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F O Belzer

Publications and source records attributed to F O Belzer.

At least 73 records · Page 4Linked to original sources
PubMed1993

Renal transplantation at the University of Wisconsin in the cyclosporine era.

1. Immunological graft loss in the cyclosporine (CsA) era has been decreasing over the past decade with current 94% immunological graft survival at one year. 2. The rates of both immunological graft loss and graft loss from all causes gradually decrease after the first year for primary transplants. This implies that rejection gradually becomes less likely between one and 10 years follow-up. 3. On CsA immunosuppression, better DR matching results in significantly less immunological graft loss and a slower rate of late graft loss. 4. Roughly equal proportions of cadaveric renal transplants are lost due to acute rejection, chronic rejection, and death with a functioning graft (25-30% each). 5. Improving immunological graft outcome correlates with a lower incidence of a first rejection episode. Although OKT3 increases the success of rejection treatment, having a rejection episode nevertheless increases one's risk of immunological graft loss. 6. Cardiovascular deaths are by far the leading cause of mortality (42%) in this series. Improved strategies of prevention and treatment of cardiovascular disease are needed in this patient group. 7. Long-term CsA immunosuppression usually is not associated with graft loss due to CsA toxicity. Late graft loss from acute and chronic rejection is far more common, implying the need for continued immunosuppression even in patients with long-surviving grafts. 8. There is no measurable benefit of 3 or more random blood transfusions prior to cadaveric renal transplantation in the CsA era.

Academic Medical Centers↗
PubMed1993

Histocompatibility and liver transplantation.

BACKGROUND: The role of histocompatibility between donor and recipient in liver transplant rejection is unclear because of a paucity of data. The influence of human leukocyte antigen (HLA) type on immunologic graft loss was examined for primary liver transplantations performed at this center. METHODS: Immunologic graft loss included patient death or retransplantation as a result of rejection or impending graft loss caused by either late hepatic artery thrombosis or severe, unremitting rejection requiring FK 506 rescue therapy. HLA A, B, and DR matching was available on 205 donor-recipient combinations, and an additional 31 patients had A and B matching only. RESULTS: A mismatch of class I antigens (HLA A and B) was predictive of immunologic graft loss (p = 0.018). DR mismatch did not correlate with graft loss. When the A and B loci were analyzed separately, an A mismatch correlated significantly with immunologic graft loss (p = 0.02), in contrast to a B mismatch (p = 0.17). Better matching significantly improved patient survival (p = 0.02) and overall graft survival (p = 0.009). CONCLUSIONS: The beneficial effect of HLA class I antigen compatibility on liver transplantation outcome is in contrast to pancreatic and kidney transplantation in which class II antigen matching but not class I matching is beneficial. Immunologic mechanisms of hepatic allograft rejection may differ from those involved in kidney transplant rejection.

Forecasting↗
PubMed1993

Long-term results of liver transplantation for biliary atresia.

BACKGROUND: Biliary atresia can be treated by portoenterostomy, which is primarily palliative, or by liver transplantation, which is primarily curative. The purpose of this study was to determine the long-term outcome of liver transplantation for the treatment of biliary atresia. METHODS: During an 8-year period, 45 patients who underwent liver transplantation for biliary atresia and 10 patients who were referred to our center for portoenterostomy were retrospectively analyzed. RESULTS: No patient with biliary atresia died awaiting liver transplantation. The waiting time for all patients was 36.7 +/- 42.8 days. Thirty-four patients (75.6%) required one transplant, whereas 11 patients (24.4%) required 17 retransplants. Twenty-two patients (48.9%) required 39 reoperations (1.8 per patient). There were 4.9 infectious episodes, 2.2 rejection episodes, and 4.4 readmissions per patient. However, 91% of reoperations, 80% of infections, and 78% of rejections occurred within 6 months of transplantation. The overall 7-year actuarial patient and graft survival for patients with biliary atresia was 86.2% and 62.7%, respectively. CONCLUSIONS: Our results indicate that long-term patient survival after liver transplantation for biliary atresia is excellent. However, portoenterostomy continues to have an initial complementary but limited long-term role in the treatment of infants with biliary atresia.

Biliary Atresia↗
PubMed1993

Two hundred consecutive simultaneous pancreas-kidney transplants with bladder drainage.

BACKGROUND: Since 1982, 288 pancreas transplantations have been performed at the University of Wisconsin. This report reviews our experience with 200 consecutive simultaneous pancreas-kidney (SPK) transplantations during a 7-year period. METHODS: Two hundred consecutive SPK transplantations were performed between December 1985 to October 1992. Immediate posttransplant function and surgical and infectious complications were evaluated. Frequency of rejection episodes were analyzed, as was 5-year patient and graft survival. RESULTS: All but four pancreas transplants functioned immediately after transplantation. Three pancreas transplants failed because of thrombosis and one from primary nonfunction. Five-year patient survival was 90.2%, kidney survival 80.3%, and pancreas survival 78.6%. There were 54 surgical complications. Fifteen patients have died since 1985. The most frequent cause of death was infection (three patients). A total of 678 infectious episodes were recorded. Urinary tract infection (n = 344) was the most frequent type of infection. Enteric conversion was necessary in 35 patients, with the most frequent indication being a leak of the duodenal segment. CONCLUSIONS: We concluded from this series that SPK transplantation is associated with higher cost and morbidity as compared with kidney transplantation alone. However, excellent long-term survival in combination with the clearly demonstrated benefits for secondary diabetic complications indicate that SPK transplantation is the procedure of choice for carefully selected patients with diabetes.

Adolescent↗
PubMed1993

Glycine protects hepatocytes from injury caused by anoxia, cold ischemia and mitochondrial inhibitors, but not injury caused by calcium ionophores or oxidative stress.

Isolated hepatocytes, suspended in an organ preservation solution, can be preserved at 4 degrees C for up to 6 days. After preservation, normothermic-normoxic incubation causes loss of hepatocyte viability. The addition of 3 mmol/L glycine to the rewarming medium prevents the loss of viability. In this study we investigated the cytoprotective effects of glycine under many conditions known to cause hepatocellular injury to understand the mechanism of cold-induced injury in the liver. Hepatocytes were suspended in modified Krebs-Henseleit buffer with or without 3 mmol/L glycine and exposed to agents or conditions known to induce cell death. Hepatocyte viability was assessed by measuring the percentage of lactate dehydrogenase leakage from the cells and the concentration of ATP during incubation at 37 degrees C under room air for up to 90 min. Mitochondrial inhibitors (potassium cyanide and carbonyl cyanide m-chlorophenylhydrazone); calcium ionophores (ionomycin and A23187); an oxidizing agent, tert-butyl hydroperoxide; and anoxia were all used to cause cell injury. Hepatocytes were also isolated from fasted rats and hypothermically preserved as another model of cell death. Other amino acids were also tested in the hypothermic preservation model to study the specificity of the amino acid requirement for prevention of lactate dehydrogenase leakage. Of the amino acids tested, only alanine (10 mmol/L) and the combination of alanine (3 mmol/L) and serine (3 mmol/L) were as effective as glycine in preventing lactate dehydrogenase release in the hypothermic preservation model.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗