic factor which promotes the development of obliterative arterial lesions in the transplant.

Adult↗
PubMed1982

[The use of labeled thrombocytes in the monitoring of patients after kidney transplantation].

Indium 111 (111In) labelled autologous platelets were used in the diagnostic observation of patients after renal transplantation. 75 patients were collected in 3 groups of 25 cases each. The first group consisted of patients who were examined during the first 4 weeks after transplantation. Group 2 were patients suffering from histologically proved chronic graft rejection. The 3rd group included cases with good and stable transplant function tested at least 9 months after transplantation. By means of a computerized static study the transplants were examined under the gamma-camera concerning a platelet trapping. Thereby a platelet-uptake-index (PUI) was calculated and compared with the platelet half-life-time (t1/2). This diagnostic method turned out to be suitable for early diagnosis of acute graft rejection. Hereby the PUI increased from 1.13 +/- 0.11 to 1.74 +/- 0.17. The further course of rejection episode manifested itself in corresponding changes of PUI. In irreversible rejections the PUI stayed in the high range or increased further. On the other hand reversible graft rejections showed a reduction of PUI, however, in the most cases not to the original basic level. The platelet t1/2 exhibited a strong negative correlation with PUI. Cases suffering from chronic transplant rejection revealed significantly higher platelet trapping by the graft than patients with good and stable transplant function.

Adolescent↗