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J R Ackermann

Publications and source records attributed to J R Ackermann.

At least 19 recordsLinked to original sources
PubMed1996

Flow cytometry crossmatching and primary cadaver kidney graft outcome: relevance of T and B cell targets, historic sera and autologous controls.

There is limited information regarding the role of flow cytometry crossmatching (FCXM) in primary cadaver kidney allografting and even less about B cell reactivity and graft survival (GS). Furthermore, there is little or no published data concerning reaction strength (cutoff value), the effect of historic sera reactions, and the usefulness of performing autologous crossmatches (XMs) on GS. These factors were examined retrospectively on 214 primary transplants performed from August 1991 to January 1994 with follow-up to July 1995. Three-color FCXMs were done on a 1024-channel BD-FACScan, and the shift in median channel fluorescence (MCF) over the negative control was calculated. All patients had a negative T cell (AHG) and warm B cell (2 was, extended incubation) cytotoxicity XM, and none was excluded in calculating GS. A quantitative effect was noted as stronger MCF shifts vs. T or B cells correlated with decreased GS (r = 0.98 and 0.92, respectively). Significant differences were seen with cutoff values of T = 50 and B = 110 which were 1.7-1.8 times the SD above the mean MCF of normal sera controls T neg patients (n = 198) and 1- and 3-yr actuarial GS of 86% and 79% compared to T pos patients (n = 16) of 75% and 49%, p = 0.008. B neg patients (n = 177) had 1- and 3-yr GS od 86% and 81% compared to B pos patients (n = 37) of 78% and 47%, p = 0.005. Most informative was the analysis of combined T and B cell FCXM results. Three years GS for T neg - B neg patients (n = 171) was 81% and for T pos - B neg patients (n = 6), it was 83%, p = 0.98. The 27 T neg - B pos group's GS was lower at 62% but did reach significance. Poorest GS was seen for T pos - B pos patients (n = 10) at 23%, p = 0.0001. Reaction patterns showed that T cells detected only HLA Class I antibodies, whereas B cells detected both Class I and II. Historic sera (> or = 1 month old) reactivity influenced GS. Patients with > or = 2 past sera positive but current serum negative reactions vs. T or T plus B cells (n = 7) had a poor 29% GS, while those historically positive only vs. B cells (n = 7) had 100% GS. On the other hand, patients positive only with the current serum (n = 16) had 2-yr GS of 100% (false positive test?), while patients whose current and historic sera reactions were positive (n = 21) had a 25-50% GS (true positive test?). About 1 in 15 patients (19%) displayed positive autologous FCXM reactions. Subtraction of autologous MCF shift values from those vs. the donor converted 17 patients to the T neg - B neg or T pos - B neg group whose 2-yr actual GS was not significantly different (p > 0.8) from those initially testing T neg B neg vs. their donors.

Actuarial Analysis↗
PubMed1994

Sclerosing peritonitis.

Sclerosing peritonitis (SP) is an uncommon and devastating problem which involves the visceral and parietal peritoneal surfaces of the abdominal cavity. SP has been reported in association with peritoneal dialysis, with medications, and following peritonitis. No clear etiology or preventative treatment exists for this unusual problem. Herein, we report 3 cases with the unusual aspect of apparent progression of this fibrotic and sclerosing process after the termination of the peritoneal dialysis and successful renal transplantation. Each of these cases resulted in a mechanical small bowel obstruction secondary to a densely fibrosing and encasing peel of reactive connective tissue visibly different from the usual postoperative adhesions. Sclerosing peritonitis should be included in the differential diagnosis of a current peritoneal dialysis patient who exhibits signs of partial small bowel obstruction with a continual decrease in peritoneal clearance and/or successfully transplanted patients who had utilized peritoneal dialysis therapy in the past and now exhibit signs and symptoms of a mechanical small bowel obstruction.

Adult↗
PubMed1992

Hyperacute and acute kidney graft rejection due to antibodies against B cells.

Because of the perception of its uncertain clinical significance, the B cell crossmatch is not universally performed before renal transplantation. Even though sporadic cases of hyperacute rejection associated with B cell antibodies have been reported, doubts remain in light of other studies suggesting no effect on graft survival. This report describes 4 cases of graft rejection (3 hyperacute and 1 acute) that occurred in patients with anti-B-cell antibodies specific against donor HLA-DR or DQ antigens. Absence of anti-donor class I antibodies was confirmed in all cases by 2-color flow cytometry. Strong evidence for an antibody-mediated mechanism was found in one patient with anti-class I and anti-class II antibodies in serum transplanted with a class II mismatched kidney. In this case, only anti-class II antibodies were recovered in the eluate of the nephrectomy specimen. These four cases were compiled from three different institutions over a four-year period, which confirms the infrequent occurrence of these events. While anti-class II antibodies may not always be detrimental for graft survival, these results also confirm that they have the potential to cause hyperacute or acute graft loss. We conclude that the information provided by the B cell crossmatch should be available at the time that a decision to proceed with a renal transplant is made.

Adult↗
PubMed1991

Extension of the right renal vein in cadaveric renal transplants with use of the vena cava and the TA-30 V3 surgical stapler.

The aforementioned technique offers an expeditious and safe means of extending the cadaveric right renal vein for 3 to 5 centimeters, while greatly minimizing the ischemic time of the kidney during preparatory dissection. The cuff of the cadaveric right renal artery can also be preserved, and the danger of kinking of the arterial graft is minimized. Our experience has shown that separation of the left renal vein 3 to 4 millimeters away from the vena cava allows a left renal vein of adequate length for transplantation of the left kidney. Between June 1985 and August 1989, we have used this technique successfully in more than 120 cadaveric right renal transplants and have seen no vascular complications attributable to the stapled conduit of the vena cava.

Anastomosis, Surgical↗
PubMed1988

Four-year experience with exclusive use of cytomegalovirus antibody (CMV-Ab)-negative donors for CMV-Ab-negative kidney recipients.

Because of unacceptable CMV related morbidity, mortality, and graft loss, we adopted a policy that (-) patients would receive renal allografts only from (-) donors. This policy has resulted in a significant decrease in (1) morbidity (10.6% v 1.7%, P less than .0001), (2) mortality (3.7%) v 0%, P = .002), and (3) graft loss (2.5% v 0%, P = .016). CMV-Ab-negative patients (1) constitute 26% of all patients tested (compared with 36% of all donors tested), (2) receive transplants at the same rate as (+) patients, (3) do not have a prolonged waiting time, and (4) received greater HLA-A, B, -DR mismatched kidneys (3.6 v 3.1, P less than .01).

Antibodies, Viral↗