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S H Kashi

Publications and source records attributed to S H Kashi.

13 recordsLinked to original sources
PubMed2001

European randomised trial of dual versus triple tacrolimus-based regimens for control of acute rejection in renal allograft recipients.

Two large multicentre studies have shown superiority of tacrolimus-based immunosuppressive regimens compared with standard cyclosporine-based therapy in renal transplantation. In these studies, tacrolimus was used in a triple drug regimen of tacrolimus, corticosteroids, and azathioprine. The present study aimed to determine whether a tacrolimus-based dual regimen achieves a similar efficacy and safety profile compared with conventional triple therapy. In this prospective, open, multicentre trial, 249 patients were randomised to receive either dual therapy (n = 125) of oral tacrolimus (initial daily dose of 0.2 mg/kg) and oral prednisone or additionally, as a triple therapy (n = 124), oral azathioprine. The primary endpoint was the incidence of acute rejection at month 3. In addition, all patients were included into a follow-up evaluation at 1 year after transplantation. Both treatment groups had similar baseline characteristics. At month 3, patient survival was 97.6 % (dual) and 96.7 % (triple); graft survival was 92.7 % (dual) and 91.7 % (triple). The incidence of treated acute rejection confirmed by biopsy was 27.4 % (dual) and 24.8 % (triple); difference 2.6 %, 95 % CI [-9.4 %-12.9 %], P = 0.755. The incidence of corticosteroid-resistant rejection (biopsy-confirmed) was 9.7 % (dual) and 10.7 % (triple). The overall adverse events profile was similar; leukopenia (1.6 % vs 11.6 %, P = 0.002) was more frequent with triple therapy. Between months 4 and 12, six (dual) and eight (triple) patients had a rejection. At month 12, patient survival was 95.6 % (dual) and 93.6 % (triple); graft survival was 91.8 % (dual) and 90.7 % (triple). Tacrolimus proved to be efficacious and safe with both dual and triple low-dose regimens. The addition of azathioprine to a tacrolimus/corticosteroid-based therapy did not result in an increased efficacy.

Acute Disease↗
PubMed1998

Organ transplantation from donor who died of cyanide poisoning: a case report.

Shortage of donor organs has become on of the most important limiting factors in the field of transplantation. Suitability of organs from patients dying from poisoning is an unexplored area. This is because of the suspicion that the organs, in particular the liver and the kidneys, might have been irreversibly damaged by the poison. We report a case of cyanide poisoning in which the kidneys and corneas were harvested after the level of poison fell to below lethal concentration. These organs were later transplanted without any evidence of adverse effects at follow-up.

Adult↗
PubMed1995

Meckel's diverticulum: a continuing dilemma?

Forty-three cases of Meckel's diverticulum (MD) encountered in an academic department of surgery over a 15-year period were reviewed. All of the patients and their general practitioners were contacted and long-term follow-up was obtained in 36 cases (85%). In 21 of 35 diverticulectomies, MD was an incidental finding. An overall complication rate of 26% was recorded over an average follow-up period of 8 years. In the asymptomatic group this rose to 30%. None of the eight cases in whom the diverticulum was not resected has developed early or late complications. Our findings suggest that an incidentally discovered Meckel's diverticulum should be left in situ.

Adolescent↗
PubMed1994

An evaluation of vesical urodynamics before renal transplantation and its effect on renal allograft function and survival.

This prospective study investigated the urodynamics of the urinary bladder prior to renal transplantation in 57 patients and related this to graft function and transplantation outcome. The study demonstrated a clear deterioration in the pretransplant urodynamic characteristics in all subgroups, with male patients in the hemodialysis group (HD) showing a more substantial decline: 1st sensation volume (ml) in male HD patients = 112 (120) vs. 171 (173) in male CAPD patients, P < 0.05; and corresponding average flow rate for same groups 3 (3) ml/sec vs. 5 (5) ml/sec, P < 0.05. Figures are median (interquartile range). We have identified a subgroup of patients with a small bladder capacity (less than 100 ml) who have a reduced graft survival (55% vs. 92% for bladders larger than 100 ml at 2 years) apparently unrelated to immunological processes.

Adult↗
PubMed1993

The reflush effect--a prospective analysis of late perfusion.

This prospective randomized trial examines the effect of a "reflush" with preservation solution immediately prior to renal allograft implantation, using hyperosmolar citrate (HOC, n = 10) or phosphate-buffered sucrose (PBS140, n = 10) versus no reflush (n = 10). All kidneys had been stored in HOC. The HOC reflush did not alter the postpreservation intra- or extracellular electrolyte milieu, whereas the PBS140 reflush resulted in an apparent overall loss of both sodium and potassium from the kidney (P < 0.0005). A small amount of calcium was released into the venous effluent in both reflush groups. A similar amount of lactic acid was released into the venous effluent of the two reflush groups, reflected by a lower pH (P < 0.0005), and there was a similar loss of lactate dehydrogenase and creatine phosphokinase. An analysis of procoagulant activity in the first urine produced was performed as a marker of reperfusion injury. The median value was higher in the No Reflush group at 457.5 units, compared with 263.0 and 209.0 units for the PBS140 and HOC Reflush groups, respectively (P = 0.06). Reflushing the kidneys reduced the postoperative dialysis requirement (from 40% to 15%), but by the end of the first posttransplant week there was no significant difference between the renal functional analyses of the three groups, and there was no difference at one year. The proposed mechanism for the early renal functional improvement is a reduction in the calcium paradox and free radical formation, by release of calcium and ATP breakdown products into the venous effluent prior to implantation.

Adolescent↗
PubMed1993

Does the Whitaker test add to antegrade pyelography in the investigation of collecting system dilatation in renal allografts?

Significant pelvicalyceal dilatation in renal allografts is currently investigated by antegrade pyelography. However, the clinical significance of a radiologically demonstrated narrowing of the ureter is unclear. Over a 21-month period 26 of 155 renal allografts with pelvicalyceal dilatation were investigated by antegrade pyelography. In eight allografts no ureteric stenosis could be identified. Two grafts were shown to have ureteric necrosis and required surgical intervention and 16 of the other grafts appeared to have a ureteric stenosis. 15 of the 16 allografts with radiological ureteric stenosis underwent a concurrent pressure flow study to assess the functional relevance of the ureteric narrowing. As shown by a pressure rise of > 7 mmHg at a perfusion rate of 10 ml min-1, 11 of the 15 grafts were functionally obstructed and were treated by a nephrostomy catheter followed by antegrade insertion of a ureteric stent. The four grafts with a negative pressure flow study were subsequently shown on biopsy to have rejection. The diagnosis of allograft rejection was also confirmed by biopsy in seven of the eight allografts without a radiological ureteric stenosis. The last of the eight allografts was found to be cyclosporin toxic. Pelvicalyceal dilatation of renal allografts is appropriately investigated by antegrade pyelography in combination with a pressure flow study which identifies those grafts with mechanical obstruction.

Adult↗
PubMed1993

Improving the evaluation of renal transplant collecting system dilatation by computerized ultrasound image digitization.

43% of the renal allografts transplanted at our centre demonstrate pelvicalyceal dilatation on ultrasonography. However, only 6% of grafts are ultimately shown to be obstructed by antegrade pyelography. We have attempted to improve the specificity of ultrasonography by a quantitative analysis of 394 serial ultrasound studies from 150 renal transplant recipients. Representative images in the longitudinal and transverse axes were selected by a single observer for each of the studies and the outline of the kidney and its pelvicalyceal system was traced out. The images were then digitized using a Summagraphics tablet so that the length, width and area of the kidney and its pelvicalyceal system were calculated for each image. A step-wise discriminant analysis was performed which showed that the ratio of the area of the kidney to its pelvicalyceal area in both axes discriminated between normal, dilated but non-obstructed, and obstructed grafts. The median ratio of kidney to collecting system area in the obstructed grafts was 5.2 in the longitudinal and 4.4 in the transverse scan planes (vs median ratios of 32.8 and 22.0 for non-dilated grafts). Using canonical discriminant function, an index was derived which combines these ratios for the longitudinal and transverse images of the same kidney and this has further improved the diagnostic accuracy (median index of 2.45 in obstructed group vs -0.85 in non-dilated kidneys). This method improves upon the radiologist's report and identifies those grafts which require intervention.

Adolescent↗
PubMed1992

Complications of renal transplantation and the role of interventional radiology.

As rejection therapy has improved, the interventional complications of renal transplantation have increased in relative importance as potentially reversible causes of graft malfunction and failure. Ultrasonically guided aspiration and drainage techniques are essential for the characterization and subsequent management of perinephric fluid collections that occur in as many as 51% of cases, of which up to 18% may be clinically significant. In a series of 507 consecutive renal transplants, urological complications were seen in 9% of patients, consisting of ureteric obstruction in 6% and urinary leaks in 3%. Detection via ultrasound scanning, evaluation via antegrade pyelography and pressure-flow tests, and management via percutaneous nephrostomy and ureteric stenting all contribute to rapid diagnosis and subsequent treatment. Serial ultrasound scanning of renal transplants and the aggressive use of interventional radiological techniques are vital to the early detection and management of complications, and can lead to preservation of graft function and continued improvement in graft survival figures.

Graft Rejection↗
PubMed1992

Ureteric complications of renal transplantation.

Of 507 consecutive recipients of renal allografts, 45 developed a urological complication. In 39 patients (7.7%) ureteric problems were implicated and these comprised 30 cases of obstruction and 9 cases of ureteric necrosis presenting as urinary leakage. In 7 patients ureteric obstruction resolved following a period of nephrostomy decompression; 10 patients were reconstructed surgically and this was successful in 8, with 2 patients requiring further surgical procedures. Ten patients were successfully treated by percutaneous stenting after dilatation of the stricture. Stenting failed in 4 patients and in 1 patient caused rupture of a calix. All 10 stents have now been removed and there is no recurrence of stricture (follow-up 32.0 +/- 8.6 months). Of the remaining 3 grafts, 2 were removed and the other graft had percutaneous removal of a ureteric calculus. The 1-year survival rate of allografts in the ureteric complication group was 84.6%; in the recipients without a urological complication it was 81%. It was concluded that an active approach to ureteric problems following renal transplantation results in the rescue of the majority of allografts.

Adolescent↗
PubMed1991

Ultrasonography of renal allografts: collecting system dilatation and its clinical significance.

Reports and ultrasound scans (658 studies) of 135 renal allografts, transplanted in the years 1987 and 1988, have been reviewed. Records of the recipients were also studied in order to determine the clinical status of the kidney at the time of each ultrasound examination and to obtain long-term follow-up of allograft function. Seventy-seven allografts (57%) never showed pelvicalyceal dilatation on 342 serial examinations. Forty-two kidneys (31%) had mild dilatation reported on at least one scan, which did not progress. However, 11 mildly dilated allografts developed moderate to severe dilatation on later examinations and these, together with 5 allografts reported as exhibiting moderate to severe hydronephrosis on their first dilated scan, were classed as moderate to severe (n = 16 = 12%). Thirty-eight patients (90%) with mild dilatation of the collecting system had no evidence of obstruction. However, in allografts with moderate to severe dilatation and poor or deteriorating function, ten patients (70%) were found to have ureteric obstruction. There was no significant difference in 1-year graft survival (87% versus 81.8%) and the median serum creatinine at 3 and 12 months after transplantation between non obstructed 'dilated' and non-dilated allografts (149 mumol/l versus 153.7 mumol/l; 139 mumol/l versus 147.3 mumol/l). All 14 obstructed allografts were salvaged with a graft survival of 85.7% at 1 year. Median serum creatine in these patients was significantly elevated at 200 mumol/l and 189 mumol/l at 3 and 12 months; P = 0.05 and 0.01 compared to dilated non-obstructed allografts. Our results indicate that grafts with moderate to severe dilatation should be urgently investigated to minimise further allograft damage.

Adult↗
PubMed1990

Primary lymphoma of the bladder: a clinicopathological study of 3 cases.

Primary involvement of the bladder by lymphoma is rare but is associated with a favourable prognosis if diagnosed early and treated appropriately. The clinicopathological features of 3 cases of primary, non-Hodgkin's lymphoma of the bladder are described. This small study suggests a better prognosis with a favourable histological grade and an uncomplicated lymphoma confined to the bladder. We emphasise the value of aggressive treatment of the tumour.

Aged↗