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M Kalayoglu

Publications and source records attributed to M Kalayoglu.

At least 145 records · Page 8Linked to original sources
PubMed1988

Cadaveric renal transplantation in the cyclosporine and OKT3 eras.

With advances in clinical immunosuppression, results in organ transplantation continue to improve. During a 52-month period, 507 cadaver renal transplants were performed, including 435 primary and 72 nonprimary transplants. All patients were managed with quadruple immunosuppression (prednisone, azathioprine, sequential MALG and cyclosporine). Our experience is divided into pre-OKT3 (n = 228) and OKT3 (n = 279) eras. All kidneys were harvested locally and preserved with pulsatile machine perfusion. The mean duration of preservation was 30.1 hours, with an organ utilization rate of 98.1%. The preservation-related dialysis rate was 13.6%, and primary nonfunction occurred in 8 kidneys (1.6%). Actuarial patient survival in primary and secondary transplant recipients was 90% at 3 years. Overall primary graft survival was 81.6% and nonprimary graft survival, 61.1%. However, the current OKT3 era is characterized by improved patient survival (98% vs 90%, p = 0.001) and primary graft survival (91% vs 80%, p = 0.002) at 1 year when compared with the previous era. Forty-nine patients have received OKT3 therapy, with 31 grafts (63.3%) successfully rescued. Cadaveric renal transplantation with machine preservation, quadruple therapy, and OKT3 rescue is associated with excellent early graft function, reduced acute rejection, and improved patient and allograft survival, even in high-risk recipients.

Adolescent↗
PubMed1988

Acute colonic ileus (pseudo-obstruction) in renal transplant recipients.

Colon complications are a potential source of serious morbidity to the immunosuppressed patient. Because of multiple predisposing factors, renal transplant patients are a high-risk group for the development of acute colonic pseudo-obstruction. During a recent 18-month period, 290 renal transplants (79 living, 211 cadaveric donors) were performed and prospectively analyzed for colonic dysmotility. A total of 34 episodes of acute colonic ileus (30 primary, 4 recurrent) occurred in 30 (10.3%) renal transplant recipients. Acute colonic ileus was more frequent after living-donor transplantation (19.0% vs. 7.1%, p = 0.006). Analysis of multiple variables revealed that the incidence of acute colonic ileus was directly related to mean cumulative prednisone dosage (p less than 0.05). Medical therapy (rapid steroid reduction, bowel rest) resulted in a 76.7% response, whereas 8 patients underwent colonoscopy because of progression to acute pseudo-obstruction. The success rate for colonoscopic decompression was 87.5%; in 1 patient cecal perforation developed after unsuccessful decompression. Overall, 33 of 34 (97.1%) episodes of acute colonic ileus were successfully treated. Steroid-induced ileus (pseudo-obstruction) is a potentially malignant early form of colonic dysmotility infrequently reported in transplant recipients. Successful management requires early clinical recognition, reduction in steroid dosage, bowel rest, and urgent colonoscopic decompression in select cases.

Adult↗
PubMed1988

A simplified technique for transplantation of the canine liver.

A method of orthotopic transplantation in the dog is described. It uses cuffs for the portal and lower vena caval anastomoses and a single shunt from the portal vein to the external jugular vein. The upper caval anastomosis is sutured in conventional fashion. The technique is simple and reliable producing consistent good results and minimises technical causes for failure. It is of particular value in preservation studies and has been extensively applied in this laboratory for such studies.

Animals↗
PubMed1988

Kidney retransplantation in the cyclosporine era.

The results of kidney retransplantation in the cyclosporine era remain to be determined. Over a 42-month period, 76 nonprimary renal transplants (66 second, 7 third, 3 fourth allografts) were performed in 73 recipients under cyclosporine immunosuppression. The patient population was predominantly white (90.4%) with a mean age of 32.3 years. Twenty-one recipients (28.8%) were diabetic, and 36 (49.3%) were highly sensitized (panel-reactive antibody [PRA] greater than 50%). Sixty-two patients received cadaver donor grafts while the remaining donations were living-related (12) or living-unrelated (2). A sequential antilymphocyte globulin/cyclosporine protocol was employed, with cyclosporine therapy delayed until adequate renal function occurred. Overall patient and graft survival is 92.1% and 60.5%, respectively, after a mean follow-up of 20.0 months. The mean serum creatinine is 1.64 mg/dl in the 46 functioning allografts. Graft survival is 63.6% for secondary grafts, 28.6% for tertiary grafts, and 66.7% for fourth kidney transplants. In second transplants, recipients of cadaver donor kidneys have a graft survival of 58.5%, while living-related donor graft survival is 84.6% (P = 0.07). In the cadaver retransplant population, duration of previous transplant function greater than one year and HLA-DR matching were associated with increased graft survival, while age over 39 and presence of diabetes mellitus with reduced graft survival. However, these trends were not significant. Peak PRA above 50% did demonstrate a significant negative impact on graft survival both in the univariate and multivariate analyses of risk factors. Acute rejection occurred in 50 patients (65.8%), and was successfully reversed 50% of the time. Of the 30 grafts lost, 25 (83.3%) occurred within four months of retransplantation. Transplant nephrectomy was performed in 20 patients. Cyclosporine was not administered in 21 (70%) of these early graft failures, negating any potential beneficial effect. Retransplantation can be performed safely, with living-donor graft survival superior to cadaver retransplant rates. Rejection and early graft loss are common, especially in the highly sensitized patient. The impact of cyclosporine immunosuppression in renal retransplantation is much less dramatic than in primary transplantation in a protocol that delays cyclosporine therapy until allograft function is demonstrated.

Blood Transfusion↗
PubMed1987

Pancreas transplantation: the University of Wisconsin experience.

The data presented in this chapter demonstrate that acceptable short-term results can now be achieved for patients receiving a pancreas transplant. We feel that urinary drainage and the use of a whole pancreas with a duodenal segment currently represent the most optimal technical approach. Immunosuppressive therapy using the quadruple induction protocol will prevent early rejection episodes in the majority of patients. Once rejection is diagnosed, one should not hesitate to institute immediate antirejection treatment with OKT3 monoclonal antibody. In our most recent series of 24 combined kidney and pancreas transplants an extremely encouraging outcome can be reported. Of the 24 patients who received a combined cadaver kidney and pancreatic allograft within the last 2 years, 23 are alive and well. Twenty-three also have good-functioning kidneys, of which 21 have a functioning kidney and pancreatic allograft. Based on these results, which will undoubtedly be duplicated in the very near future by a number of other centers, we believe that pancreas transplantation has now emerged into a therapeutic and effective procedure.

Graft Rejection↗
PubMed1987

A new technique for arterialization of the hepatic graft.

We believe that the new technique described herein for reconstructing the hepatic artery is the method of choice for arterialization of hepatic grafts. This technique is easily performed, even during retransplantation and even if the recipient or donor has double arteries. Since submission of this article, an additional 20 transplantations of the liver have been performed without graft loss using this technique. This includes five infant livers with donors as small as two days old and weighing 3.2 kilograms.

Adult↗
PubMed1987

The University of Wisconsin experience in pancreas transplantation.

This paper describes the Madison experience in pancreas transplantation. With the use of pancreaticocystostomy, overall mortality could be decreased to a level similar to the results reported for kidney transplantation in diabetic patients. Particularly encouraging are the results obtained in combined kidney and pancreas transplantation, with current actuarial graft survival rates for kidneys of 95% and pancreatic grafts of 85%. Overall, the quality of life for patients receiving a pancreatic transplant has been good, and in cases where no postoperative complications were encountered, a tremendous feeling of well-being from a physiological and psychological standpoint was achieved. It is our conclusion that pancreatic transplantation should be pursued as a viable form of therapy in selected patients and centers with large experience in the transplantation of diabetic patients.

Diabetes Mellitus, Type 1↗
PubMed1987

Pancreas transplantation with pancreaticocystostomy and quadruple immunosuppression.

Forty-three whole-pancreas transplantations with pancreaticocystostomy were performed. Eighteen patients received pancreas transplants after previously receiving living-related kidney transplants, 18 patients received simultaneous kidney and pancreas transplants, and seven patients received pancreas transplants after previously receiving cadaver kidney transplants. All patients were immunosuppressed with quadruple immunosuppression including antilymphocyte globulin, prednisone, cyclosporine, and azathioprine. Overall graft survival for pancreas transplants is 73.1%. In the group with pancreas after living-related kidney, 1-year graft survival was 50% for the pancreas and 95.4% for the kidney. In the pancreas after cadaver kidney group, pancreas and kidney survival rates were 100% at 1 year, and in the simultaneous pancreas and kidney group, pancreas 1-year graft survival was 87.5% and kidney transplant survival was 93.8%. Overall patient survival at 1-year is 95.6%. Technical complications occurred in 21 patients. These included wound infections, intra-abdominal abscess formation, bleeding, and disruption of the pancreaticocystostomy. We believe that pancreas transplantation can now be performed with acceptable graft and patient survival.

Adult↗