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Biomedical subjects

T G Peters

Publications and source records attributed to T G Peters.

At least 19 recordsLinked to original sources
PubMed1992

Factors affecting the waiting time of cadaveric kidney transplant candidates in the United States.

UNLABELLED: OBJECTIVE--To evaluate the relative impact of various factors that could account for differences in waiting time of cadaveric kidney transplant candidates (eg, black and sensitized patients). DESIGN: --A cohort study using multivariate analyses to identify associations between 36 patient, donor, and center factors with waiting time for all US cadaveric kidney transplant candidates listed between October 1, 1987, and June 30, 1990. SETTING--All US kidney transplant centers. PATIENTS--The study included 23,468 cadaveric renal transplant candidates on active waiting status. RESULTS--The patient characteristics most significantly associated with increased waiting time (adjusted for all other variables) were immunologic and included presensitization to HLA antigens, O or B blood type, candidacy for a repeat transplantation, and expression of rare HLA-A or HLA-B antigen phenotypes. Nonimmunologic factors also affected waiting times, which were significantly shorter for patients younger than 15 years vs those aged 15 through 44 years (8.4 vs 12.9 months, respectively; P less than .0001), for those listed at multiple centers vs one center (7.0 vs 13.3 months, respectively; P less than .0001), or for white vs black patients (11.9 vs 15.4 months, respectively; P less than .0001). Local transplant center characteristics associated with a significantly shorter waiting time included a small number of transplantation candidates, a high (greater than 35 per million population) local kidney organ recovery rate, and an approved variance from the Organ Procurement and Transplantation Network allocation algorithm. CONCLUSIONS--The time renal transplant candidates must wait for kidney transplantation is influenced by several factors in addition to those expected due to immunologic reasons of donor incompatibility, the algorithms used for organ distribution, or the effectiveness of local kidney recovery. The impact of these factors should be considered as the current US system for allocating scarce donor organs for kidney transplantation is modified.

Black or African American↗
PubMed1990

Splenic injury and repair during bariatric surgical procedures.

Incidental splenectomy during exploratory laparotomy significantly increases morbidity and mortality. These rates, elevated in the morbidly obese, prompted a splenic preservation policy for any splenic injury during bariatric surgery. This review was needed to assess how this policy affected this population's intrinsically high perioperative risks. Six of 200 patients having primary or revisional vertical banded gastroplasty for morbid obesity or failure of previous bariatric surgery had splenic injury. In one case, splenectomy was necessary; in the other five, splenic repair was relatively easy and was not followed by problems related specifically to splenic surgery. Risks for splenic injury include previous operation, rigid retractors, adhesions in the left upper quadrant, and traction on adjacent viscera. We conclude that splenic injury during bariatric surgery should be repaired by the simplest hemostatic method(s). Splenectomy should be reserved for the irreparably injured organ or when instability of the patient's condition demands promptness.

Adult↗
PubMed1990

Organs for transplantation: analysis of 27,000 cadaveric donor organs.

Organs from brain-dead cadaveric donors have been increasingly used for saving lives and preserving health. During the 5 calendar years 1984 through 1988, specific organ recovery patterns were reported for 10,488 donors of 27,833 vascular organs. Transplantation of 18,277 kidneys, 3425 hearts, 2957 livers, and 411 pancreatic grafts (as well as smaller numbers of lung, intestine, heart-lung, and multivisceral grafts) represented an organ utilization rate exceeding 90%. Organ sharing was common and had a beneficial effect overall. Renal allografts from multiorgan donors showed better early function and long-term survival. A steady decrease in organ wastage has been accompanied by a substantial increase in numbers of cadaveric multiorgan donors. The resource of life-saving cadaveric organs is effectively and widely dispersed, allowing increasingly common treatment of end-stage organ failure by transplantation.

Age Factors↗
PubMed1990

Beneficial effect of cyclosporine on renal transplantation. A multicenter long-term study.

Data were collected prospectively on 8581 cadaveric renal transplants performed by institutions of the South-Eastern Organ Procurement Foundation (SEOPF) during the period November 1, 1983 through December 31, 1987. Cyclosporine was the initial then always used immunosuppressant for 5742 of these patients while 1050 never received cyclosporine. The drug was started late in the course of 481 transplants and stopped early in 378 cases. This allowed for 7651 transplants to be analyzed regarding these four categories of cyclosporine use or non-use. Actuarial graft survival for the cyclosporine "ALWAYS" group was 75% at one year, 68% at two years, 62% at three years, and 59% at four years compared with 55%, 49%, 45%, and 43%, respectively for the cyclosporine "NEVER" group (P less than 0.0001). Inclusion of the 930 cases that could not be categorized regarding cyclosporine use or for which actuarial data was not complete allowed all 8581 transplants to be analyzed by multivariate methods. This analysis disclosed significant effects on graft survival due to delayed graft function, prior transplant, recipient race, HLA match, level of PRA, and cyclosporine use. Organ sharing had no effect on graft outcome. While cyclosporine improves outcome in renal transplantation, the importance of other biologic factors affecting graft survival is not diminished by its use.

Cadaver↗
PubMed1990

Transplantation in the military: state of the art--a progress report from the Army-Navy Transplant Program.

The commitment to clinical transplantation services by the Army and Navy is now in its third decade. Located at the Walter Reed Army Medical Center, the Army-Navy Organ Transplant Service has been staffed and led by some of the most prominent transplant surgeons in America. Military beneficiaries are eligible for evaluation and care regardless of their geographic assignment or residence. Principally a renal transplant clinical service, the Organ Transplant Service also gives support to patients with heart, liver, and pancreas grafts. Organs for transplant are largely (85%) from the civilian sector, although the Department of Defense has officially encouraged organ donation. Research, scientific publication, protocol development, teaching, and interaction with reserve components have been major facets of the Organ Transplant Service. Clinical outcome in renal transplantation at the Army-Navy Unit is comparable to that at the best civilian units: 2-year graft and patient survival 81% and 98%, respectively. These superior clinical results and the major roles that the Army-Navy Transplant Service have played make continued support and expansion of military transplantation compelling.

Hospitals, Military↗
PubMed1989

Amputation of the distal portion of the foot.

For 101 patients, initial amputation of 124 extremities involved some distal portion of the foot. Amputations done for atherosclerosis healed in eight of 21 cases (38%), compared with 40 of 77 extremities (52%) in diabetic patients. Presence of cellulitis (44 cases) and absence of a popliteal pulse (44 cases) had no significant effect on success of amputation, but a palpable foot pulse was significantly associated with a successful outcome (29/35 cases, or 83%) (P less than .005). Serial amputations to preserve the foot were successful for 18 of 31 extremities (58%), a success rate equal to that of the entire series, 72 of 124 (58%). Attempts to preserve viability in the distal portion of the foot were not associated with mortality. Cellulitis and absence of a distal pulse are not contraindications to attempting preservation of the extremity, although the best results occur when distal extremity pulses are palpable. In nearly six of every ten cases, amputation of the distal portion of the foot resulted in a successful outcome.

Adult↗
PubMed1989

Splenectomy and the sick asplenic patient.

The sick asplenic patient bears risk to infectious complications and mortality. That risk is not widely accepted since no specific syndrome is applicable to all asplenic patients who are ill. In order to determine outcome following splenectomy, 624 patients having simple splenic injury, splenic plus multisystem trauma, elective splenectomy, incidental or accidental splenectomy, or splenectomy associated with transplantation were studied. Nonfatal complications specifically related to splenectomy occurred in 23 per cent of patients with multiorgan injury and 18 per cent with incidental-accidental splenic removal; splenectomy associated with transplantation had the highest mortality. The classic postsplenectomy sepsis syndrome was encountered late only twice. In the already sick patient rendered asplenic, conditions heralding susceptibility to progressive and sometimes fatal infection must be considered at all times. Sound indications for splenectomy must prevail before splenic removal since morbidity and mortality follow splenectomy, especially in the sick asplenic patient.

Adult↗
PubMed1988

Suppurative pylephlebitis caused by toothpick perforation.

We have reported a case of suppurative pylephlebitis in an elderly, debilitated patient. The infection was caused by toothpick perforation of and migration from the gastrointestinal tract. The patient had risk factors for foreign body ingestion, including poor dentition, aphasia caused by a previous cerebrovascular accident, and alcohol abuse. Investigation for the otherwise obscure cause of suppurative hepatic disease should take into account the possible, yet difficult to define, source related to an ingested foreign body.

Aged↗
PubMed1988

Conventional immunosuppressive therapy in modern renal transplantation.

Conventional immunosuppression has been replaced by cyclosporine protocols for renal transplantation in most centers. Some centers have continued using conventional immunosuppression in certain instances. In our series, 104 patients received 105 kidney allografts (58 cadaver, 47 living donor) in 1983 and 1984. No patients was treated with cyclosporine. Patient survival was 95% and 92% at six months and one year, respectively. Eight deaths were caused by sudden cardiorespiratory events (four), liver failure (one), and suicide (one); fatal infection occurred after regrafting in two asplenic patients. Actuarial graft functional survival was 80% at 12 months; living related donor graft survival of 94% at one year was comparatively better than the 66% with cadaveric grafts. Death from excessive pharmacologic immunosuppression did not occur. Graft survival was excellent with living donor and acceptable with cadaveric grafts, especially with good tissue matching. Conventional immunosuppression may remain applicable in renal transplantation under conditions of low risk for graft loss.

Adolescent↗
PubMed1988

Investigation of passive venovenous shunts during the anhepatic period of canine hepatic transplantation.

The anhepatic period of canine orthotopic hepatic transplantation is usually accompanied by cardiovascular instability due to occlusion of both the portal and inferior systemic venous systems. The present study was undertaken in order to determine some of the hemodynamic and renal alterations that occur during a 2 hour anhepatic period in the dog and to investigate the use of a passive endoportal, endocaval venovenous shunt that places both the portal and infrahepatic vena caval limbs of the shunt directly into the divided ends of these vessels. Three groups of experimental animals were studied. One group had hepatectomy without a shunt and was compared with two other groups which had hepatectomy with some form of venovenous shunting. Systemic arterial blood pressure, portal and inferior vena caval pressure, urinary output, and renal histology were all better maintained when a shunt was used.

Animals↗