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Biomedical subjects

I Fehrman

Publications and source records attributed to I Fehrman.

At least 19 recordsLinked to original sources
PubMed1992

Living donor nephrectomy. Complication rates in 490 consecutive cases.

490 living donor nephrectomies were performed during a 25-year period, all through a retroperitoneal approach. In this report, short-term complications and donor renal function are analysed. There was no mortality. The major complication rate was 1.4%. There were 5 cases of postoperative haemorrhage requiring reoperation, one of which developed non-A-non-B hepatitis. There was one case each of septicemia and pulmonary embolism. All these patients recovered. Minor complications were noted in 13.6% of the cases, mostly bacteriuria or minor pulmonary infiltrates. There were 5 cases of reversible heart disorders and 6 cases of mental disorders. After 6-12 months, all donors had satisfactory function of the remaining kidney, which had increased its GFR by 32-38%. We conclude that the short-term consequences of donor nephrectomy are acceptable. From previous reports, from this unit and from others, it is evident that the procedure does not carry any definite long-term health risks. With a permanent shortage of cadaveric organs and with continued superiority in the outcome of living donor transplantations, this important resource should not be disregarded.

Adolescent↗
PubMed1992

Long-term effects on lymphocytotoxic antibodies and immune reactivity in hemodialysis patients treated with recombinant human erythropoietin.

Twenty-six hemodialysis patients were given human recombinant erythropoietin to correct anemia. Eighteen patients had previously received multiple transfusions and 18 had been transfused within the preceding six months. Ten patients had lymphocytotoxic antibodies (panel reactive antibodies, PRA), measured as percent positive reactions against a panel of lymphocytes from 22 lymphocyte donors before the start of erythropoietin treatment. There was a significant decrease in mean PRA activity from 60% to 35% (p less than 0.05) during 6-18 months of treatment. Three of 26 patients received blood transfusions after the start of erythropoietin treatment, because of intercurrent disease or blood loss. Kidney transplantation was performed in four of the PRA-positive patients and in eight of the PRA-negative patients. Nine kidney transplants are currently functioning. The three graft losses were due to rejections. The lymphocyte immune reactivity measured after stimulation in MLC (mixed lymphocyte culture) against pooled lymphocytes and after PHA (phytohemagglutinin) and Con A (Concanavalin A) stimulation, was significantly lower in the hemodialysis patients than in the healthy controls (p less than 0.05). The responses did not change after correction of anemia. The number of OKM1 (Ortho's monoclonal antibody against M1 cells [monocytes])-positive cells among peripheral blood lymphocytes were significantly higher (p less than 0.001) in uremic patients than in healthy controls. After 12-18 months of treatment with erythropoietin this difference disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Impaired glucose tolerance in cyclosporine-prednisolone-treated renal graft recipients.

In 33 renal transplant patients, an intravenous glucose tolerance test (IVGTT) was performed, and fasting plasma C-peptide concentrations analyzed. Nineteen of the patients were on treatment with cyclosporine-prednisolone (CsA-Po), and 14 were treated with azathioprine-prednisolone (Aza-Po). In the Aza-Po group, the K-values at IVGTT were normal in 13/14, but in the CsA-Po group they were only normal in 9/19 (P = 0.02). The fasting C-peptide levels were significantly higher in the CsA-Po group (P less than 0.001). within this group, there was no correlation between C-peptide level and serum-creatinine concentration, i.e. retention of C-peptide due to decreased renal function as judged by serum creatinine level was not suspected. Intrinsic prednisolone clearance was determined in the CsA-Po patients and was found to be lower than that previously described in Aza-Po patients. However, between those CsA-Po-treated patients with a pathologic K-value at IVGTT and those with a normal K-value there was no difference in prednisolone clearance, fasting C-peptide levels, CsA dose, or serum-creatinine concentrations. The pathophysiology of the cyclosporine-induced glucose intolerance is uncertain, and increased insulin resistance is possible.

C-Peptide↗
PubMed1985

Increased incidence of sensitization among patients with polycystic kidney disease following pretransplant blood transfusions.

Following pretreatment with at least 5 blood transfusions to 58 nontransfused uremic patients, 23 (40%) formed lymphocytotoxic antibodies against B cells and 9 (15%) against T cells as well. Significantly more (p less than 0.01) patients with polycystic kidney disease (6/16) formed T cell antibodies compared to patients with other diseases. The presence of antibodies delayed kidney transplantation, since significantly more (p less than 0.01) patients without antibodies (28 out of 35) received kidney grafts than patients with antibodies (9 out of 23). 5 patients received kidney grafts despite the occurrence of antibodies against donor B cells, but 3 of the patients lost their grafts within 1 month. In vitro lymphocyte subpopulations were studied in 4 patients before and after each of the planned blood transfusions. No persistent changes in lymphocyte responses to phytohemagglutinin and in mixed lymphocyte culture were seen. T cell subpopulations identified by monoclonal antibodies were unchanged, but the proportion of macrophages/monocytes (OKMl-positive cells) increased from 22 +/- 6 to 46 +/- 10% (p less than 0.05).

Antibodies↗
PubMed1983

Blood transfusions as pretreatment for kidney transplantation: immunization rate and effect on cellular immune response in vitro.

A group of 28 untransfused uremic patients was given five or more units of stored blood as pretreatment for kidney transplantation; 9 patients formed lymphocytotoxic antibodies against B cells and 1 patient developed multispecific antibodies against both B and T cell panels (greater than 80% reactivity). During the same period 22 previously transfused patients received up to five transfusions as pretreatment for kidney transplantation. B cell antibodies were formed by 10 patients, and 4 of these patients also formed T cell antibodies, 2 with broad reactivity. Cellular immune reactivity in vitro was studied on frozen cells from 17 randomly chosen patients. After five blood transfusions no significant changes were seen in blood lymphocyte responses to phytohemagglutinin (PHA), Concanavalin A (Con A), or in mixed lymphocyte cultures (MLC) and cell-mediated lympholysis (CML). After transfusion 3 patients got Non-A, non-B hepatitis and were withdrawn for up to six months from the transplantation list because of increased S-ALAT and S-ASAT. Of the 50 patients, 27 have received kidney grafts, 6 out of 20 who were sensitized, and 21 out of 30 who were nonsensitized. Because of positive crossmatches no patient with multispecific T cell antibodies has received a graft. We conclude that our transfusion regimen for kidney recipients has rendered barely one-third of the patients sensitized (mostly against B cells) and 3 out of 50 hypersensitized. No effect on T cell reactivity could be seen following five planned transfusions. Because fewer patients with antibodies received grafts (30% with antibodies, as compared with 70% without [P less than 0.01]) the blood transfusions seem to have led to a selection effect.

Antibodies↗