Biomedical subjects
Publications and source records attributed to S Pomer.
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As an adjunct to the monitoring of intracellular high-energy phosphorus metabolites by 31P NMR1 for assessment of renal viability, a study of vasculature of preserved kidneys was performed by Image-Guided Volume Selective 19F MR Spectroscopy. 1H and 19F of the same preserved rat and porcine kidneys were obtained. The technique enabled the analysis of the vessel and tissue properties and opens new possibilities for pretransplant assessment of renal vasculature.
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In this study we compared the invagination technique with the commonly used end-to-side anastomosis. A total of 30 invaginations and 30 end-to-side anastomoses was performed randomly in 30 Wistar rats. We checked the patency of the anastomoses 4 months after operation by macroscopic examination, spermiogram, methylene blue injection, and X-radiography studies as well as histology. The examination of the anastomoses showed patency in 19 (63.2%) compared with 24 patent invaginations (80%). The introduction of the simple time-saving technique of invagination could be useful for clinical purposes, since it is easier to learn and to practise and might also improve the clinical results concerning the patency of anastomoses.
The prevalence of anti-HCV in patients after kidney transplantation was tested by HCV-Antibody-ELISA (Ortho Diagnostics). In addition, reactive samples were tested by HCV-EIA (Abbott Laboratories), neutralization, anti-HBc (Corzyme, Abbott) and by HBs-Ag (Auszyme, Abbott). 27 of 271 patients (10%) were anti-HCV positive. Receiving more than one kidney graft (TPL) or the transfusion of more than four blood units (BU) increases the risk of HCV infection four times (OR: 4.1; p less than 0.01) or 2.5 times (OR: 2.5; p less than 0.05), respectively, compared with one TPL or less than 4 BU. Receiving more than one kidney graft and transfusion of more than four BU raises the risk of HCV infection 6.8 times. 52% of anti-HCV positive patients were anti-HBc positive, 48% were anti-HBc negative as well as HBs-Ag negative.
Among 1050 consecutive renal transplants (Rtx) performed in Heidelberg since 1967 we have gained experience with 163 children and adolescents under the age of 16, receiving a Rtx since 1969. 30% of these were terminally renal insufficient due to congenital obstructive uropathy, mainly infravesical obstruction and/or reflux nephropathy. A special diagnostic work-up (flow chart) for evaluating and eliminating potential pre- and posttransplant risk factors consisted of noninvasive screening methods (ultrasonography and uroflow) followed step by step by more invasive imaging procedures (MR, MCU) and finally invasive methods of evaluating upper urinary tract and voiding disorders (complete urodynamic work-up). We emphasize the preservation or rehabilitation of urinary bladder function, eradication of significant UTI and pre-Rtx surgical treatment of otherwise hard to handle nephrogenic hypertension. Unnecessary psychologically and somatically traumatizing pretransplant diagnostic and therapeutic procedures can be avoided in pediatric non-obstructive nephropathy patients.
The interposition of the greater omentum was used for treatment of lymphoceles in combination with peritoneal fenestration and for prevention of urinary fistulas in cases of lower pole renal artery lesions and feared ureteral necrosis as well as for protection of pyeloureterostomics and pyelovesicostomics, secondary to ureteral necrosis postrenal transplantation. Especially the combination of peritoneum fenestration with interposition of the greater omentum proved to be the procedure of choice for treatment of posttransplant lymphoceles. The incidence of lymphoceles following renal transplantation is in the range of 5-15%. Even by meticulous surgical technique--ligature of donor and recipient lymph vessels--they cannot be prevented totally since perioperative anticoagulation plays a significant role. Following unsuccessful repeated punctures for decompression, external drainage, local application of tetracycline or fibrinogen glue, internal marsupialisation to the peritoneal cavity is the established ultimate treatment. Inherent risks and difficulties of this procedure can be reduced, if peritoneal fenestration of the lymphoceles is combined with the interposition of the greater omentum. This technique described in details gave totally satisfactory results in 14 cases.
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A 4.5-year-old boy received a combined liver and kidney transplant for correction of hyperoxaluria type 1. Both organs were from the same donor and functioned primarily. Three months after transplantation, urine oxalate excretion reached a maximum of 10,500 mumol/24 h and remained above 2300 mumol/24 h for the next 2 months. Two months later, oxalate excretion decreased to about 565 mumol/24 h, indicating exhaustion of a large oxalate pool. Six months after transplantation plasma oxalate is near normal (4.9 mumol/l). With the exception of one episode of acute rejection of the renal transplant, both organs were tolerated well and continue to have a unimpaired function 9 months after transplantation. However, there is increased echogenity on renal ultrasound, indicating oxalate deposits in the grafted kidney. This case illustrates that successful combined transplantation of both liver and kidney can be performed in infants, resulting in cure of the metabolic defect. The prolonged or acute excretion of oxalate may lead to oxalate deposition in the grafted kidney without impaired graft function or early graft loss.
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Fifty-one pediatric patients undergoing a first cadaveric kidney transplantation were followed for at least 2 years after grafting. They were divided into two groups: those treated with methylprednisolone plus azathioprine (AZA) and those treated with methylprednisolone plus low-dose cyclosporin A (CyA; median dose 109 mg/m2 per day = 3.4 mg/kg per day after 1 year). The steroid dosage given was significantly lower in the second group. The 4-year graft survival rate was 68% for the AZA group and 78% for the CyA group. Renal function did not differ significantly in the two groups; after 1, 2, and 3 years, the median 24-h creatinine clearance was 79, 69, and 51 ml/min/1.73 m2, respectively, for the AZA group and 78, 63, and 68 ml/min/1.73 m2, respectively, for the CyA group. Linear growth was similar in the two groups. We conclude that in pediatric patients the results of low-dose CyA immunosuppression do not differ significantly from those obtained with AZA in terms of graft survival, renal function, or growth.
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Monitoring of immunoglobulin-secreting cells in peripheral blood was performed in 88 renal transplant recipients using a reverse hemolytic plaque-forming cell assay. Comparison with other in vitro tests for rejection (plasma neopterin, CD4/CD8 ratio) demonstrated that the number of immunoglobulin-secreting cells in peripheral blood provides a highly sensitive rejection marker. Evidence of rejection was obtained 1.7 +/- 0.4 (mean +/- SEM) days before a rise in creatinine, with a significant PFC rise in 95% (73/77) of rejection episodes. The PFC response was not influenced by HLA matching, number of preoperative blood transfusions, acute tubular necrosis, or uremia. A significant PFC rise in the absence of an ongoing rejection episode occurred in the presence of bacterial or viral infections, in case of posttransplant surgical complications, and regularly during the early posttransplant period (days 4-9). However, even early posttransplant the PFC peak was significantly higher in patients with an ongoing rejection episode than in patients without rejection (P less than 0.001).
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