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Biomedical subjects

P Wienand

Publications and source records attributed to P Wienand.

At least 19 recordsLinked to original sources
PubMed1993

Cyclosporin A: early or delayed onset by prophylactic immunosuppression?

In a prospective randomized trial, 57 renal transplant patients received sequential immunosuppression consisting of lymphocytoglobulin (ALG), azathioprine, and steroids for 14 days (group A) and another 57 patients for only 2 days (group B). In each case therapy was continued with cyclosporin A and steroids. The purpose of this study was to find the most favourable time to switch over to continuous cyclosporin A therapy with avoidance of its nephrotoxic side-effects during the perioperative phase. As a consequence of ALG intolerance, conventional immunosuppression had to be changed in group A after a mean of 7.8 days, as opposed to 2.1 days in group B. The patients receiving a prophylactic therapy with ALG, azathioprine, and steroids for 14 days (group A) had to be dialysed at a significantly greater frequency than patients with an early start to cyclosporin A (group B) from the second to the fourth week. Patient survival rates 1 and 2 years after transplantation of group A (95 and 92%) and group B (96 and 92%) were not distinct, and there was no significant difference in graft survival rates of group A (79 and 79%) and B (89 and 82%) after the same time. A delayed start of cyclosporin A after 14 days showed no further advantage but rather a significantly greater frequency of dialysis; thus the early onset of cyclosporin A treatment post-transplant is preferable.

Adult↗
PubMed1992

The risk of infection following OKT3 and antilymphocyte globulin treatment for renal transplant rejection: results of a single center prospectively randomized trial.

Some 43 of 60 (72%) renal allograft recipients who were prospectively randomized to receive either OKT3 monoclonal antibody (n = 30) or ALG (antilymphocyte globulin) polyclonal antibody (n = 30) for steroid-resistant rejection suffered from infection, 25 (83%) following OKT3 and 18 (60%) following ALG treatment (P < 0.05). Clinically evident herpes infection was most frequently seen (9 and 7, respectively), followed by pneumonia (6 and 1, respectively P < 0.05), urinary tract infection and wound infection (2 of each in both groups) fungal (Candida) and multibacterial infections. One patient died in each group due to cytomegalovirus (CMV) pneumonia, giving a mortality of 4.3% in each group. Actuarial 1-year graft and patient survival rates were 80% and 97% in both groups, respectively. It is concluded that ALG and OKT3 are equally effective in renal allograft rejection resistant to steroid treatment, however, the risk of infection appears to be higher with OKT3.

Adult↗
PubMed1992

Early or delayed onset of cyclosporine by sequential immunosuppression?

In a prospective randomized trial, 57 renal transplant patients (group A) received a sequential course of 14 days conventional immunosuppression (anti-lymphocyte globulin (ALG), azathioprine and steroids) and cyclosporine and steroids thereafter, while 57 patients (group B) received the conventional immunosuppression for 2 days followed by cyclosporine and steroids. In group A, ALG was tolerated for a mean of 7.8 days while, in group B, conventional therapy had to be changed to cyclosporine therapy after a mean of 2.1 days due to ALG intolerance. Patient survival rates 1 and 2 years after transplantation were 95% and 92% in group A and 96% and 92% in group B, and graft survival rates were 79% and 79% in group A and 89% and 82% in group B. In group A, the dialysis frequency in the second, third and fourth weeks after transplantation was significantly higher than in group B. Serum creatinine 1 year post-transplant showed no significant difference between the two groups.

Antilymphocyte Serum↗
PubMed1992

CMV prophylaxis after renal transplantation with immunoglobulin or CMV-hyperimmunoglobulin--a prospective clinical trial.

Three groups of 40 patients each entered this prospective randomized trial. Patients of group A received 2 ml/kg body weight CMV-Polyglobulin, patients of group B 15 g Intraglobin and patients of group C, serving as controls, received no specific anti-CMV prophylaxis. All patients were given the same sequential immunosuppressive therapy. Patient survival and graft function did not show any significant differences at 2 years follow up. The incidence of fever, CMV infections, dialysis and steroid bolus therapy were lower in group A, but without statistical significance. Patients receiving a graft from a CMV-AK-positive donor were at high risk of developing an infection or reactivation of CMV. A study examining this subgroup seems appropriate.

Adrenal Cortex Hormones↗
PubMed1992

Donor conditions and graft survival--a retrospective study.

In a retrospective study (one centre) the influence of donor and recipient factors were evaluated (n = 308). Head injury as the cause of death and anastomotic time less than 35 min were associated with a significantly better graft survival rate (P < 0.05). Although some of the donor factors influence graft survival, a stricter selection of grafts is not advisable, firstly because fewer kidneys would then be offered, and secondly because even comparatively bad graft survival rates are still better than dialysis.

Adolescent↗
PubMed1989

[Duplex sonography and magnetic resonance tomography in the clarification of nephrologic complications following kidney transplantation].

A prospective study compared duplex sonography and magnetic resonance imaging in evaluating renal transplants. One hundred and two duplex sonographic and 24 MR examinations were performed and correlated with clinical course or biopsy. All normal renal allografts, 6 transplants with acute tubular necrosis and 2 cases of cyclosporin toxicity had normal Doppler waveforms, whereas 9 renal transplants with evidence of interstitial rejection by biopsy showed an obliteration or reversal of diastolic flow. MR imaging was less specific in identifying allograft rejection. There were false positive results in normal renal transplants, allografts with acute tubular necrosis and after rejection therapy. With regard to cost, accessibility and specificity, duplex sonography is the method of choice for the evaluation of renal allografts.

Adult↗
PubMed1988

[Pregnancy during cyclosporin medication following a kidney transplant].

A 33-year-old patient became pregnant two years after transplantation of a cadaver kidney and continuous cyclosporine administration. An uncomplicated spontaneous delivery of a healthy boy weighing 3360 g took place in the 40th week. Cyclosporine was demonstrated in umbilical cord and neonatal blood and in the mother's milk, but not in amniotic fluid. Because mother's milk contained one sixth the concentration of cyclosporine in maternal blood, the mother was dissuaded from breast feeding.

Adult↗
PubMed1988

[Preoperative nonspecific immunostimulation with Propionibacterium granulosum KP-45 in patients with colorectal cancer. A prospective randomized study].

The effect of preoperative unspecific immunomodulation with Propionibacterium granulosum KP-45 (P.g.) on postoperative complications and patient survival was evaluated in a prospectively randomized trial in patients with colorectal tumor resection. Patients of the therapy group (n = 51) received at least 3 days before operation an infusion of 10 mg P.g., patients of the control group (n = 49) were not treated at all. The wound infection rate and the number of re-explorations were significantly lower in the therapy group, however, patient survival and tumor recurrence rates were not positively affected by this P.g. pre-treatment.

Clinical Trials as Topic↗
PubMed1987

Graft survival and long-term renal function after sequential conventional cyclosporin A therapy in cadaver kidney transplantation--a prospective randomized trial.

In a prospective randomized trial 50 renal transplant patients (group A) received a sequential course of 14 days conventional immunosuppression (Lymphocytoglobulin (ALG), azathioprine, steroids) and cyclosporin and steroids thereafter, while 50 patients (group B) received the conventional immunosuppression for 7 days followed by cyclosporin and steroids. In the latter group ALG was tolerated for the whole period while in the first group conversion from conventional to cyclosporin A therapy had to be performed after a mean of 11 days, due to ALG intolerance. Actual patient survival rates 1 year posttransplant were 100% in both groups and graft survival rates 96% in group A and 86% in group B (P less than 0.05). There was a mean dialysis frequency per patient of 0.7 +/- 2.0 in group A and 1.8 +/- 3.4 in group B (P = 0.064). Serum creatinine 1 year posttransplant was 1.8 +/- 0.8 mg/dl in group A and 2.2 +/- 1.4 in group B. A total of 58 patients had a serum creatinine of less than 2 mg/dl at the time of conversion to cyclosporin. These patients had a significantly better graft survival rate (98.3%) and serum creatinine 1 year posttransplant (1.6 +/- 0.5 mg/dl) than the 40 patients with a serum creatinine of more than 2 mg/dl at the time of conversion (85%; 2.4 +/- 1.4 mg/dl), indicating that a delayed onset of cyclosporin therapy might benefit the kidney in the immediate posttransplant period when it is susceptible to nephrotoxicity due to the damage from hypothermic storage.

Adult↗
PubMed1987

[Cytomegalovirus hyperimmunoglobulin prophylaxis following kidney transplantation. Results of a prospective randomized study].

The effectiveness of preventing cytomegalovirus (CMV) infections by administering CMV hyperimmunoglobulin was evaluated in a prospective randomized trial. The patients in the treatment group (n = 50) had intravenous infusions of 2 ml/kg bodyweight of CMV-Polyglobin at three-week intervals, up to day 105 after kidney transplantation. The 50 patients in the control group received no infusions. There was no significant difference between the treatment and control groups in transplant survival or patients survival rates. But the number of symptomatic CMV infections was higher in the control (n = 11) than the treatment group (n = 5). There were also significantly fewer symptomatic herpes-simplex infections in the treatment (n = 6) than in the control group (n = 25). It is concluded from these results that prophylaxis with CMV hyperimmunoglobulin should be undertaken either selectively or for shorter periods than those chosen for the reported trial.

Adult↗