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Biomedical subjects

J A Light

Publications and source records attributed to J A Light.

At least 19 recordsLinked to original sources
PubMed1992

Experience with schistosomiasis in renal transplantation.

Schistosomiasis involving the urinary tract has only occasionally been reported in North American literature and rarely from American hospital experience. Chronic infection may result in numerous abnormalities of the urinary tract which may interfere with the function of a transplanted kidney. Our institution has performed a number of renal transplants in patients who are from countries where schistosomiasis is endemic. Six patients in our group had evidence of schistosomal disease during their pretransplant evaluation and were appropriately treated. None of these patients had postoperative complications attributable to the schistosomal disease. We recommend that all patients who are from areas where urinary schistosomiasis is endemic undergo a cystoscopic examination and bladder biopsies in addition to the routine pretransplant urologic evaluation.

Adult↗
PubMed1990

Renal transplantation at the Washington Hospital Center: experience with OKT3 and Minnesota antilymphoblast globulin for induction of immunosuppression.

These data demonstrate excellent long-term patient and graft survival rates when cytolytic induction therapy is combined with sequential addition of CsA. OKT3 and MAG produce virtually indistinguishable outcomes with low rates of rejection and DGF. The frequency of serious posttransplant complications, infection, rejection, and malignancy was low. Although both MAG and OKT3 are effective, each has its drawbacks. Problems associated with MAG therapy are leukopenia, thrombocytopenia, cumbersome administration, and difficulty monitoring the patient's specific level of induced immunosuppression. OKT3 is simpler to administer, easy to monitor, but first dose reactions may produce additional graft injury. Furthermore, OKT3 may not protect completely against all mechanisms of cellular rejection. In our patient population, the best results occurred when kidneys functioned immediately, when CsA was introduced promptly, and when there were several days of overlap, with MAG or OKT3, especially when OKT3 was used as the induction agent.

Adult↗
PubMed1989

Renal transplantation from a blood group A1B donor to an A2B recipient: a case report.

This case report describes the transplantation of a kidney from an A1B donor to a recipient who was blood group A2B. The donor/recipient pair were ABO mismatched but compatible. In the majority of cases, A1 antibodies fail to react at 37 degrees C and are of no clinical significance. However, hemolytic transfusion reactions due to A1 antibodies active at 37 degrees C have been reported but are extremely rare. When the opportunity for transplantation arose for this patient, who had received multiple blood transfusions because of dialysis, the question of safety concerning the subject of transplanting across ABO sub-grouping mismatches was presented. Inquiries regarding this matter proved fruitless and the transplant was performed mainly due to the lack of preformed anti-A, antibodies in the recipient at the time of transplant. It was hoped that the A2B recipient would fail to make an anti-A1 antibody due to antigen exposure or if it did, would not pose a hazard to the allograft. Therefore we present our experience with a patient who was successfully transplanted across an ABO incompatible sub-grouping, A1B allograft to an A2B recipient.

ABO Blood-Group System↗
PubMed1989

Changes in lymphocyte subset distribution aid in the differential diagnosis of renal allograft dysfunction.

The distribution of selected lymphocyte subset populations in renal transplant patients was used to assist in the differential diagnosis of graft dysfunction. Patients experiencing dysfunction due to rejection showed consistent and significant decreases in relative numbers of CD 8 (cytotoxic/suppressor) lymphocytes. The ratio of CD 4 cells to CD 8 cells in this group of patients was generally greater than 2.00 due to decreases in CD 8 cells. Patients showing graft dysfunction due to viral infections showed consistent and significant increases in CD 8 cells which also bear the HNK-1 or the HLA-Dr determinants. Serial monitoring for these dual-marked lymphocytes on a weekly basis can be of considerable use in determining the etiology of graft dysfunction. Increases in other "activation" markers, including transferrin receptors, CD 38, and a T cell lineage specific activation antigen (TLiSA) were not specific for rejection; in fact, increases in CD38 were more often associated with viral infections. These studies indicated that lymphocyte subset determinations done on a regular basis can help distinguish graft dysfunction due to viral infections from other causes. The ability to distinguish rejection episodes from stable grafts is less obvious. Although the alterations in lymphocyte subset distribution are not entirely specific, they can distinguish viral infections from rejection.

Diagnosis, Differential↗
PubMed1989

Quadruple immunosuppression: comparison of OKT3 and Minnesota antilymphocyte globulin.

From May 1977 to June 1988, 110 patients receiving cadaveric kidney transplants were selected to receive Orthoclone (OKT3; Ortho Pharmaceutical Corporation, Raritan, NJ; 5 mg intravenous bolus) (n = 43) or Minnesota antilymphocyte globulin (MAG; 20 mg/kg/day) (n = 67) as the induction phase of a quadruple immunosuppressive protocol. The duration of treatment ranged from 5 to 16 days for OKT3 (mean, 8 days) and 7 to 14 days for MAG (mean, 9 days) as dictated by the postoperative recovery of renal function. All patients were followed-up for at least 3 months (maximum, 18 months; mean, 10 months). Of the 43 patients receiving OKT3, 11 (26%) had rejection episodes that were reversed and did not reoccur. Two patients had episodes that could not be reversed, resulting in graft loss. Of the 67 patients receiving MAG, 38 (57%) experienced a first rejection episode within the follow-up period; 16 of these had repeat rejections. Renal function was significantly better in the OKT3 group. Although both OKT3 and MAG were associated with excellent patient (98%) and graft (92%) survival, OKT3 was easier to administer with fewer rejection episodes. It was concluded that OKT3 is superior to MAG as perioperative cytoreductive therapy following cadaveric kidney transplantation.

Adult↗
PubMed1989

Comparison of Minnesota antilymphocyte globulin and OKT3 for induction of immunosuppression in renal transplant patients.

From May 1977 to April 1988, 88 patients receiving cadaveric kidney transplants were selected to receive Orthoclone (OKT3; 5 mg intravenous bolus) (n = 28) or Minnesota antilymphocyte globulin (MAG; 20 mg/kg/day) (n = 60) as the induction phase of a quadruple immunosuppressive protocol. The duration of treatment ranged from 5-16 days for OKT3 (mean, eight days) and 7-14 days for MAG (mean, nine days), as dictated by the post-operative recovery of renal function. All patients were followed for at least four months (maximum 16 months, mean 10 months). Of the 28 patients receiving OKT3, six (21%) had rejection episodes which wre reversed and did not reoccur. Two patients developed OKT3 antibody. Only one graft was lost to rejection. Of the 60 patients receiving MAG, 30 (50%) experienced a first rejection episode within the follow-up period; 15 of these had repeat rejections. Three allografts were subsequently lost in the MAG group. Renal function was significantly better in the OKT3 group. While both OKT3 and MAG were associated with excellent patient (98%) and graft (92%) survival, OKT3 was easier to administer with fewer rejection episodes. We conclude that OKT3 is superior to MAG as perioperative cytoreductive therapy following cadaveric kidney transplantation.

Adult↗
PubMed1988

The utility of cytodiagnostic urinalysis for monitoring renal allograft injury. A clinicopathological analysis of 87 patients and over 1,000 urine specimens.

Cytodiagnostic urinalysis was tested to determine its utility in the evaluation of allograft dysfunction in renal transplant patients. Specimens were prepared using the Papanicolaou stain on cytocentrifuge preparations of standardized quantities of urine. Differential counts of blood cells (neutrophils, lymphocytes, red cells), renal tubule cells (convoluted, collecting duct, necrotic), and casts (i.e. hemoglobin, renal tubule cell) were included in the sediment evaluation. Receiver operating characteristic curves demonstrated collecting duct cell exfoliation at 20 per 10 hpf to be a more sensitive and specific reflector of acute rejection than lymphocytes at their optimum decision point of 13 per 10 hpf. Sixty-four percent of cytodiagnostic urinalysis diagnoses preceded the clinical diagnoses. Ciclosporin nephrotoxicity was differentiated by the exfoliation of renal tubule convoluted cells in excess of collecting duct cells. The advantages of this technique over membrane-filter or phase-microscopic techniques for examining urine sediment of both transplant and nephrology patients include improved sensitivity and specificity in identification of sediment elements and reliable quantitative data for use in detecting renal disease and for monitoring therapy.

Cyclosporins↗