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Biomedical subjects

M Bewick

Publications and source records attributed to M Bewick.

At least 37 records · Page 2Linked to original sources
PubMed1994

The negative influence of delayed renal allograft function on longer-term graft survival in a pediatric population.

The influence of delayed graft function on renal allograft survival has been studied in a review of 322 renal transplants performed at one pediatric institution. The appearance of the first radionuclide renal scan was used to indicate early function in patients receiving their first cadaveric allograft. Patients whose first radionuclide renal scan showed both good renal perfusion and good function (n = 52) were compared with those whose scans demonstrated good perfusion but no function (n = 32). the actuarial graft survival of those with no function was significantly worse (P < .05). The difference in graft survival was not solely due to grafts lost in the early posttransplant period. Analysis of serial serum creatinine estimations suggests a process of continued inexorable nephron loss in some patients whose grafts showed a delay in achieving function.

Adolescent↗
PubMed1994

Outcome of renal transplantation in hepatitis BsAg-positive patients.

Renal transplantation of patients with previous or ongoing hepatitis B virus infection has been tempered with a concern that immunosuppression may lead to viral replication and progressive liver damage. However, renal transplantation as therapy for end-stage renal failure in these patients improves quality of life and reduces the risk of body fluid exposure to their carers. To assess the long-term outcome of renal transplantation in hepatitis-BsAg-positive patients a retrospective study was carried out on the patients transplanted in this unit since 1969. Seventy-six patients received 98 grafts up to December 1991; follow-up was available on 68. Thirty-one of the 68 patients died; the causes of death were infective 23, cardiovascular 6, liver failure 4, pancreatitis 2, aspiration 1, GI haemorrhage 1, and stopped therapy 1. Serological markers of hepatitis B virus infection did not correlate with outcome. The risk of developing liver failure after renal transplantation appears small in the hepatitis-BsAg-positive patients and no patient should be denied a renal transplant on the basis of serological tests.

Adolescent↗
PubMed1994

Evaluation of Doppler ultrasound in primary non-function of renal transplants.

Doppler ultrasound investigation was performed in the renal grafts of 86 patients with primary non-function following cadaveric renal transplantation. Pulsatility Index, defined as: [formula: see text] was assessed to examine its predictive use in the diagnosis of rejection episodes as judged by a retrospective analysis of histological data. Altogether 415 Doppler examinations and 228 renal biopsies were performed. In our population the incidence of rejection was 57%. Using a pulsatility index (PI) > 1.8 to be indicative of rejection, the sensitivity of our test was 68% for vascular rejection and 65% for all rejection episodes. The specificity was 25%. We conclude that Doppler ultrasound cannot replace the need for transplant renal biopsy in patients with primary non-function.

Graft Rejection↗
PubMed1993

Primary use of a double J silicone ureteric stent in renal transplantation.

Vesicoureteric leakage and obstruction are the commonest urological complications after renal transplantation. A retrospective analysis of our initial experience using a double J silicone ureteric stent showed that primary splinting of the vesicoureteric anastomosis eliminated these complications, whereas their combined incidence was 13.6% in the non-stented patients. The presence of the stent was not associated with increased risks of urosepsis.

Adolescent↗
PubMed1993

The influence of recipient and donor age on the outcome of renal transplantation.

This paper assesses the impact of age on the outcome of cadaveric renal transplantation. Data are presented on 99 consecutive patients undergoing first renal allografts at one unit. Patients are divided into those aged less than 50 (n = 53), patients between 50 and 60 (n = 16), and those aged 60 years and over (n = 30). There was no significant difference in graft survival at one year between the three groups. There was however an increased mortality with increasing recipient age (1.9%, 12.5% and 20.0% respectively for each age group). The effect of increasing donor age on graft survival was also studied. Graft survival at two years for first grafts was not influenced by donor age. We conclude that age alone is not a criterion for exclusion of patients from transplant programs. In addition we provide data to support the use of elderly donors as a potential source of cadaveric renal grafts for certain patients.

Actuarial Analysis↗
PubMed1992

The management of renal transplant artery stenosis in children by percutaneous transluminal angioplasty.

Between 1967 and 1989 in this unit 262 children (age at transplantation 9 months to 17 years, mean 9.6 years) had 345 renal transplants performed. Transplant artery stenosis (TAS) was found in 30 (8.7%) as demonstrated by arteriography, performed only when there was unexplained deterioration in transplant function, hypertension that was difficult to control, or in the presence of a vascular bruit. All patients with TAS except one had received a cadaveric allograft. From 1980 onward, percutaneous transluminal angioplasty (PTA) has been available for TAS, and this was attempted on 21 occasions in 16 patients. Nine patients demonstrated angiographic improvement following the procedure, and 7 showed immediate clinical improvement. On one occasion angioplasty precipitated graft loss. Five patients underwent planned corrective surgery, 4 after unsuccessful angioplasties. Our experience suggests that PTA should be the first method of intervention for TAS. Moderate success, both in angiographic and clinical terms, can be achieved, negating the need for surgery, while failure of PTA does not preclude surgical attempts at correction.

Adolescent↗
PubMed1990

Incidence of thin membrane nephropathy: morphometric investigation of a population sample.

To explore the incidence of thin membrane nephropathy (thin basement membrane syndrome, benign familial haematuria), glomerular basement membrane thickness was assessed by light and electron microscopy and by morphometry in a series of newly transplanted allograft kidneys, in lieu of normal kidney specimens. Five of the 76 donors possessed an abnormally thin basement membrane, similar to that observed in thin membrane nephropathy, while in two others the measurements fell in the overlap range between thin and normal. Seven donors therefore had a definite or possible basement membrane lesion. After taking account of an additional series of controls, unrelated to transplantation, it is suggested that the incidence of this abnormality in the general population lies between 5.2% and 9.2%. Circumstances did not allow any association between a thin basement membrane and haematuria or other clinical manifestations to be detected.

Adolescent↗
PubMed1989

Effect of graft perfusion with two CD45 monoclonal antibodies on incidence of kidney allograft rejection.

In a blind trial, 77 patients were randomised to receive first cadaver kidney allografts that had been perfused either with a pair of CD45 monoclonal antibodies (mAbs), in an attempt to reduce the immunogenicity of passenger leucocytes, or with control human albumin solution. No complications of mAb perfusion were observed. Patient and allograft survival were similar in both groups. Rejection episodes were recorded in 7 (18%) of the patient with mAb perfused allografts compared with 24 (63%) of the controls.

Animals↗
PubMed1989

Removal of anti-HLA antibodies by extracorporeal immunoadsorption to enable renal transplantation.

10 highly and persistently sensitised patients awaiting renal transplantation underwent extracorporeal immunoadsorption to remove anti-HLA antibodies. 7 patients have since received transplants. Only 1 allograft has been lost because of rejection, and there have been no serious side-effects attributable to treatment. Extracorporeal immunoadsorption may therefore be of considerable value in the management of highly sensitised patients.

Adult↗
PubMed1989

Increased incidence of renal transplant arterial stenosis in children.

We have found an increase from 10% to 16.4% in the incidence of clinically significant transplant arterial stenosis since the introduction of cyclosporin immunosuppression. During the same period there has been a coincidental increase in the use of donor kidneys harvested from children less than 6 years of age. In patients treated with cyclosporin these stenoses of the donor artery are not related to the surgical anastomosis, and have only rarely been associated with clinical or histological evidence of rejection, whereas those patients who have developed transplant arterial stenosis whilst receiving azathioprine have had a higher incidence of rejection. Regardless of immunosuppressive regimes, the use of small donor kidneys appears to be the most significant association with transplant arterial stenosis in our experience, and this finding has major implications for cadaveric renal transplantation in children.

Adolescent↗