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H J Metselaar

Publications and source records attributed to H J Metselaar.

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

[Liver transplantation in acute liver insufficiency: definitive replacement or auxiliary liver?].

Orthotopic liver transplantation (OLT) has greatly improved the chances of survival in patients with acute hepatic failure. However, this mode of treatment requires lifelong immunosuppressive medication and negates the potential recovery of the host liver. In theory, auxiliary heterotopic liver transplantation (HLT) offers the diseased host liver a chance to regenerate, so that immunosuppression can be tapered off and eventually stopped. In the University Hospital Rotterdam Dijkzigt OLT and HLT were performed in two patients, with acute and subacute hepatic failure respectively. The patient undergoing OLT recovered quickly but needed a successful re-OLT after a serious rejection episode. The removed diseased liver showed no signs of regeneration at histology. The patient undergoing HLT also recovered well. HIDA scanning as well as liver biopsies of the host liver and the grafted liver 1 and 6 months after transplantation indicated full recovery of the host liver, so that immunosuppression is being tapered off.

Adult↗
PubMed1990

Cytomegalovirus seronegative heart transplant recipients. Prophylactic use of anti-CMV immunoglobulin.

Thirty-two CMV seronegative heart transplant patients received prophylactic anti-CMV immunoglobulin during the first three posttransplant months. One of the 16 recipients of a heart from a seronegative donor acquired CMV infection and developed CMV disease. In eight of the 16 recipients of a heart from a seropositive donor, CMV infection was observed. Viremia was diagnosed in seven of them, but only two of these patients developed CMV disease. The incidence of CMV infection and of CMV disease in the globulin-treated CMV seronegative recipients of a heart from a seropositive donor was comparable to the incidence of CMV infection and of CMV disease in 31 nonglobulin-treated CMV seropositive recipients. This was significantly lower (percentage difference 69 percent, 95 percent CI 42-97 percent, p less than 0.001) than expected on the basis of the data from the literature and indicates that passive immunization with anti-CMV immunoglobulins induces the same protection against CMV disease as natural acquired anti-CMV resistance. This protective effect was temporary, as one patient developed symptomatic CMV infection four months after transplantation at a time when the anti-CMV immunoglobulin levels had decreased to pretransplantation values.

Cytomegalovirus↗
PubMed1989

Cytomegalovirus infection and renal transplantation.

Cytomegalovirus (CMV) infections remain a major clinical problem after renal transplantation. Reported incidences of CMV disease range from 17 to 25% in patients with azathioprine treatment and from 2 to 23% in patients on cyclosporin A. CMV-related death occurs in 1-3% of the total kidney transplant population. CMV seronegative kidney recipients of a transplant from a seropositive donor are especially at risk for primary infection as CMV can be transmitted by the transplant. In patients treated with antilymphocyte globulin (ALG) preparations for rejection, CMV disease is diagnosed three to four times more frequent than in patients without ALG therapy. Prevention of CMV infection is possible by selecting CMV seronegative donors for seronegative recipients. Active and passive immunization does not prevent CMV infection after renal transplantation, but immunoprophylaxis may result in less severe CMV disease. Effective treatment of clinical overt CMV disease is possible with the new guanine analogue ganciclovir. However, the use of this drug is associated with neutropenia, especially in patients with compromised kidney function. More pharmacokinetic data are needed to determine optimal dosing schemes.

Acyclovir↗
PubMed1989

Prevention of cytomegalovirus-related death by passive immunization. A double-blind placebo-controlled study in kidney transplant recipients treated for rejection.

In a double-blind placebo-controlled study, the value of prophylactic anti-CMV immunoglobulin administration was evaluated in 39 kidney transplant recipients treated for rejection with rabbit antithymocyte globulin. Passive immunization completely prevented CMV-related death, although it did not reduce the incidence of CMV isolation, viremia, or disease. The effect of passive immunization was exclusively observed in CMV-seronegative recipients of a CMV-seropositive kidney donor. It could be demonstrated even when instituted when antirejection therapy was started. Seropositive recipients did not benefit from immunoglobulin treatment. Moreover, CMV-seronegative recipients of a kidney from a seronegative donor were not at risk for CMV infection at all. Therefore passive immunization should be restricted to seronegative recipients of seropositive allograft donors treated for rejection.

Antibodies, Viral↗
PubMed1988

Development of resistance to a long-acting somatostatin analogue during treatment of two patients with metastatic endocrine pancreatic tumours.

UNLABELLED: Two patients with metastatic endocrine pancreatic tumours initially responded well to therapy with the long-acting somatostatin analogue SMS 201-995. In the first patient with an insulinoma both the number of hypoglycemic attacks and the increased insulin levels decreased initially, but returned to pretreatment intensity and concentrations within 9 days after the start of therapy with 200-300 micrograms SMS 201-995 daily. After a short interruption, no effect was observed of re-institution of therapy at a dose of 400 micrograms SMS 201-995 daily. In the other patient with a metastatic vipoma both diarrhea, hypokalemia and plasma VIP levels reacted initially well to SMS 201-995 treatment with 300 micrograms per day, but resistance to therapy developed after 2 weeks. An increase in the dose of the analogue to maximally 600 micrograms/day was followed by a transient improvement, but finally both the volume of diarrhea and the levels of vasoactive intestinal polypeptide were higher than those before the start of therapy. CONCLUSIONS: Development of resistance to SMS 201-995 both with regard to the clinical effect and to the inhibitory effect on tumour hormone secretion can be expected in some patients with metastatic endocrine pancreatic tumours. On the basis of our clinical observations down-regulation of somatostatin receptors is suggested to be one of the mechanisms of this development.

Adenoma, Islet Cell↗
PubMed1988

Prevention of CMV infection by screening for CMV antibodies in renal allograft recipients and their blood and kidney donors.

The influence of the cytomegalovirus (CMV) serostatus of blood and kidney donors on patient and graft survival was studied prospectively in 73 cadaveric renal graft recipients. Six out of 12 (50%) CMV seronegative recipients receiving a kidney from a CMV seropositive donor developed CMV disease, in contrast to none of 7 CMV seronegative donor/recipient combinations. Transmission of CMV with blood products to seronegative recipients was not observed in this study. A poor graft survival of 41% 3 years after transplantation was found in CMV seronegative recipients with CMV seropositive allograft donors, compared with an actuarial 3 year graft survival of 72% in the 7 CMV seronegative donor/recipient combinations. Six patients with graft failure had a CMV infection. This study, in accordance with other studies, suggests that selection of CMV seronegative renal allograft donors for CMV seronegative recipients will improve graft survival.

Adolescent↗
PubMed1986

Mononuclear subsets during cytomegalovirus disease in renal transplant recipients treated with cyclosporine and rabbit antithymocyte globulin.

The effect of cytomegalovirus (CMV) disease on mononuclear subpopulations of 49 renal transplant recipients treated with cyclosporine and prednisone are reported. Clinical overt CMV infection developed in 8/21 patients treated for rejection with rabbit antithymocyte globulin. They all showed true inversions of the T helper/T suppressor-cytotoxic (Th/Ts-c) ratio. A reduction of T helper cells and increase in T suppressor-cytotoxic cells preceded clinical symptoms of CMV disease by one week. None of the 26 patients without RATG anti-rejection treatment developed CMV disease and in only three of them an inversion of Th/Ts-c ratio was found.

Antilymphocyte Serum↗