Biomedical subjects

M Kalayoglu

Publications and source records attributed to M Kalayoglu.

At least 55 records · Page 3Linked to original sources

PubMed1993

Prolongation of canine intestinal allograft survival with RS-61443, cyclosporine, and prednisone.

The efficacy of RS-61443 and cyclosporine utilized either alone or in combination was assessed in both a segmental heterotopic and total orthotopic canine intestinal transplant model. Twenty-eight dogs underwent segmental (150-cm) heterotopic intestinal transplants and five dogs total orthotopic transplants. Five heterotopic groups were compared: group 1, no immunosuppression; group 2, cyclosporine and prednisone; group 3, RS-61443, cyclosporine and prednisone; group 4, RS-61443 and prednisone; and group 5, RS-61443 and subtherapeutic cyclosporine. Group 3 animals achieved a median survival of 136 days, while the median survivals of groups 1, 2, 4, and 5 were < or = 10 days (P < .001). Twenty deaths in groups 1 through 5 were secondary to allograft rejection, two were due to infection, and two were unexplained. Four animals in group 3 were sacrificed, one at 83 days due to diarrhea and weight loss and three at the termination of the study. The median survival of five dogs undergoing total orthotopic transplantation (group 6) was 27.0 days and was significantly longer than groups 1, 4, and 5 (P < .01). No dog in this group had intestinal rejection--however, four were sacrificed due to weight loss and one died of malnutrition. The combination of RS-61443 and cyclosporine significantly prolonged intestinal allograft survival in both the heterotopic and orthotopic transplant models. Clinically, this combination may be promising for both combined liver-intestinal and isolated intestinal transplantation.

Animals↗

PubMed1993

Risk factors for primary dysfunction after liver transplantation--a multivariate analysis.

In a retrospective analysis on 323 orthotopic liver transplant procedures performed between July 1984 and October 1991 the incidence of two forms of primary dysfunction (PDF) of the liver: primary nonfunction (PNF), and initial poor function (IPF) were studied. The incidence of PDF was 22% (73/323) with 6% PNF (20/323) and 16% IPF (53/323), while 78% (250/323) had immediate function (IF). Occurrence of both IPF and PNF resulted in a higher graft failure rate (P < 0.001), retransplantation rate (P < 0.001), and patient mortality (P < 0.003) within the first three months after OLTx. Univariate analyses of donor and recipient factors and their influence on PDF demonstrated that longer donor hospitalization (> 3 days), older donor age (> 49 years), extended preservation times (> 18 hr), and fatty changes in the donor liver biopsy, as well as reduced-size livers, younger recipient age, and renal insufficiency prior to OLTx, significantly affected the incidence of IPF and PNF. Multivariate analysis of potential risk factors showed that reduced-size liver (P = 0.0001), fatty changes on donor liver biopsy (P = 0.001), older donor age (P = 0.009), retransplantation (P = 0.01), renal insufficiency (P = 0.02), and prolonged cold ischemia times (P = 0.02) were independently associated with a higher incidence of IPF and PNF. No statistical correlation was found between PDF and etiology of ESLD, nutritional status of the recipient, UNOS status, and Child-Pugh classification in this study. We conclude that PNF and IPF are both separate clinical entities that have a significant effect on outcome after OLTx. Routine donor liver biopsies are recommended to decrease the rate of IPF and PNF. The combination of risk factors shown to be significant for PDF should be avoided--and, if that is not possible, the only variable that can be controlled, the preservation time, should be kept as short as possible.

Adolescent↗

PubMed1993

Retransplantation of the liver--a seven-year experience.

Three hundred and four patients underwent 362 liver transplants between July 1984 and April 1992. Fifty-eight retransplants were performed in 44 patients (14.5%). Thirty-four patients underwent two (77.3%), seven patients three (15.9%), two patients four (4.5%), and one patient five (2.3%) transplants. Poor function accounted for 23 retransplants (6.4%), technical problems for 19 retransplants (5.2%), and rejection for 15 retransplants (4.1%). One-month patient survivals after retransplantation for poor function, technical problems, or rejection were similar (79.0%, 73.4%, and 80.0%, respectively). No difference in retransplantation rates were seen between adults and children receiving whole liver transplants (WLT) (11.6% versus 19.1%). However, retransplantation for poor function was more common in pediatric recipients receiving reduced-size liver transplants (RLT) (20.0% versus 0.0%, P < 0.01), while retransplantation for hepatic artery thrombosis (HAT) was more common in pediatric recipients receiving WLT (16.7% versus 2.8%, P < 0.05). The presence of multiorgan system failure of greater than four was associated with a high mortality (90%), whereas patients undergoing emergent retransplantation who had less than four systems fail had a survival of 73.9% and patients who underwent elective retransplantation had a survival rate of 81.8%. Length of stay and cost of liver transplantation was higher in patients undergoing retransplantation when compared with primary transplants (29.7 +/- 14.9 days versus 58.4 +/- 38.9 days and $122,358 +/- 59,782 versus $289,302 +/- 126,907, P < 0.01). The overall actuarial one-year patient survival in primary transplants was 86.6% and in retransplants 74.8%, and at five years these were 71.4% versus 62.5%, respectively (P < 0.05). Our results support continued retransplantation of the liver unless the patient's medical condition dictates otherwise.

Adolescent↗

PubMed1993

Renal transplantation at the University of Wisconsin in the cyclosporine era.

1. Immunological graft loss in the cyclosporine (CsA) era has been decreasing over the past decade with current 94% immunological graft survival at one year. 2. The rates of both immunological graft loss and graft loss from all causes gradually decrease after the first year for primary transplants. This implies that rejection gradually becomes less likely between one and 10 years follow-up. 3. On CsA immunosuppression, better DR matching results in significantly less immunological graft loss and a slower rate of late graft loss. 4. Roughly equal proportions of cadaveric renal transplants are lost due to acute rejection, chronic rejection, and death with a functioning graft (25-30% each). 5. Improving immunological graft outcome correlates with a lower incidence of a first rejection episode. Although OKT3 increases the success of rejection treatment, having a rejection episode nevertheless increases one's risk of immunological graft loss. 6. Cardiovascular deaths are by far the leading cause of mortality (42%) in this series. Improved strategies of prevention and treatment of cardiovascular disease are needed in this patient group. 7. Long-term CsA immunosuppression usually is not associated with graft loss due to CsA toxicity. Late graft loss from acute and chronic rejection is far more common, implying the need for continued immunosuppression even in patients with long-surviving grafts. 8. There is no measurable benefit of 3 or more random blood transfusions prior to cadaveric renal transplantation in the CsA era.

Academic Medical Centers↗

PubMed1993

Long-term results of liver transplantation for biliary atresia.

BACKGROUND: Biliary atresia can be treated by portoenterostomy, which is primarily palliative, or by liver transplantation, which is primarily curative. The purpose of this study was to determine the long-term outcome of liver transplantation for the treatment of biliary atresia. METHODS: During an 8-year period, 45 patients who underwent liver transplantation for biliary atresia and 10 patients who were referred to our center for portoenterostomy were retrospectively analyzed. RESULTS: No patient with biliary atresia died awaiting liver transplantation. The waiting time for all patients was 36.7 +/- 42.8 days. Thirty-four patients (75.6%) required one transplant, whereas 11 patients (24.4%) required 17 retransplants. Twenty-two patients (48.9%) required 39 reoperations (1.8 per patient). There were 4.9 infectious episodes, 2.2 rejection episodes, and 4.4 readmissions per patient. However, 91% of reoperations, 80% of infections, and 78% of rejections occurred within 6 months of transplantation. The overall 7-year actuarial patient and graft survival for patients with biliary atresia was 86.2% and 62.7%, respectively. CONCLUSIONS: Our results indicate that long-term patient survival after liver transplantation for biliary atresia is excellent. However, portoenterostomy continues to have an initial complementary but limited long-term role in the treatment of infants with biliary atresia.

Biliary Atresia↗

PubMed1993

Two hundred consecutive simultaneous pancreas-kidney transplants with bladder drainage.

BACKGROUND: Since 1982, 288 pancreas transplantations have been performed at the University of Wisconsin. This report reviews our experience with 200 consecutive simultaneous pancreas-kidney (SPK) transplantations during a 7-year period. METHODS: Two hundred consecutive SPK transplantations were performed between December 1985 to October 1992. Immediate posttransplant function and surgical and infectious complications were evaluated. Frequency of rejection episodes were analyzed, as was 5-year patient and graft survival. RESULTS: All but four pancreas transplants functioned immediately after transplantation. Three pancreas transplants failed because of thrombosis and one from primary nonfunction. Five-year patient survival was 90.2%, kidney survival 80.3%, and pancreas survival 78.6%. There were 54 surgical complications. Fifteen patients have died since 1985. The most frequent cause of death was infection (three patients). A total of 678 infectious episodes were recorded. Urinary tract infection (n = 344) was the most frequent type of infection. Enteric conversion was necessary in 35 patients, with the most frequent indication being a leak of the duodenal segment. CONCLUSIONS: We concluded from this series that SPK transplantation is associated with higher cost and morbidity as compared with kidney transplantation alone. However, excellent long-term survival in combination with the clearly demonstrated benefits for secondary diabetic complications indicate that SPK transplantation is the procedure of choice for carefully selected patients with diabetes.

Adolescent↗

PubMed1993