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L Uber

Publications and source records attributed to L Uber.

8 recordsLinked to original sources
PubMed1998

Assessment of function and survival as measures of renal graft outcome following kidney and kidney-pancreas transplantation in type I diabetics.

Reports on renal graft outcome after kidney-alone (KA) and simultaneous pancreas-kidney (SPK) transplants have focused on graft survival instead of function. The aim of this study is to compare renal graft outcome after KA and SPK using graft function and survival as the measures of outcome. The records of 102 transplants performed in type I diabetics from 10/90 to 9/96 were reviewed (SPK 42, KA 60). Serum creatinine (Cr) and calculated glomerular filtration rate (GFR) were used as estimates of graft function. Cr were similar in SPK and KA on day 3 (4.8 +/- 2.9 vs. 4.8 +/- 2.8 mg/dl, P = 0.9) and day 7 (2.5 +/- 1.8 vs. 3.0 +/- 2.5 mg/dl, P = 0.3). GFR was higher KA at 6 months (57 +/- 18 vs. 51 +/- 12 ml/min, P = 0.08), 1 yr (55 +/- 23 vs. 51 +/- 11 ml/min, P = 0.4) and 3 yr (60 +/- 22 vs. 42 +/- 16 ml/min, P = 0.03). Kidney graft survival was similar in KA and SPK at 1 and 5 yr (87% vs. 89% and 44% vs. 47%, P = 0.8). Immunologic failure of the renal graft occurred more frequently in SPK (58% vs. 48%, P = 0.04) whereas death with function was more common in KA (33% vs. 17%, P = 0.04). In KA, risk factors for failure of the renal graft included acute rejection (P = 0.008, relative risk or rr = 3.4) and African American recipient (P = 0.06, rr = 2.8). In SPK, risk factors included donor age > 40 yr (P = 0.05, rr = 5.3) and African American donor (P = 0.03, rr = 4.5). Logistic regression analysis revealed the following risk factors for GFR < 50 ml/min at 1 yr: acute rejection (P = 0.03, rr = 2.2) and Cr > 3 mg/dl on day 7 (P = 0.06, rr = 2.3). In conclusion, although renal graft survival was similar after KA and SPK, better graft function was observed in KA at 3 yr. Assessment of renal graft function allows us to evaluate outcome from a different perspective than graft survival, and these two measures of outcome complement each other.

Adult↗
PubMed1996

Prostaglandin E1 administration following orthotopic liver transplantation: a randomized prospective multicenter trial.

BACKGROUND & AIMS: Prostaglandin E1 (PGE1) has been used after orthotopic liver transplantation (OLT) based on limited clinical data suggesting PGE1 infusion improves immediate hepatic allograft function. The aim of this study was to conduct a randomized double-blinded multicenter trial to evaluate the effect of PGE1 on early hepatic and renal function in patients undergoing OLT. METHODS: One hundred eighteen patients were randomized to receive either PGE1 or crystalloid placebo intravenously after allograft revascularization. Primary end points were incidence of primary allograft nonfunction (PNF) or severe renal dysfunction. RESULTS: The incidence of PNF was 6.7% (4 of 60) and 6.9% (4 of 58) in the control and PGE1 groups, respectively. PGE1 infusion was, however, associated with improved early renal function (mean peak creatinine level of 1.4 +/- 1.0 and 2.0 +/- 1.0 in patients treated with PGE1 and placebo, respectively; P < 0.001). Severe renal dysfunction occurred more frequently in the placebo group (26.7%) than in the PGE1 group (13.8%; P = 0.65). Additionally, dialysis treatments were more frequent in the placebo group (0.7 +/- 2.0 per patient) than in the PGE1 group (0.2 +/- 1.0 per patient; P = 0.10). Initial intensive care unit stay was shorter in patients treated with PGE1 (4.0 +/- 3.6 days) compared with controls (10.5 +/- 17.1 days) (P < 0.01). CONCLUSIONS: PGE1 administration after OLT resulted in improved renal function and decreased initial postoperative intensive care unit stay but did not affect the incidence of PNF.

Adult↗
PubMed1996

The effects of prostaglandin E1 on hepatic allograft vascular inflow: a prospective randomized double-blind study.

Improved hepatic microcirculation is one of the postulated mechanisms by which prostaglandin E1 (PGE(1)) could improve liver function in the setting of fulminant hepatic failure or poor allograft function immediately post-transplant. The purpose of this study was to determine whether PGE(1) improves hepatic allograft arterial and portal vein inflow. Fifty patients receiving a primary liver transplant were entered into a prospective randomized double-blind study. Measurements of hepatic arterial and portal venous flow were taken immediately after revascularization and after steady state drug infusion. PGE(1) (or placebo) was infused peripherally at an increasing dose and titrated for blood pressure to a target dose of 1 microgram/kg/hr (80 microgram/hr maximum). Changes in hepatic arterial and portal vein flow, and time to reach maximum dose were compared using the student's t test. Of the 50 patients entered, 15 were excluded from analysis (10 because of inability to obtain flow measurements, 4 because they were pediatric recipients <2 yrs of age, and 1 patient who was placed on open PGE(1)). Thirty-five patients were available for final analysis (control, N = 14; PGE(1),N = 21). There were no statistical differences in the change in hepatic artery of portal vein flow between PGE(1)-treated and -untreated grafts. The time to reach maximum dose of PGE(1) was longer in the PGE(1) treatment group. Maximum dose was reached in 85.7 per cent of patients in both groups. There was an effect on blood pressure in the study group as demonstrated by a longer time to reach maximum dose. There was no effect on hepatic vascular in flow.

Adult↗