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J Burdick

Publications and source records attributed to J Burdick.

35 records · Page 2Linked to original sources
PubMed1996

Liver transplantation for alcoholic liver disease.

UNLABELLED: Orthotopic liver transplantation (OLT) for individuals with alcoholic liver disease (ALD) remains controversial. This review was designed to evaluate the survival, recidivism, and rehabilitation of the alcoholic liver transplant recipient in a single transplant center. METHODS: Between 10/86 and 11/92 203 liver transplants were performed in 179 patients. In 42 patients (23%) the primary etiologic diagnosis was ALD (36 males, 6 females, median age 47 yr). All ALD patients were evaluated preoperatively by social service, psychiatry, and medical psychology, in addition to hepatology and transplant surgery. A minimum abstinence period of 3-6 months was encouraged, although exceptions were made for cases of extreme medical urgency in which a good prognosis for abstinence was predicted. RESULTS: In OLT recipients with ALD, actuarial survival at 1, 2, and 3 yr was 74%, 71%, and 71%, respectively, compared to 71%, 71%, and 69% for all OLT recipients. One- and two-year survival was 85% in the most recently transplanted 86 patients, 20 of whom (23%) had ALD with 1- and 2-yr survival of 84% (N.S.). Recidivism was monitored postoperatively by interviews with the patient and family, supplemented by random urine and serum toxicology. Of the 29 survivors, 2 (7%) returned temporarily to alcohol use but are presently abstinent. Although none of the ALD patients in this study was able to work prior to OLT, 76% of the survivors at least 4 months post-transplantation were employed. CONCLUSIONS: Although our experience is small, our results suggest that OLT is appropriate therapy for carefully selected patients with end-stage liver failure due to ALD. The multi-disciplinary approach to preoperative evaluation of the alcoholic liver transplant candidate is effective in determining those patients committed to abstinence after a successful transplant.

Actuarial Analysis↗
PubMed1995

FK506 (tacrolimus) compared with cyclosporine for primary immunosuppression after pediatric liver transplantation. Results from the U.S. Multicenter Trial.

We report on the efficacy and safety of FK506 (tacrolimus) compared with a cyclosporine (CsA)-based immunosuppressive regimen after 1 year of treatment in pediatric liver allograft recipients (< 12 years) participating in a multicenter U.S. randomized trial. Patients received either FK506 or CsA as primary immunosuppression following a first ABO-compatible liver transplant. Intravenous FK506 was initiated at 0.1 mg/kg per day, followed by oral FK506 beginning at 0.3 mg/kg per day. The dose was adjusted to maintain plasma trough levels of 0.5-2.0 ng/ml. The CsA group was treated according to each center's usual protocol. Both groups received the same initial doses of corticosteroids. All rejection episodes were biopsy-proven and a standardized algorithm was adopted for the treatment of rejection. Thirty patients were randomized to the FK506 group and 20 to the CsA group. After twelve months of follow-up 20 patients remained in the FK506 group and 13 in the CsA group. Patient survivals were 80% and graft survival 70% in the FK506 group compared with 81% and 71% respectively, in the CsA group. 48% of the FK506 group remained rejection-free compared with 21% of the CsA group, and 79% of FK506-treated patients did not require OKT3 compared with 68% of CsA treated patients. The cumulative corticosteroid dose was less at each time point throughout the first year in the FK506 group. The incidence of serious and minor infections was similar in both groups. Nephrotoxicity, neurotoxicity, and gastrointestinal disturbances were the major toxicities reported. Differences did not reach statistical significance between the two groups although major neurologic events, diarrhea and dyspepsia were more often reported in the FK506 group. There was no difference in mean serum creatinine at 12 months between the two groups. There was a tendency toward lower mean serum cholesterol in the FK506 group. There was no hirsuitism in the FK506 group compared with a 30% incidence in the CsA group. In conclusion, compared with CsA, there is a trend toward less rejection in FK506-treated pediatric allograft recipients, while both drugs have a similar spectrum of side effects.

Adrenal Cortex Hormones↗
PubMed1995

Proximal renal tubular acidosis secondary to FK506 in pediatric liver transplant patients.

We hereby report our experience with an index case of a pediatric liver transplant patient in whom FK506 administration was associated with the development of proximal renal tubular acidosis (RTA), as well the prevalence of acidosis and renal dysfunction in all pediatric liver transplant patients in our institution followed long term during a 6-year period. Data were grouped according to immunosuppressant regime: cyclosporine (CsA) only, FK506 only, or CsA with conversion to FK506. A 23-month-old female treated with FK506 after orthotopic liver transplantation (OLT) performed 15 months earlier presented with a 1-wk history of fever, watery diarrhea and metabolic acidosis. Although the acidosis did not improve following correction of her hydration status, administration of oral bicarbonate was effective. Discontinuation of this therapy resulted in acidosis. Since other indirect measurements of renal tubular function were normal, the patient was judged to have an isolated proximal RTA. In our group of pediatric liver transplant patients converted from CsA to FK506, FK506 administration was associated with a decline in serum bicarbonate (19 +/- 1 vs. 16 +/- 1 mEq/l, p < 0.02); neither blood urea nitrogen nor serum creatinine differed between the two groups. The number of rejection episodes/patient/month was comparable, allowing clinically relevant comparison of relative drug nephrotoxicities. We conclude that proximal RTA may be a relatively common treatable complication of FK506 administration in children.

Acidosis, Renal Tubular↗
PubMed1994

A new percutaneous technique for establishing venous bypass access in orthotopic liver transplantation.

Partial veno-venous bypass (VVB) is commonly used in orthotopic liver transplantation (OLT). Venous access for blood return during VVB classically uses a surgical cutdown on the left axillary vein (LAV), which may prolong operating time and can be associated with significant complications. The authors have developed an alternative means of establishing venous access whereby the anesthesia team places 8.5F venous cannulae preoperatively in one or two vessels (internal jugular, antecubital, or subclavian) percutaneously using the Seldinger technique. These cannulae then serve to accept venous return from below the diaphragm via a centrifugal pump. The aim fo the present study was to compare the hemodynamic profiles obtained during the anhepatic phase of OLT in patients in whom either a conventional LAV catheter (group 1) or percutaneous catheters (group 2) were used for return flow from a centrifugal pump. There were no identifiable complications related to venous access in either group of patients. Total operating room time was 800 +/- 30 minutes in group 1 and 720 +/- 40 minutes in group 2 (P = 0.17). Hemodynamic parameters were determined from continuous strip chart recordings of arterial, right atrial, and inferior vena caval (IVCP) pressures. Cardiac output (CO) was measured by thermodilution whereas pump flow was determined by an electromagnetic probe. Renal perfusion pressure (RPP) was calculated as the difference between mean arterial pressure (MAP) and IVCP. Bypass pump flow was greater, but not significantly different between group 1 (3.0 +/- 0.2 L/min) and group 2 (2.4 +/- 0.2 L/min) (P = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)

Axillary Vein↗
PubMed1991

Vascularized muscle allografts and the role of cyclosporine.

This study examined the fate of vascularized muscle allografts using a genetically defined rat model. Its purposes were (1) to analyze the histologic/immunologic responses, (2) to study the effect of cyclosporine on graft survival, and (3) to examine the possibility of inducing tolerance. In rats differing at a major histocompatibility locus, vascularized gastrocnemius muscle transplants were performed based on the sural branches of the femoral artery and vein. Forty-two animals studied were divided into three groups: Group 1, allografts, was treated without cyclosporine; Group 2, allografts, was administered continuous cyclosporine; and Group 3, allografts, was administered cyclosporine for 6 weeks only. Evaluation consisted of gross examination, H&E histology, and immunologic studies (MLC, CML, and complement-dependent 51Cr lysis assay). Lytic units (LU) were derived from the assays and served as the indicator of immune response. Group 1 animals had uniform rejection with intense cell-mediated response (LU 23 to 47) and low humoral response. Group 2 animals had viable allografts throughout with suppressed lytic unit values of 0 to 9 initially, which rose to 14 to 29 at 6 weeks despite continuous cyclosporine treatment. Group 3 animals showed rejection similar to the untreated animals. Autografts were performed as controls and survived indefinitely. Analysis of variance was significant at p less than 0.05. Using a reliable rat model for vascularized muscle allografts, we found that in transplantation across a major histocompatibility barrier, the initial immune response was primarily cell-mediated. Cyclosporine suppressed rejection only when given continuously, and short-term cyclosporine treatment did not induce a tolerant state. These data should be useful for future studies of vascularized muscle allografts.

Animals↗
PubMed1981

Mural thrombus of the aorta: an important, frequently neglected cause of large peripheral emboli.

The association between white thrombus in the aorta and multiple embolic occlusions of peripheral vessels was made 22 years ago. However, mural thrombus has been neglected as a major cause of embolus because the process was attributed to paradoxical effects of heparin. Our recent experience indicates it is a more generalized problem. During the past five years, AP and lateral abdominal aortograms demonstrated the presence of large filling defects within the lumen of the aorta in 20 of 39 patients with sudden occlusion of a distal artery. Thirteen patients were not on heparin. These 3.4 X 1-2 cm defects were present anywhere from T-10 to the aortic bifurcation and were suprarenal in ten patients. The 20 patients had a total of 36 separate embolic events, with five patients experiencing seven occlusions of renal or superior mesenteric arteries. Serious medical problems coexisted, and all patients had at least two of five important "risk factors." These were heart disease, recent thrombophlebitis, heparin therapy, abdominal atherosclerosis and postoperative status. Catheter embolectomy alone was associated with recurrent embolization in four of six patients. Three patients died and two required amputation. Of 12 patients treated by embolectomy combined with open aortotomy, recurrent embolization occurred in none, death in one and amputation in two. All patients with visceral artery occlusions survived with normal function of the previously occluded structure. We urge wider application of abdominal angiography in order to treat more appropriately a sizable proportion of patients whose distal emboli originated from large chunks of white thrombus in the abdominal aorta.

Aged↗
PubMed1980

The extended retroperitoneal approach for treatment of extensive atherosclerosis of the aorta and renal vessels.

The aorta was exposed by a standard "nephrectomy" incision through the eleventh interspace in 53 patients with aneurysmal or occlusive disease. The plane posterior to the kidney and ureter was developed easily, enabling exposure of the aorta above the level of the celiac axis to its bifurcation by dividing only the crus of the diaphragm and the lumbar branch of the left renal vein. Twenty-five patients with abdominal aortic aneurysms were treated in this fashion. In all but four there were significant risk factors, including extension of the aneurysm to or above the level of the renal arteries in eight and coexisting renal artery stenosis with hypertension in two. Twenty-eight patients with occlusive vascular disease were treated surgically. In eight, this was the second operation on the aorta while in 11, major occlusive disease involved the aorta as well as the renal/visceral arteries. The operative mortality rate was 8%. Eighty-nine percent of the patients were alive at this writing. Of 18 hypertensive patients, 9 were not taking medication and only 3 have not improved significantly. We recommend this approach for reoperations on the aorta and for patients who have extensive aneurysmal and/or occlusive disease of the aorta, renal, and visceral arteries.

Adolescent↗