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Biomedical subjects

R Gunnarsson

Publications and source records attributed to R Gunnarsson.

At least 73 records · Page 4Linked to original sources
PubMed1981

The influence of HLA-DR match on cadaveric renal graft survival. Experience from Stockholm.

The influence of HLA-DR match on graft and patient survival was analyzed in 124 cadaveric kidney transplant recipients treated between January 1977 and September 1980. The material consisted of 90 primary transplant and 34 retransplants. The mean patient age was 49 years, 72 were males and 52 females. Eighteen of the recipients were diabetics. Sera against the HLA-DR antigens 1-5, 7 and DRw8 were available, for DRS only during the later half of the period. When the case material was divided according to the number of donor-recipient HLA-DR antigens shared, a significant improvement in graft survival was found if one antigen was shared as compared to none shared. When 2 antigens were shared graft survival was excellent but there were only 7 such cases. When division was performed according to the number of existing HLA-DR incompatibilities, a significant improvement in graft survival was noted when there were no incompatibilities as compared with 2 incompatibilities. The distribution of foreign HLA-A, B antigens was even between the DR match groups and did therefore not constitute a bias. We conclude that matching for the HLA-DR antigens has a major beneficial effect on cadaveric kidney graft survival.

Actuarial Analysis↗
PubMed1980

Plasma C-peptide and serum insulin antibodies in diabetic patients receiving pancreatic transplants.

Plasma C-peptide and serum insulin antibody levels were determined in 5 diabetic patients undergoing vascularized pancreatic transplantation. The grafts functioned well at first and exogenous insulin could be withdrawn, but one to 7 weeks later the grafts were rejected. After the transplantation there was an increase in the fasting plasma C-peptide level, and B-cell stimulation with glucose or glucagon evoked a C-peptide response. Healing of ischaemic damage was reflected in an increase in the C-peptide level. During graft rejection the C-peptide level fell. Measurement of plasma C-peptide levels provides a direct index of the B-cell function of the pancreatic graft. After transplantation the insulin antibody level fell exponentially, with an apparent half life of 10-11 days, whereas the level of total IgG was variable. The results indicate that formation of insulin antibodies ceases immediately on removal of the immunogenic stimulus, that is, on withdrawal of xenogeneic insulin.

Adult↗
PubMed1980

Experience with pancreatic transplantation in Stockholm.

Eight attempts at segmental pancreatic transplantation were made in 6 diabetic patients. While the indications for transplantation differed all the patients were severely incapacitated by the disease. None was uremic. The body and tail of the pancreas from cadaveric donors was used, the grafts were revascularized to the recipient's iliac vessles. Six of the grafts provided control of blood glucose for 7-51 days. Five of the grafts then failed owing to rejection, and one had to be removed while still functioning, because of arterial bleeding. Important lessons have been learned concerning both surgical and immunological aspects of this form of treatment : 1) Ducto-jejunostomy should be used to provide exocrine pancreatic drainage. 2) HLA-DR typing for donor-recipient selection and thoracic-duct drainage as an adjunctive immunosuppressive measure should be used to reduce the incidence of graft rejection. 3) An elevation of the postprandial blood glucose concentration is a first sign of rejection and should cause treatment. 4) Graft rejection can be reversed by conventional steroid medication.

Adult↗
PubMed1980

Segmental pancreatic transplantation with duct ligation or drainage to a jejunal Roux-en-Y loop in nonuremic diabetic patients.

The results of seven segmental pancreas transplantations in diabetic patients, using a jejunal Roux-en-Y loop for drainage of digestive enzymes, are presented. An initial case with pancreatic duct ligation is also included. The patients ranged in age from 30 to 45 yr, with duration of diabetes from 8 to 24 yr, and were incapacitated but not uremic. Immunosuppression was attempted with azathioprine, prednisone, and antilymphocyte globulin, and, in one patient, thoracic duct drainage was added. The pancreas tolerated at least 16 min of warm ischemia and at least 4 h of cold storage; flushing with a balanced electrolyte solution was optimal. Six of the grafts provided control of blood glucose for 7--51 days, and, in one patient, an intravenous glucose tolerance test was normal at 7 and 21 days. Five of the grafts failed due to rejection 7--51 days after transplantation, and one was removed at 14 days, while still functioning, due to bleeding. In one case, early detection of rejection by a rise in post-prandial blood glucose was treated and reversed by corticosteroid administration. Two failed in the immediate postoperative period from vascular thrombosis. Drainage of pancreatic secretions from a fistula was a common problem.

Adult↗
PubMed1980

Transplantation of fetal pancreatic microfragments via the portal vein to a diabetic patient.

Human fetal pancreas preserved in culture was used as a donor organ in a 45-yr-old man with diabetes of 14-yr duration complicated by severe retinopathy and nephropathy. Renal failure had been successfully treated by a cadaveric renal transplant 2 yr earlier. Six fetal pancreases, obtained within 30 min of delivery after prostaglandin-induced abortion at 14--20 wk of gestation, were minced and placed in tissue culture for 3 h at the earliest and 15 days at the longest duration. The cultures were harvested 2--3 h before transplantation. Approximately 3 ml of tissue was infused into a right portal vein branch. Azathioprine was continued at 2 mg/kg and prednisolone increased from 10 mg to 100 mg/day on the day of transplantation and gradually reduced to 25 mg/day. Only two doses of antilymphocytic globulin were given because of a severe reaction. During the 40 days since transplantation, insulin requirements have not changed, but C-peptide has appeared in the urine, suggesting function of the transplanted tissue.

C-Peptide↗
PubMed1980

Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?

The development of steroid diabetes was studied in a consecutive series of 114 patients receiving a cadaveric renal graft. All were first-time transplantations. For acceptance in the series the graft should have functioned for at least 2 weeks after the transplant operation. The median age of the patients was 52 years. The follow-up period was at least one year. The criterion for a diagnosis of steroid diabetes was an elevated fasting blood glucose concentration of more than 8 mmoles/l. Fifty-two of the patients (46 per cent) developed steroid diabetes. Thirty-four (65 per cent) of them required insulin therapy or peroral anti-diabetic drugs. The mean age of these patients was higher than for those not afflicted by this complication. The first-year mortality was significantly higher, 42 against 13 per cent, respectively (p less than 0.01). The level of significance was not notably affected by correction for age at transplantation. Severe infection was the cause of a large proportion of the deaths in the diabetes group. The findings suggest that the development of steroid diabetes can serve as a warning signal for excessive dosage of corticosteroids, and help to identify patients that are particularly sensitive to immunosuppressive therapy with large doses of steroids.

Adolescent↗
PubMed1980

The significance of HLA-A, -B matching for the survival of cadaveric kidney transplants performed in Stockholm in 1970-78.

Of the 320 cadaveric renal transplantations carried out between 1970 and 1978 in Stockholm 308 were analysed with respect to dependence of graft survival on HLA-A, -B matching. From November, 1973, kidneys with 3 or 4 HLA-A, -B incompatibilities were accepted much more often than had previously been the case. All but 7 of the 90 grafts with 3 or 4 incompatibilities were transplanted during that period. In order to obtain as homogeneous a group as possible the transplantations performed during this period were analysed separately, and transplantation performed on diabetic patients and retransplantations were excluded. This material comprising 141 transplantations was examined also with respect to other factors that may have a bearing on graft survival. As regards the factors mean age, pre-transplantation dialysis and blood transfusions, primary diuresis at transplantation and high-dose ALG therapy there was no essential difference between the recipients of kidneys from donors with 1 or 2 HLA-A, -B incompatibilities and the 3 or 4 incompatibility group. Thirteen of the 141 transplantations were fully compatible but because this group was small it was not included in the statistical analysis. After 2 years the group with 3 or 4 HLA-A, -B incompatibilities displayed a significantly poorer graft survival than the one with 1 or 2 incompatibilities (p less than 0.05).

Graft Survival↗