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Biomedical subjects

M Slapak

Publications and source records attributed to M Slapak.

At least 37 records · Page 2Linked to original sources
PubMed1985

Azathioprine and cyclosporin: different tissue matching criteria needed?

Of 275 renal transplants performed over seven years in a single unit, azathioprine was the main immunosuppressive agent in 128 and cyclosporin in 147. With azathioprine graft survival was, as expected, negatively related to the number of HLA mismatches; with cyclosporin the reverse held true.

Actuarial Analysis↗
PubMed1985

Varying expression of major histocompatibility complex antigens on human renal endothelium and epithelium.

Pre-anastomosis wedge biopsies from 14 cadaveric donor kidneys were examined for the expression of class I (HLA-ABC) and class II (HLA-DR) antigens in renal tissue. Two monoclonal antibodies to class I antigens and four to class II antigens were used in an indirect immunoperoxidase technique. Consistent expression of both antigens was demonstrated on the surface of glomerular, peritubular capillary and venous endothelial cells. Renal arteries contained only class I antigens. Proximal tubules contained varying amounts of each antigen in their cytoplasm. Sixteen human lymphocytotoxic allo-antisera showed marked variation in their ability to detect HLA antigens on the kidney. The selection of donors for recipients of renal allografts involves the complement-dependent cytotoxicity test and the failure of some lymphocytotoxic antisera to bind to the kidney indicates that some suitable patients may be incorrectly excluded. The use of a binding assay using an immunoperoxidase technique should be included in cross-match techniques particularly for patients who have high levels of circulating cytotoxic antibodies.

Antibodies, Monoclonal↗
PubMed1983

Plasma exchange in acute renal allograft rejection. A controlled trial.

A controlled trial was carried out to assess the value of intensive plasma exchange in 27 renal transplant recipients with clinical and histological evidence of acute vascular rejection. In addition to standard immunosuppression, 13 patients received plasma exchange on six consecutive days at a mean exchange volume of 40.6 ml/kg of body weight each day using an intermittent cell separator. A further 14 patients received standard immunosuppression only. In addition, 10 patients exchanged prior to the controlled trial have been studied. Analysis of short-term benefit, as evidenced by a reduction in serum creatinine, and by subsequent graft survival revealed no significant difference in these parameters between the two groups in the controlled trial. This regimen of plasma exchange has not, therefore, been shown to modify acute renal allograft rejection.

Creatinine↗
PubMed1983

Variable localization of blood group antigen in group A kidneys.

The distribution of the blood group A antigen has been examined in 7 Group A kidneys using an indirect immunoperoxidase technique. Monoclonal antibody consistently demonstrated A antigen on the endothelium of all kidneys, particularly peritubular capillary endothelial cells and also the epithelial cells of distal tubules of all but 1 case. Nine hyperimmune anti-A alloantisera gave a variable pattern of staining on different endothelial cells, but no kidney was negative. Epithelial cell staining showed considerable variation both within an individual cell and between adjacent cells. Twenty-six out of 40 alloantisera from normal Group O blood donors failed to bind to endothelial cells of one kidney which was known to show strong expression of A antigen. Absorption was completely achieved using Group A red blood cells but not with a synthetic blood group substance. The variation in reaction intensity using different antisera emphasises that there is variation in antigen expression between cells and indicates the complexity of antibodies directed against the blood group A antigen.

ABO Blood-Group System↗
PubMed1981

Renal transplant in a patient with major donor-recipient blood group incompatibility: reversal of acute rejection by the use of modified plasmapheresis.

A 47-year-old patient with blood group O inadvertently received a mismatched kidney from a donor of blood group A. Two days after transplantation, the clinical, biochemical manifestation of an intrarenal, intravascular coagulation was seen. This was treated by plasma exchange with the rapid reversal of all parameters, and reduction of both the IgG and IgM component of the circulating anti-A antibody. The patient, 20 months after transplantation, has normal renal function. Subsequent repeated biopsies have shown no recurrence or manifestation of the effects of the intravascular coagulopathy. This case report documents, for the first time, the reversal of the known deleterious effects of major blood group incompatibility on renal transplantation by the use of a new technique, modified plasmapheresis. Furthermore, it implies that the limitation of transplantation of kidneys on the basis of major ABO blood groups may not be justifiable in all instances.

ABO Blood-Group System↗