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Biomedical subjects

H M Kauffman

Publications and source records attributed to H M Kauffman.

At least 55 records · Page 3Linked to original sources
PubMed1979

Posttransplant hypersplenism.

Posttransplant hypersplenism, manifested by leukopenia and azathioprine intolerance, can be diagnosed with a high degree of accuracy and promptly reversed by emergency splenectomy. Functioning cadaver kidney homograft survival rates in patients undergoing posttransplant splenectomy are equal to that of patients undergoing pretransplant splenectomy and are statistically superior (p less than 0.01) to recipients who have never had their spleens removed. However, mortality (21%) for posttransplant splenectomy is excessively high when compared to our mortality (1.3%) for pretransplant splenectomy.

Azathioprine↗
PubMed1979

Plasmapheresis in the treatment of renal allograft rejection.

Thirty-four patients with renal allograft rejection unresponsive to conventional therapy underwent plasmapheresis. Twenty-four patients evidenced prompt and marked improvement and were discharged. Seventeen of these are presently stable off dialysis. Ten patients were not improved and required return to dialysis and/or transplant nephrectomy. Four hour warm, complement-dependent crossmatches which had become positive following transplant became negative following plasmapheresis in 3 patients who now have stable long-term function. Plasmapheresis appears promising in the treatment of refractory acute renal allograft rejection.

Cadaver↗
PubMed1979

Hypercoagulability: a cause of vascular access failure.

In a group of 58 patients requiring tertiary vascular access procedures for maintenance of hemodialysis, 29 patients who thrombosed well-functioning fistulas were evaluated for both antithrombin deficiencies as well as platelet hyperaggreability. Thirteen of these 29 patients were found to have one or more coagulation defects. Following correction of the hypercoagulable state, tertiary vascular access procedures, using autologous tissues, were 100% successful in these 13 patients.

Antithrombin III Deficiency↗
PubMed1978

A model for planning health care in patients with end-stage renal disease.

Treatment modalities of end-stage renal disease (ESRD) patients include in-center dialysis, home dialysis, and kidney transplant. We present a model to account for all aspects of modality use to aid in planning regional facilities. Five years of data for 979 patients on dialysis in Wisconsin between 1970 and 1975 are used. The model shows movement (transit probabilities) from one modality to another, eg, transition from in-center dialysis to transplantation, and data were used to derive all transitional probabilities characterizing patient movement from one modality to another. Model and probabilities were used to predict number of patients in each modality in 1976, and the model was used to predict number of patients in each treatment modality through 1990. These figures may be used for planning regional facilities. Extrapolation of this model and derived probabilities for nationwide projections may be possible.

Adolescent↗
PubMed1978

Randomized steroid therapy of human kidney transplant rejection.

This randomized, double-blind study failed to show any therapeutic benefit of a 30-mg/kg bolus over a 3-mg/kg bolus of methylprednisolone for the treatment of acute kidney transplant rejection. Since there was a slight associated increase in infections and septic mortality, routine use of high-dose methylprednisolone bolus therapy is not recommended or justified.

Double-Blind Method↗
PubMed1977

High dose (bolus) intravenous methylprednisolone at the time of kidney homotransplantation.

A completely randomized double-blind study of bolus methylprednisolone versus dextrose in water, administered at the time of human kidney transplantation, has failed to demonstrate any beneficial effect of the steroid therapy. No differences were observed in the number of complete, irreversible graft rejections, the number of acute rejection episodes, or the number of postoperative steroid boluses administered in the treated or the control groups. Similarly, there were no differences in the mean serum creatinines at 30, 60, 90 days post-transplantation. There was a slight increase in mortality and incidence of complications in the group of patients receiving an intravenous bolus of methylprednisolone at the time of transplantation as compared to controls. The failure to demonstrate any beneficial effect and the slight increased mortality and morbidity associated with the bolus methylprednisolone dosage makes this therapy unjustifiable.

Clinical Trials as Topic↗
PubMed1977

Prevention of transplant renal artery stenosis.

Transplant renal artery stenosis occurred in 17 of 142 consecutive transplants (12 percent). All stenoses were in the renal artery distal to the anastomosis and two separate forms are recognized: angulation and segmental stenosis. Successful surgical correction in 12 of 17 patients relieved the hypertension and resulted in improved renal function. No patients receiving dipyridamole, a drug which inhibits platelet aggregation and intravascular fibrin deposition, developed segmental renal artery stenosis. No other factors could be identified which were important in either causing or preventing renal artery stenosis. Since intrarenal vascular changes are an integral aspect of rejection, the protection afforded by dipyridamole against segmental renal artery stenosis indicates that segmental stenosis is probably a manifestation of rejection.

Cadaver↗
PubMed1976

Interaction of rifampin and glucocorticoids. Adverse effect on renal allograft function.

Three renal transplant patients experienced progressive loss of renal allograft function during rifampin treatment for Mycobacterium tuberculosis. Previous studies have shown that rifampin causes induction of enzymes in hepatic microsomes that increase the catabolism of glucocorticoids. Evidence is presented that in our patients, the loss of renal allograft function during rifampin therapy was the result of decreased glucocorticoid effect presumably related to increased catabolism of the glucocorticoid drug they received. Thus, the adverse effects of rifampin on renal transplant function might be overcome by increasing the dose of glucocorticoid drug.

Adult↗
PubMed1976

Clinical efficacy of adenine arabinoside in therapy of cytomegalovirus infections in renal allograft recipients.

Three renal allograft recipients, two with cytomegalovirus pneumonia and one with cytomegalovirus retinitis, were treated with adenine arabinoside. The dose was 5-10 mg/kg per day administered for four to six days. There was no clinical improvement in any of the patients. One patient died from overwhelming interstitial viral pneumonia. Cytomegalovirus was readily isolated from two patients after therapy (autopsied lung of one and the saliva of the other). Suppression of viruria was observed and quantitated in one patient (10(4.0)-10(2.5) 50% tissue culture infective doses/0.2 ml). However, the suppression was transient, and viral titers returned to the levels before therapy within two months after completion of therapy. Treatment was stopped in two cases when hematologic toxicity (drop in hematocrit and platelet and leukocyte counts) was noted in the patients five days after initiation of therapy with adenine arabinoside. The drug appears to be ineffective and possibly toxic in immunosuppressed renal allograft recipients infected with cytomegalovirus.

Adult↗
PubMed1976

Suppressor activity of the human spleen and thymus.

Both the spleen and thymus of man contain a population of cells which can suppress the mixed lymphocyte reaction. Splenic cells suppress the MLC 58 +/- 4.8 percent, and the thymus is able to suppress the MLC 90 +/- 2.6 percent. However, splenic cells require stimulation by vegetable mitogens before suppressor activity can be observed, and the thymus displays spontaneous suppressor activity without prior stimulation. The suppressor effect is linearly related to the log of the cell dose (r = 0.8, p less than 0.01), and at low doses the suppressor cells stimulate rather than inhibit the MLC. The cells are exquisitely sensitive to immunosuppressive drugs, and blood levels encountered in clinical organ transplantation abrogate their suppressive activity. The suppressive activity of the cells is nonspecific, and they are able to inhibit the MLC between individuals totally unrelated to the spleen or thymus donor. Since these cells likely play a role in the development of tolerance, further characterization of their properties is required.

Histocompatibility Testing↗
PubMed1976

Immunological responses in identical twins with renal transplants from a common donor.

Two identical twins suffering from end stage renal failure due to chronic pyelonephritis received cadaver renal allografts from one donor. Immune status was measured in both by in vitro responses to vegetable mitogens and by reactivity in mixed lymphocyte culture with a random volunteer. Both patients underwent rejection episodes at different times; these were of differing severity. Reactivity to PHA and in MLC was minimal during rejection and increased following recovery in spite of continued high levels of immunosuppression. In contrast, reactivity to pokeweed mitogen and concanavalin A increased at the time of rejection and fell with recovery. The changes seen in the twins, while qualitatively similar, differed in magnitude and timing. It is concluded that environmental factors as well as histocompatibility play a part in influencing immune responsiveness, and that studies of immune responsiveness should be interpreted with caution in the management of renal allograft recipients.

Diseases in Twins↗
PubMed1975

The human splenic suppressor cell.

Studies of human spleen cell suspensions show that they contain a population of cells which can inhibit the mixed lymphocyte reaction. The cells appear to be able to suppress the patient's own response to an antigenic challenge in slightly greater degree than their ability to suppress a nonspecific mixed lymphocyte culture. The suppressive effect is dependent on cell dose and is linearly related to the log of cell concentration. At low dose these cells have no suppressive effect and, in fact, behave as stimulators. Exposure of these cells to an environment containing immunosuppressive drug abrogates their suppressor activity. Manipulation of these cells may prove to be of value in the control of graft rejection.

Azathioprine↗
PubMed1975

Homotransplant renal artery stenosis.

Transplant renal artery stenosis occurred in 12 of 101 consecutive kidney transplants. Stenoses were all located in the renal artery distal to the anastomosis. Two separate forms of stenosis are recognized: angulation and segmental. All transplant patients with severe diastolic hypertension, refractory to medical management, and an audible abdominal bruit should undergo angiography. Surgical correction of the stenosis was accomplished in nine of 12 patients with cure of their hypertension.

Angiography↗