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R J Stratta

Publications and source records attributed to R J Stratta.

At least 253 records · Page 14Linked 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

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

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↗
PubMed1986

Immunologic parameters in burned patients: effect of therapeutic interventions.

Complex immunologic alterations occur following thermal injury. To further delineate the intricacies of the immune response, a longitudinal profile of immunologic parameters was investigated in burned patients with specific reference to clinical criteria (resuscitation, plasma exchange, surgical excisions, sepsis). During a 17-month period, 26 adult patients with a mean age of 32.6 years and a mean burn size of 45.6% TBSA were evaluated with serial (twice weekly) assays of immunocompetence. The immunologic variables monitored included complement components, fibronectin, immunoglobulins, acute-phase reactants, serum proteins, catecholamines, and the mixed lymphocyte reaction. Resuscitation from burn shock and clinical sepsis were associated with a wide array of serologic abnormalities and lymphocyte suppression. Plasma exchange and surgical excision and grafting procedures were also characterized by multiple serologic changes and improvement in lymphocyte function. No specific serologic parameter correlated well with cellular function; however, patterns of humoral alterations were consistently present and may represent a combined effect.

Adult↗
PubMed1985

The effect of surgical excision and grafting procedures on postburn lymphocyte suppression.

Previous reports have stressed the immunosuppressive effects of major surgical procedures. In this study, 30 adult patients with a mean burn size of 42.8% TBSA and a mean age of 31.9 years underwent 78 surgical excision and grafting (E/G) procedures. The mean surface area excised was 2,373 cm2, with a mean blood transfusion requirement per E/G of 3,355 cc or 1.4 cc/cm2. The suppressive effect of burn serum was assayed in mixed lymphocyte cultures. Before E/G, burn serum caused a mean 42.2 +/- 3.3% suppression of normal lymphocyte blastogenesis; serum suppressive activity following E/G was reduced to 29.1 +/- 2.9% (p less than 0.005). The mean duration of improvement in lymphocyte function was 5.0 days. E/G procedures which achieved complete burn wound closure were more effective in restoring lymphocyte immunocompetence. E/G has a significant beneficial effect on restoring lymphocyte responsiveness in burn patients. Preliminary evidence suggests that this effect is related to blood transfusions.

Adolescent↗
PubMed1984

The effect of plasma exchange on lymphocyte suppression after burn.

Circulating mediators have been implicated in the pathophysiology of immunodepression after burn injury, suggesting the beneficial effect of plasma exchange in immunorestoration. In this study, 19 adult patients with a mean burn size of 52.2% of total body surface area and mean age of 33.4 years underwent 51 plasma exchange procedures in five different clinical settings, without complication. The suppressive effect of burn serum was assayed in mixed lymphocyte cultures. The mean (+/- SEM) suppression by burn serum drawn prior to plasma exchange was 61.9% +/- 3.6%, while that following plasma exchange was 27.3% +/- 2.7%. The lymphocyte response decrease 55.1% +/- 4.4% in suppressive activity. The mean duration of improvement in lymphocyte function was 4.8 days. Plasma exchange has a significant beneficial effect in restoring lymphocyte immunocompetence in burned patients in a number of clinical settings.

Adolescent↗
PubMed1984

The effect of exchange therapy on postburn lymphocyte suppression.

Circulating mediators have been implicated in the pathophysiology of postburn immunologic depression, suggesting the restorative potential of exchange therapy. Previous reports have stressed the immunosuppressive effects of massive transfusions and major surgical procedures. The effect of plasma exchange (PLA/EX) and surgical excision and grafting (E/G) procedures on postburn lymphocyte function was evaluated retrospectively in one-way mixed lymphocyte reaction assays. Twenty one adult patients with a mean total body surface area (TBSA) burn of 52.6% underwent a total of 54 PLA/EX procedures without complications. The mean volume of plasma exchanged was 5079 ml. PLA/EX was performed at a mean time of 10.4 days after burn injury. Thirty adult patients with a mean TBSA burn of 42.8% underwent a total of 78 E/G procedures. The mean graft size was 2373 cm2 per E/G procedure or 7.25% TBSA. The mean transfusion requirement per E/G was 3355 ml. The initial E/G occurred at a mean of 7.5 days after burn injury. PLA/EX decreased suppression of normal lymphocyte blastogenesis by burn serum from 62.7% to 28.3% (p less than 0.001). The mean duration of improvement in lymphocyte function was 4.8 days. Similarly, the mean suppression by burn serum drawn pre-E/G was 42.2%, while serum suppressive activity post-E/G was 29.1% (p less than 0.05). The mean duration of mixed lymphocyte reaction improvement was 5.0 days. Both PLA/EX and E/G procedures have a significant beneficial effect in restoring lymphocyte function in burn patients.

Adolescent↗
PubMed1984

Exchange transfusion therapy in pediatric burn shock.

Irreversible burn shock, which persists despite fluid resuscitation, remains a significant cause of early mortality in thermally injured children. Since circulating serum factors have been implicated in the pathophysiology of burn shock, the use of exchange transfusion therapy was analyzed retrospectively in children filing to respond to conventional volume therapy during burn shock. Seven children with a mean burn size of 42.9% and a mean age of 3.2 years underwent exchange transfusion for ongoing burn shock after standard resuscitation failed. A therapeutic response was documented in all patients, characterized by a sharp decrease in fluid requirements from a mean of 332% of the predicted hourly volume to calculated requirements by 2.9 hr following exchange. Markedly improved urine output and resolution of lactic acidosis were also demonstrated. All patients recovered from shock with one late mortality. Exchange transfusion therapy facilitates resuscitation from burn shock in children who do not respond to conventional volume therapy.

Burns↗
PubMed1983

Management of tar and asphalt injuries.

Tar and asphalt burns are unique injuries because the chemical is difficult to remove without inflicting further tissue injury. Since 1978, 42 patients have been treated for hot tar or asphalt injuries, 30 of whom required hospitalization. Inpatients were all male with a mean age of 27.2 years and a mean burn size of 9.3 percent total body surface area (mean full-thickness injury 5.3 percent total body surface area). Burns of critical areas were present in 63.3 percent of the inpatients. A petroleum-based, surface-active solvent was used to remove the tar or asphalt. This solvent proved nonirritating and removed tar much faster than other agents. Early excisional therapy was performed in 63.4 percent of the patients, 80 percent of whom returned to work within 6 weeks of injury. Principles of management include rapid cooling of tar or asphalt to solidify the inciting agent and dissipate heat; removal with a new, non-toxic solvent; early excision and grafting of appropriate injuries; and an aggressive, early back-to-work philosophy.

Accidents, Occupational↗
PubMed1983

Thermal injury in an adrenalectomized patient.

The occurrence of thermal injury in an adrenalectomized patient on long-term steroid replacement therapy illustrated the role of adrenal hormones in the systemic responses to thermal injury. This unusual patient demonstrated an inadequate response to fluid resuscitation and excessive third-space fluid losses, defective thermogenesis, profound nutritional abnormalities, impaired wound healing, and compromised immunologic function. Nutritional support required correction of calorie-nitrogen proportions from 180:1 to 90:1, following which the patient was in positive nitrogen balance.

Adrenal Glands↗
PubMed1983

Plasma exchange therapy in patients failing to resuscitate from burn shock.

Irreversible burn shock results from failure of fluid resuscitation and is almost invariably fatal. Because of the implied role of circulating serum factors in the generation of burn shock, the use of plasma exchange was evaluated retrospectively in patients with major thermal injuries who had failed to respond to conventional therapy. Twenty-two patients with a mean burn size of 47.9% total body surface area and a mean age of 22.7 years underwent plasma exchange for ongoing burn shock after standard fluid resuscitation failed. A therapeutic response was documented in 95.4% of the patients, characterized by a sharp decrease in fluid requirements from a mean of 260% above the predicted hourly volume to within calculated requirements by 2.3 hours following plasma exchange. Markedly improved urine output and resolution of lactic acidosis were also demonstrated. No major complications occurred. We conclude that plasma exchange facilitates resuscitation from burn shock in a select group of patients who do not respond to conventional volume therapy.

Burns↗