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Biomedical subjects

W C Waltzer

Publications and source records attributed to W C Waltzer.

106 records · Page 6Linked to original sources
PubMed1983

Procurement of cadaveric kidneys for transplantation.

Kidney transplantation is safe, cost-effective, and beneficial for patients with end-stage renal disease. The number of patients who can receive transplants is severely limited by the availability of donor organs. Because most patients do not have a suitable living, related donor, transplant programs now rely on the use of cadaveric kidneys. Proper selection and management of cadaveric donors, coupled with the legal recognition of brain death, has now given this source of organs primary importance in the treatment of end-stage renal disease. To balance the number of transplants done and the number of patients maintained on dialysis, increased recognition and participation by both physicians and the public are needed to maximize cadaveric organ procurement.

Brain Death↗
PubMed1982

Acute renal failure.

Acute renal failure is most commonly associated with renal ischemia, although nephrotoxins such as antibiotics, radiographic contrast media and anesthetic agents have become important causes. Although the pathophysiology has not been completely explained, renal vasoconstriction appears to be an important factor. Oliguria, isosthenuria and a urinary sodium concentration over 25 mEq per L are characteristic features. Control of volume and avoidance of metabolic disequilibrium can be accomplished by careful management and dialysis. The major causes of death are infection and the primary disease itself.

Acute Kidney Injury↗
PubMed1981

Factors influencing outcome of kidney allografts from pretreated cadaveric donors.

A five-year retrospective analysis of patient and graft survival after initial cadaveric kidney transplantation showed that recipients of kidneys from cadaveric donors pretreated with cyclophosphamide (Cytoxan) and methylprednisolone (Medrol) had better graft survival than those patients who received nonpretreated kidneys. In patients not receiving transfusions, transplantation of a pretreated kidney improved the chances of success, with graft survival equivalent to that for patients receiving transfusions. Splenectomy was beneficial for graft survival and did not affect overall patient survival. The effect of splenectomy could not be clearly separated fro the effect of donor pretreatment.

Adolescent↗
PubMed1981

Renal transplantation after failure of a first graft.

Renal transplantation in the nondiabetic patient can be achieved with a graft survival comparable with the over-all survival of the cadaveric first graft. The utilization of immunologic donor pretreatment in second cadaveric renal transplantation was of no benefit to graft survival. The second graft survived significantly longer than the first graft when the survival in the same patients was evaluated in a paired fashion. In our experience, retransplantation in the patient with juvenile-onset diabetes using a cadaveric graft gives disastrous results. Of pretreatment, splenectomy, transfusion, preformed antibodies, antigens mismatched, course and time of first-graft loss, diabetes, age and donor source analyzed in this study, only diabetes was found to have a significant effect upon the survival of the second graft.

Adult↗
PubMed1980

Renal transplantation: its use in a patient with systemic lupus erythematosus and complete occlusion of inferior vena cava.

A 22-year-old woman with systemic lupus erythematosus and complete occlusion of the inferior vena cava underwent a living related donor renal transplantation, with the kidney placed in the standard pelvic extraperitoneal position. If adequate collateral circulation bypassing the impedance of vena caval obstruction can be demonstrated, there is no need for orthotopic renal transplantation.

Adult↗
PubMed1980

Urinary tract reconstruction in renal transplantation. Mayo Clinic experience and review of literature.

Althrough rejection remains the most frequent cause of renal allograft failure, technical problems have contributed and continue to contribute to graft loss. Urologic complications may be caused by technical errors in the donor nephrectomy or in urinary tract reconstruction. During the past decade, however, with advances in medical and surgical management, the reported incidence of urologic complications in renal transplantation has declined steadily. This may be due to (1) more extensive donor and recipient preparation and evaluation for surgery, (2) improvement of surgical technique with increasing experience in donor and recipient, and (3) more refined diagnosis and treatment of urologic and infectious complications.

Adolescent↗
PubMed1980

In vitro alteration of canine renal allograft immunogenicity.

Significant prolongation of renal allograft survival was demonstrated in a controlled canine model with the host suboptimally immunosuppressed when grafts were perfused for 24 hr with cryoprecipitated plasma (CPP) that had been obtained from plasma of dogs "pretreated" with i.v. cyclophosphamide (80 mg/kg for 5 1/2 hr) and i.v. methylprednisolone (60 mg/kg for 2 1/2 hr). The active metabolites of these drugs within the pretreated plasma may have modified the graft immunogenicity in vitro. However, the use of pretreated kidneys in combination with 24 hr of perfusion with CPP did not result in prolonged graft survival. Furthermore, 24-hr perfusion of pretreated kidneys with their own pretreated CPP did not improve graft survival. This suggests that the pretreated canine kidney does not tolerate pulsatile preservation with CPP; this is in contrast to the human experience and may be attributable to a species difference.

Animals↗
PubMed1980

Open-lung biopsy in the renal transplant recipient.

In 22 renal transplant recipients, 23 open-lung biopsy procedures were performed. There were two (8.7%) biopsy-related complications (hemorrhage and pneumothorax) and five deaths (22.7%), although the deaths could not be definitely related to the biopsy procedure itself. Seventeen biopsy specimens yielded specific diagnoses, and six were nonspecific. The mortality rate for the patients with specific diagnoses was not significantly different from that of patients with nonspecific diagnoses (25% vs. 16.7%). Other factors analyzed, such as age, diabetes, hypoxia, leukopenia, and donor source, did not affect the result of biopsy. We conclude that the patient's underlying disease and added immunosuppressive therapy are the factors most responsible for the clinical outcome. We suggest that without early treatment of the infectious agents, the mortality rate of the group with specific diagnoses would likely have been higher.

Adult↗
PubMedDate not supplied

Immune inhibitory effects of renal cell carcinoma extract on lectin and alloantigen-induced peripheral blood and tumor infiltrating lymphocyte blastogenesis.

The presence of tumor infiltrating lymphocytes (TIL) has been attributed to the host cell mediated immune response against the evolving malignancy. However, due to specific evasive and escape mechanisms, the immune competent cells are rendered ineffective. One such mechanism may be the production of immune suppressor substance(s), inhibiting lymphocyte proliferation, and subsequently, their transformation into effector cells. To evaluate a possible impact of RCC extract on lectin and alloantigen-induced proliferation of TIL and peripheral blood lymphocytes (PBL) from renal cell carcinoma (RCC) patients and from healthy control human subjects. Tumor extract and TIL were derived from 13 patients with RCC undergoing radical nephrectomy. Tumor infiltrating lymphocytes and PBL from these patients were activated with Concanavalin A (Con-A), Phytohemoglutinine (PHA) or Pokeweed (PW) and the rate of blastogenesis was measured by (3)H Thymidine incorporation. The same procedure was used in assay with PBL from control healthy blood donors. There was a significant reduction (88.6%) in the proliferative response to ConA of TIL compared to PBL from the same patients (P = 0.007). A similar decrease was seen following stimulation by PHA (85.8%, P = 0.01) and PW mitogen (78.5%, P = 0.001). A 79.5% decrease in response level of TIL to alloantigens compared to PBL from RCC patients (P = 0.021), was observed. Lectin induced proliferative response of RCC patients was significantly lower in the presence of RCC extract (82.9%) compared to normal kidney extract (P = 0.008). Alloantigenic stimulation of healthy individual PBL was also decreased significantly in the presence of RCC extract (92.9%, P = 0.0001) compared to normal kidney extract. Similarly, lectin induced stimulation of healthy control PBL in the presence of RCC extract was significantly lower (83.2%, P = 0.003). Our data suggest that RCC extract contains an immune suppressive substance(s), capable of inhibiting lymphocyte proliferative response of tumor infiltrating lymphocytes as well as of PBL from patients and healthy individuals alike. This may be one of the mechanisms by which the tumor evades the transformation of lymphocytes into effector killer cells, and thus affects the biological inter-relationship between tumor and host. Identification of this substance and its gene may provide an effective anti-tumoral treatment modality.

Adenocarcinoma, Clear Cell↗
PubMedDate not supplied

Dinitrochlorobenzene contact sensitization in patients with end-stage renal disease.

Sixty-nine patients with end-stage renal disease (ESRD) on maintenance hemodialysis were evaluated by topical application of 2,4 dinitrochlorobenzene (DNCB). The initial sensitization dose consisted of 2,000 micrograms of DNCB; challenge doses consisted of 50 and 100 micrograms. Applications to the contralateral forearm in the absence of a spontaneous flare. Only 71% of the ESRD patients tested could be sensitized to DNCB, compared to 100% of normal controls. There was no correlation between DNCB reactivity and the helper/suppressor ratio of circulating lymphocytes in such patients. This study further documents uremic suppression of T-cell responsiveness as manifested by impaired DNCB contact sensitization.

Adult↗