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M Stangl

Publications and source records attributed to M Stangl.

30 records · Page 2Linked to original sources
PubMed1998

Aggressive treatment of the first acute rejection episode using first-line anti-lymphocytic preparation reduces further acute rejection episodes after human kidney transplantation.

The detrimental effect of acute rejection episodes on long-term outcome of renal allografts in cyclosporin-treated patients is well established, although has not been seen by all investigators. To analyse the possibility that aggressive treatment of the first episode may ameliorate this detrimental effect, we performed an open label, randomised prospective trial in cyclosporin-based, immunosuppressed recipients of postmortem renal allografts in order to compare two different treatment protocols during primary acute rejection episodes: (1) group 1 of 25 patients received 3 x 250 mg methylprednisolone (MP) i.v.; (2) group 2 of 25 patients received 7 x anti-thymocyte globulin (ATG)-Fresenius i.v. (4 mg/kg body weight). During a period of 4 years, the following clinical observations were made: (1) The incidence of an acute re-rejection episode was significantly reduced in the ATG-treated study group (16%) compared to the MP-treated study group (72%); (2) The severity of the first acute rejection episode (intensity of renal dysfunction measured in terms of 10-day creatinine area under curve) showed no significant difference between the groups (37 mg x 10-d/dl to 58 mg x 10-d/dl); and (3) The half-lives of allografts in both groups have not shown any significant differences so far. In conclusion, aggressive treatment of the first rejection episode of renal allografts with the use of ATG reduced the incidence of re-rejection episodes which, however, are not reflected so far by improvement of the 4-year survival rate of these allografts. Since it could be observed that re-rejection is an even worse predictor for chronic transplant failure, a better long-term outcome of renal allografts in ATG-treated patients may be expected during a longer observation period. The incidence of a third episode was also reduced in the ATG-treated group (0%) compared to the MP-treated group (12%).

Adult↗
PubMed1997

Application of immunoapheresis for delaying hyperacute rejection during isolated xenogeneic pig liver perfusion.

BACKGROUND: Extracorporeal liver perfusion in hepatic coma, used to eliminate toxic metabolites causing hepatic encephalopathy, is limited by the antibody (Ab) and complement-mediated hyperacute rejection of discordant xenografts. Thus, the efficacy of highly selective immunoadsorption columns to deplete xenoreactive human anti-porcine antibodies before ex vivo liver perfusion was examined in this study. METHODS: Eighteen domestic pigs were hepatectomized according to standard techniques. The livers were ex vivo perfused for 4 hr. The perfusion protocol closely followed the physiological conditions of a human liver. Parameters of liver function and damage were analyzed. Three groups were formed differing in the treatment of the perfusate. As basic control, livers were perfused with heparinized human blood (group 1; n=6). Immunoapheresis was applied in group 3 (n=6). Immunoapheresis was performed using Ig Therasorb columns consisting of sheep-anti-human IgG Abs covalently coupled to Sepharose CL-4B. Additionally, the effect of pure Sepharose CL-4B without immobilized Ab was tested in group 2 (n=6). RESULTS: The use of Ig Therasorb 100 columns in group 3 resulted in a reduction of IgG, IgM, and IgA in the order of 95.0%, 72.3%, and 81.5%, respectively. In group 2, IgG, IgM, and IgA were lowered by 30% to 39%. Determination of liver-specific enzymes and tolerance tests revealed a significant reduction of cellular damage and functional restrictions in group 3 compared with the control groups. CONCLUSIONS: Immunoapheresis conducted according to this protocol appears to be an effective approach for delaying antibody-mediated hyperacute xenogeneic rejection.

Acute Disease↗
PubMed1997

[Initial experiences with contrast enhanced MR angiography after kidney and pancreas transplantation].

PURPOSE: The assessment of vascular complications by DSA in patients who have undergone kidney and pancreas transplantation is an invasive investigation and has the risk of nephrotoxicity caused by the iodinated contrast agent. The aim of this study was to compare the diagnostic value of noninvasive gadolinium--enhanced MRA with intraoperative and DSA results. PATIENTS AND METHODS: Eleven MRA investigations were performed in eight patients after kidney and pancreas transplantation. A fast T1-weighted 3D-gradient-echo sequence with short TR and TE was used in a dynamic technique including the three consecutive data acquisitions after a Gd-DTPA (Magnevist) injection. MRA was compared with intraoperative findings in all patients and with DSA in three patients. RESULTS: In the distal abdominal aorta, the internal and external iliac arteries, the main transplanted arterial vessels, and the arteries after first branching, high signal intensity was found. Assessment of renal and pancreatic parenchyma perfusion was possible in all patients. Venous transplant vessels could be depicted in four patients. CONCLUSION: Our initial experience with the MRA sequence used shows that this technique may be promising in the assessment of larger arterial transplanted vessels and kidney/pancreas parenchyma perfusion. Improvement of the MRA technique is necessary for transplanted venous vessels.

Angiography, Digital Subtraction↗
PubMed1996

Regionalization of donor organ procurement: first experiences in southern Bavaria and results of a regional donor hospital survey.

In order to improve organizational, qualitative, and economic aspects of organ procurement, a model of regionalization was established in the local area of southern Bavaria, as from September 1993, with the following characteristics. A collaborative 24 h-duty schedule with surgeons from all active regional transplant programs. Surgeons are grouped according to their operative qualification level: (1) Group I, capable of retrieving all abdominal organs (liver, pancreas, kidney), (2) Group II, capable of removing kidneys, and (3) Group III, surgical assistance in procurement procedures. All donor organs in the local region are explanted by the local team and foreign recipient centers are supplied with the organs removed by a standardized technique. Only three times during the first, and not once during the second year, did a foreign team insist on traveling to our region to perform a liver retrieval. A survey clearly documented univocal acceptance of this model by donor hospital executives. Simplified organization and less disturbance in operating theaters were among the most frequent arguments in favor, and the familiarity of explant teams in donor hospitals was considered advantageous. Most donor hospitals do not expect to profit in terms of financial savings. When asked for further possible measures to improve organ donation, a clearer legal situation, but also the need for more information and education programs, including better media representation of transplant issues, were cited most frequently. An improvement in financial reimbursements for the donor hospitals as an instrument to enhance willingness for organ donation was not considered essential. In conclusion, our model of regionalization of organ procurement proved to be effective in achieving a high quality of organ retrieval and a reduction in personnel requirements for the transplant centers. In addition, the response from donor hospitals was unequivocally positive and may, thus, positively influence donor activity. Relevant financial savings can result from reduced on-call duties and minimized traveling costs. Further attempts to rationalize organ procurement could possibly include heart(-/lung)surgeons in the regionalized teams.

Hospitals↗
PubMed1995

[Chemoembolization in primary liver cell carcinoma. Results of a prospective study].

A remarkable progress was made in the palliative treatment of unresectable hepatocellular carcinoma using transcatheter arterial chemoembolization (TAC). The combination of doxorubicin as cytotoxic drug and of Lipiodol as carrier, which is selectively accumulated within the tumors is an effective treatment. Prolonged survival has been demonstrated in several clinical studies. In a prospective trial the effect of regional TAC with temporary ischemia of the liver was evaluated concerning liver function, systemic reactions and tumor response. Temporary ischemia of the liver was well tolerated even in patients with liver cirrhosis. Revascularization of the liver after TAC was observed in all cases. Systemic side effects of the cytotoxic drug were mild. In patients with Child C cirrhosis or tumor volume of more than 60% of the liver no impact of the treatment on the survival time was observed. In the entire patient group a survival rate of 70% after 15 months was achieved.

Aged↗
PubMed1993

Autoantibodies to nuclear mitotic apparatus in a patient with vitiligo and autoimmune thyroiditis.

Circulating autoantibodies against the nuclear mitotic apparatus (NuMA) protein have been detected in sera of patients with a variety of connective tissue diseases. A close relation of anti-NuMA antibodies to define subsets of these diseases could not be established. This is the first description of a patient with vitiligo, autoimmune thyroiditis and a high titer of antibodies against NuMA on Hep-2 cells. The possibility of a beginning of multiple autoimmune syndrome cannot be excluded.

Adult↗
PubMed1989

[The effect on wound healing of venous leg ulcers of a two-layered polyurethane foam wound dressing].

To demonstrate the effect of a two-layered polyurethane foam wound dressing (Lyomousse) on the healing of venous leg ulcers a comparative study in 41 patients (24 treated, 17 controls) was performed. For a quantification of the process of healing a computer-assisted morphometric procedure was used. This method is based on a Polaroid-photograph of the ulceration which is transferred in digital form by means of a digitizing equipment. From the digital data the primary variables area, perimeter and maximal diameter of the ulceration are calculated. For quantitative comparison the relative changes as well as the rate of the changes of the primary variables were used. The statistical comparison of the treated group and the control group showed a highly significant (p less than 0.001) promotion of wound healing for the therapy with the synthetic foam dressing using the relative changes as an indicator, and a significant (p less than 0.05) increase in the rates of changes, indicating an acceleration of healing. This therapeutical advantage can be drawn back to specific characteristics of the synthetic material, assuring a water vapour saturated micro-environment at the surface of the wound and reducing this way the detrimental effect of heat loss due to evaporation onto the healing process.

Aged↗
PubMed1983

[Influence of anatomical variations of the pancreatic artery on the surgical technic of segmental pancreas transplantation in dogs].

The surgical technique in clinical pancreas transplantation is still not standardized. Animal experimentation should allow a reproducible and reliable model by choosing the cervical region in dogs as the site of segmental grafting. A goal of the experiments was to determine the influence of preservation, operation technique, duct occlusion, immunosuppression, and gastrointestinal hormones (Somatostatin, Cyclosporin A). 50 grafts have been transplanted. It could be clearly demonstrated that in 54% the vascularization of the left lobe of the canine pancreas differs extremely from man. Successful results are to expect being aware of the anatomical variations. The varieties of the arterial blood supply indicate which technique has to be performed to avoid ischemic grafts due to inadequate preservation.

Animals↗