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J K Kievit

Publications and source records attributed to J K Kievit.

11 recordsLinked to original sources
PubMed1999

Kidney preservation in the next millenium.

For the past decades, severe hypothermia has represented the foundation of organ preservation in clinical transplantation. Beneficial as hypothermia has proven to be in preserving grafts from heart-beating donors, hypothermia does not seem to provide the window necessary for the prospective evaluation of organ function. With the increasing use of non-heart-beating donors, it is logical to propose that if organs are to be evaluated prospectively, it will be necessary to preserve them at warmer temperatures. Since both glomerular and tubular functions are inhibited at temperatures below 18 degrees C, such a goal will necessitate organ preservation at a temperature above 20 degrees C. The principle of preservation at warmer temperatures is not new, but with future developments and approaches, successful realization appears within reach. In this overview, a brief history of previous attempts at warm preservation, in the context of the current status of kidney preservation, is presented. Future developments and approaches, with the potential for prospective testing of the function and enhanced resistance to ischemic damage, will be discussed.

Animals↗
PubMed1999

The value of dextran 12,000 in ischemically damaged canine kidneys during machine perfusion.

The use of non-heartbeating (NHB) donor kidneys has led to the search for new methods of viability-testing. We investigated, in a canine model, the relationship between the filtration of dextran 12, 000 into urine and a certain period of warm ischemic time (WIT) during machine perfusion. Twenty-four canine kidneys were divided into three groups, sustaining 0 min, 30 min or 60 min of WIT. After cooling and flushing, the kidneys were perfused on a perfusion machine for 8 h. Three hundred milligrams of dextran 12,000 was added to the perfusate. In the perfusate, dextran and lactate dehydrogenase (LDH) concentrations were measured. Dextran concentrations were also analysed in urine. Intrarenal vascular resistance (IRR) was calculated from pressure and flow characteristics. The 30WIT group showed a higher dextran excretion rate than the other two groups. IRR and LDH measurements showed lower levels in the ischemic groups compared with the control group. Dextran 12,000 is not suitable as a viability test but does show interesting results regarding the low LDH and IRR levels in the ischemic groups.

Animals↗
PubMed1998

Outcome of machine-perfused non-heart-beating donor kidneys, not allocated within the Eurotransplant area.

UNLABELLED: Eleven non-heart-beating (NHB) donor kidneys considered vital during machine perfusion (MP), could not be allocated inside Eurotransplant (ET). With the help of ET, five kidneys were transplanted in Karachi and six in Basel. Our goal was to prove that NHB kidneys successfully passing MP viability tests can be transplanted safely. METHODS: Donor age, serum creatinine (some post-mortem) and warm ischaemic time were, respectively, (mean and range): 44 (14-70) years, 137 mumol/l, and 44 (9-80) min. Reasons for refusal were: bold ureter (one), suboptimal flush (one), relatively long hypotensive phase (seven), and donor age of 70 years (two). After 8 h of MP, mean lactate dehydrogenase, intrarenal resistance and alpha glutathione S-transferase were (including range): 556 U/l (range 366-819 U/l), 0.86 mmHg/ml per min (0.41-1.15 mmHg/ml per min) and 1188 micrograms/l (575-2677 micrograms/l), respectively. Mean cold ischaemic time was 45 (range 28-72) h. RESULTS: Two kidneys showed immediate function, and nine showed delayed function. Mean creatinine levels after 1, 3 and 6 months were 295, 200 and 206 mumol/l, respectively. Four patients died for reasons not related to their kidney transplantation. CONCLUSIONS: We claim that MP can successfully assess viability of NHB donor kidneys. The reluctance to accept MP, and judged vital, NHB donor kidneys is not longer justified.

Adolescent↗
PubMed1998

Non-heartbeating donors: are they worth the effort?

This review on non-heartbeating donation focusses on three issues: the number of kidneys procured from a non-heartbeating donor programme, the transplant results and the influence of a non-heartbeating programme on public opinion regarding transplantation.

Cadaver↗
PubMed1997

The non heart-beating donor.

Given the shortage of donor kidneys for transplantation, we have focused on the use of non heart-beating (NHB) donor kidneys since 1982. The major drawback for the use of NHB donor kidneys is the inherent possibility of severe ischaemic damage leading to primary non function. Thus viability assessment of ischaemically damaged kidneys is crucial, and, therefore, a machine perfusion programme was reinstituted in 1993. Machine perfusion (MP) enables viability assessment through analysis of perfusion characteristics and measurement of enzyme release into the perfusate. Of the last 100 consecutive MP NHB donor kidneys, 71 kidneys were transplanted and 29 kidneys were discarded. Nine kidneys started functioning immediately, 51 kidneys showed delayed function and 11 kidneys never functioned. When analysing in retrospect different parameters for viability assessment, only alpha-GST, an enzyme specific for damage of proximal tubular cells within the kidney, could discriminate between functioning and non-functioning kidneys. With this promising viability assessment, the large NHB donor potential and the good transplant results, we recommend the use of these donors.

Adult↗
PubMed1995

The iontophoresis of fentanyl citrate in humans.

BACKGROUND: Iontophoresis is a method of transdermal administration of ionizable drugs in which the electrically charged components are propelled through the skin by an external electric field. This study was designed to determine whether iontophoresis could be used to deliver clinically significant doses of fentanyl in humans and whether there is a charge-dose relation in the delivery of fentanyl by iontophoresis. METHODS: Five adult volunteers were tested three times on separate days, once receiving passive treatment of 0.0 mA for 2 h (0 mA.min), iontophoresis 1.0 mA for 2 h (120 mA.min), and iontophoresis 2.0 mA for 2 h (240 mA.min) in an open, randomized, crossover design. Respiratory rate, heart rate, blood pressure, and hemoglobin oxygen saturation were monitored throughout the study. Plasma fentanyl concentrations were measured several times before, during, and after iontophoresis. Plasma fentanyl concentrations were measured by radioimmunoassay. RESULTS: No fentanyl was detected after passive (0.0-mA) fentanyl delivery. The following results were obtained for the 1.0- and 2.0-mA deliveries, respectively. Mean times to detectable concentrations of plasma fentanyl were 33 and 19 min; mean times to maximum concentration were 122 and 119 min; maximum concentrations were 0.76 and 1.59 ng/ml (P = 0.010); mean areas under the curve of the plasma fentanyl concentration versus time relation were 233 and 474 ng.ml-1.min (P = 0.003); and mean elimination half-lives were 354 and 413 min (P = 0.326). Only minor adverse side effects related to iontophoresis occurred. However, typical opioid-related effects occurred frequently in the 1.0- and 2.0-mA administration groups. CONCLUSIONS: Clinically significant doses of fentanyl can be administered by iontophoresis for delivery periods of 2 h. A charge-dose relation exists after administration with currents of 1.0 and 2.0 mA. Future research into the iontophoresis of fentanyl as a method of potent opioid administration is indicated.

Adult↗
PubMedDate not supplied

The importance of non-heart-beating donor kidneys in reducing the organ shortage.

For over two decades kidney transplantation has been the treatment of choice for end-stage renal disease. Better immunosuppressive drugs with less side effects, superior infection control and sensitive methods detecting rejection episodes in an early phase are to be credited for these transplantation results. Besides improving quality of life of the recipient, kidney transplantation compared to dialysis is cost-effective.

Cost-Benefit Analysis↗