Biomedical subjects
Publications and source records attributed to V Strobelt.
The appearance, specificity and dynamics of donor reactive antibodies have been studied in 9 patients who experienced early irreversible graft failure. In 5 out of 9 patients we were able to detect donor reactive antibodies. Their reaction patterns may be ascribed to a common responder type ("high responder"). Diagnostic and preventive possibilities for preventing early irreversible graft failures have been discussed.
In 82 renal transplant recipients we measured the excretion of urinary alanine aminopeptidase (EC 3.4.11.2) activity daily after transplantation until patients' discharge from hospital. Enzyme excretion was expressed as volume activity (U/L), time-related output (U/4h) and in relation to the excreted creatinine. Diagnostic sensitivity, specificity, efficiency and likelihood ratios were calculated from all three expressions with regard to diagnosis of acute rejection crises. The term "enzyme activity per creatinine excreted" has the highest diagnostic potential.
To prevent the complications of ureteral and parenchymal ischemia it is important to revascularize all accessory and main branches of the renal arteries in kidney transplantation. 11 allografts underwent ex vivo microsurgical repair of injured polar arteries prior to allotransplantation, and 1 patient had an in situ repair. Three extracorporeal reconstructive techniques are used that are applicable to most of the vascular injuries presented by multiple renal arteries. These are simple and effective methods that avoid subjecting the allograft to prolonged warm ischemia. There were no operative complications, and only one late arterial stenosis occurred; five transplants currently are functioning. The 1-year graft survival in this group, which is 50%, does not differ significantly from those of all transplants (58%). As a result of our policy, 10.5% more allografts were utilized.
Serum samples of 110 recipients of kidney transplants and the 100 donors belonging to them taken before the transplantation were examined for complement-binding antibodies against cytomegaloviruses. A clear influence of the cytomegalovirus antibody state of donor and recipient on the cytomegalovirus infection appearing after transplantation, serologically ascertained by cytomegalovirus-IgM-antibody proof or seroconversion and fourfold increase of the titre in the complement-binding reaction, respectively, could be made evident. Cytomegalovirus negative recipients of kidneys of cytomegalovirus positive donors had significantly more infections than seronegative recipients of kidneys of seronegative donors (50% vs. 16%, p less than 0.05). According to the infection rate the seropositive recipients stand with about 30% between these two groups. It seems that in these recipients the serological state of the donors has no influence. These findings make evident that seronegative recipients receive the cytomegaloviruses essentially with the transplant, whereas the cytomegalovirus infections in seropositive recipients are endogenous cytomegalovirus reactivations caused by therapy.
It is reported on early and late complications on the efferent urinary system by 667 transplantations of allogenic kidneys of corpses. The complication rate runs to 6.3%. Indication and performance of reconstructive surgical interventions are descended to in detail.
In this paper our experiences with extracorporeal microsurgical repair and transplantation of kidneys with injured accessory renal arteries are described. We present our effort to increase the number of suitable donor kidneys for transplantation. Three extracorporeal reconstructive techniques are used that are applicable to most of the vascular injuries presented by multiple renal arteries: End-to-side-anastomosis between the polar and the main artery. Side-to-side-anastomosis of two arteries with the same diameter. Use of autologous vascular grafts, e.g. inferior epigastric artery. 13 allografts underwent ex vivo microsurgical repair of injured polar arteries prior to allotransplantation and 1 patient had an in situ repair. There was no operative complication and only one late arterial stenosis occur, seven transplants currently are functioning. Our clinical experience with ex vivo microsurgical repair has been favourable. The increasing number of transplantable cadaver donor kidneys and the decreasing incidence of urinary fistulas supports their continued application in appropriate situations.
The catalytic activities of alanine aminopeptidase, alkaline phosphatase and gamma-glutamyltransferase were determined in the soluble and particulate fractions of urine, after ultracentrifugation. In healthy adults the fractional catalytic activities in the supernatants were 0.53, 0.56 and 0.24, respectively. Nearly the same proportions were found in children. In patients suffering from chronic kidney diseases there was a tendency for the proportion of catalytic activity in the soluble fraction to increase. However, the separation into the multiple forms gave no higher diagnostic reliability than the determination of total catalytic activity of the respective enzymes. The determination of multiple forms has no clinical significance in the detection of rejection episodes in renal transplant recipients.
An improved microsurgical technique for orthotopic rat kidney transplantation is described in detail. (1) End-to-end anastomosis of renal arteries with 7-8 interrupted 10-0 sutures. (2) End-to-end anastomosis of renal veins with 2 continuous semicircular 10-0 sutures. (3) Non-splinted end-to-end ureteric anastomosis with 4 interrupted full-thickness 11-0 sutures. (4) Simultaneous bilateral nephrectomy. Seventy transplantations were analysed. No failure due to complications of the vascular anastomoses occurred. The ureteric anastomoses were complicated by stenosis in only 5 animals (7%). The operation times for vascular anastomoses were 20 (15-24) minutes and for complete transplantation 50 (45-60) minutes. This technique seems to be less time consuming than other methods. Our method has produced a success rate of 93% with well standardized and reproducible organ quality. Preliminary clinical experiences with extracorporeal microvascular reconstruction in 4 cases of injured small polar kidney allograft arteries support the continued application in appropriate situations to increase the number of suitable donor kidneys.
We determined the urinary excretion of the enzymes aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), and N-acetyl-beta-glucosaminidase (EC 3.2.1.30) in two groups of renal-transplant recipients at different times after transplantation (1.8 months and 52 months, respectively). Both groups of patients showed a higher rate of enzyme excretion than did a reference group of healthy persons. More aminopeptidase and N-acetyl-beta-glucosaminidase were excreted during the early period after transplantation than later. The time-dependence of urinary enzyme excretion was confirmed in six renal-transplant recipients studied during the course of 15 months after transplantation. There was a general correlation between the extent of urinary enzyme excretion and both the time after transplantation and the daily dose of prednisolone. Therefore, it is necessary to take into account this influence on the extent of urinary enzyme in renal-transplant recipients if urinary enzyme excretion is used as an indicator of renal disorder and especially as an early predictor of transplant rejection.
The importance of kidneys from newborn donors in transplantation has not been clearly defined. The purpose of this study was to investigate the degree of morphological and functional adaptation of the newborn kidney in an adult recipient. 7 MLS-matched kidneys from LEWE minipig puppies (age 3-4 weeks) had been transplanted en bloc to their mothers with immediately bilateral nephrectomy. Preliminary results suggested that arterial vasculature and blood supply are limiting factors in adaption of newborn donor kidneys in adult recipient.
The activity of LDH in perfusate on human kidney and in experiments on dog kidney was investigated during the preservation by the Gambro perfusion apparatus. The enzyme activity of perfusate was characterized by a quotient of volume activity in relation to the perfusion flow rate. With this method we are able to distinguish the values of damaged and normal kidneys. A correlation was established between this quotient and the function resumption day in human kidney transplantation.
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