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Biomedical subjects

W W Pfaff

Publications and source records attributed to W W Pfaff.

At least 55 records · Page 3Linked to original sources
PubMed1987

Effect of class I HLA matching on graft survival in sensitized patients.

First, the proportion of highly sensitized transplant candidates grows in the absence of organ sharing. The unsensitized patient is transplanted readily; the sensitized patient has restricted access because of the need for a well-matched kidney to permit a negative cross-match. Second, well-matched grafts are equally successful in sensitized and unsensitized recipients. Finally, emphasis on organ sharing would reverse the trend of accumulation of sensitized candidates without decreasing graft survival.

Follow-Up Studies↗
PubMed1986

Statistical analysis of statural growth following kidney transplantation.

Factors affecting the growth rates of 59 children and adolescents for the first 2 years following kidney transplantation were evaluated. The factors assessed were age at transplantation, renal function, prednisone dosage, donor source, and prior history of transplantation. The observed growth velocity was expressed as the percentage, of the growth velocity predicted by bone age. Normal growth (greater than or equal to 80%) was exhibited by 37% of the patients and 22% had accelerated growth (greater than or equal to 100%). The chronologic age at transplantation did not correlate significantly with growth when bone age was used as the reference for expected velocity. Males grew better than did females. There was a unique sex/race interaction with black males growing most rapidly. Better renal function, the ability to lower prednisone dosage, alternate day prednisone administration, and a decreasing diastolic blood pressure were positively correlated with better growth rates after transplantation. The donor source and prior history of transplantation did not significantly influence growth rate.

Adolescent↗
PubMed1986

Statistical analysis of statural growth following kidney transplantation.

Factors affecting the growth rates of 59 children and adolescents for the first 2 years following kidney transplantation were evaluated. The factors assessed were age at transplantation, renal function, prednisone dosage, donor source, and prior history of transplantation. The observed growth velocity was expressed as the percentage of the growth velocity predicted by bone age. Normal growth (greater than or equal to 80%) was exhibited by 37% of the patients and 22% had accelerated growth (greater than or equal to 100%). The chronological age at transplantation did not correlate significantly with growth when bone age was used as the reference for expected velocity. Males grew better than did females. There was a unique sex/race interaction with black males growing most rapidly. Better renal function, the ability to lower prednisone dosage, alternate day prednisone, and a decreasing diastolic blood pressure were positively correlated with better growth rates after transplantation. Donor source and prior history of transplantation did not significantly influence growth rate.

Adolescent↗
PubMed1985

Preoperative radiation therapy for clinically resectable adenocarcinoma of the rectum.

This is an analysis of 71 patients with clinically resectable adenocarcinoma of the rectum treated with preoperative irradiation and surgery at the University of Florida from July 1975 through December 1981. Seven patients were found to have liver metastasis at surgery; six had a complete resection of their primary rectal lesion and one had an incomplete resection of the rectal tumor. The remaining 64 patients had no evidence of metastasis at the time of surgery and underwent a complete resection of their rectal cancer. In the early years of the trial, the maximum tumor dose consisted of 3000 to 3500 rad in 3.5 to 4 weeks; the dose was subsequently increased to 4500 rad in 5 weeks. Patients were taken to surgery between 2 and 11 weeks (mean, 3.5 weeks) following the completion of radiation therapy. All patients have a minimum follow-up of 3 years and 63% have a minimum follow-up of 5 years. The acute complications of treatment have been acceptable, with only one patient requiring a treatment rest for moist desquamation of the perineum. All patients completed the irradiation course and all were operated on. Pathologic examination of the surgical specimen revealed no tumor in 11%, and the incidence of positive lymph nodes was 19%, which was half the incidence of positive lymph nodes in a series of historical controls treated from 1959 to 1976 with surgery alone. Comparison of patients treated with preoperative irradiation and surgery with those treated with surgery alone revealed that the postoperative complications have been similar in incidence, distribution, and severity. There have been no postoperative deaths. The overall incidence of local-regional recurrence is 5/64 (7.8%), and the combined incidence of local-regional recurrence and/or distant metastasis is 18/64 (28%). The incidence of local-regional recurrence by preoperative dose is 3/23 (13%) for doses of 3000 to 3500 rad and 2/41 (5%) for doses of 4000 to 5000 rad. The 5-year local-regional failure rate is 3/40 (7.5%) for the group irradiated before surgery, and 39/135 (29%) for the historical controls managed by surgery alone (significance level = 0.015). The 5-year determinate disease-free survival is 27/38 (71%) for the patients irradiated before surgery, and 47/114 (41%) for the historical group of patients treated with surgery alone (significance level = 0.008).

Adenocarcinoma↗
PubMed1984

Growth in children with various therapies for end-stage renal disease.

The growth of children undergoing continuous ambulatory peritoneal dialysis (CAPD) therapy for end-stage renal disease (ESRD) was compared with the growth of children undergoing hemodialysis and that of children after successful kidney transplantation. The bone ages of the children were used to predict expected growth velocities. The actual growth velocities observed were then expressed as percentages of the predicted rates. Children receiving CAPD therapy grew better than those treated by hemodialysis and as well as the children who received a kidney transplant. There was some correlation between growth and allograft function in the transplant recipients. Children receiving CAPD were less acidotic and were more likely to exhibit improvement in renal osteodystrophy than children treated by ongoing hemodialysis. There were no significant differences in reported caloric intake between the two groups.

Adolescent↗
PubMed1984

Results of kidney retransplantation.

Sixty-two patients had a second renal transplant at the University of Florida, Gainesville , between Nov 30, 1966 and June 26, 1982. Two-year graft function for all 62 patients was 53.2%, and patient survival was 83.9%. The 51 recipients of cadaveric grafts had a two-year graft survival of 47%. Eleven patients who received second grafts from related donors had a two-year graft survival of 81.8%. Source of first grafts and length of survival of first grafts did not seem to be important in determining the outcome of second grafts. Recipients of cadaveric second kidneys had a significantly better two-year graft survival if they waited longer than six months between loss of the first kidney and retransplantation (52.9%) than if they waited less than six months (35.3%). We believe the results of kidney retransplantation justify second transplants in patients who lost their first grafts.

Adult↗
PubMed1984

Assessment of the risk for broad sensitization by blood transfusions.

The risk factors associated with the production of lymphocyte antibodies were studied by evaluating the conditions of sensitization in 73 renal failure patients and by searching for lymphocyte antibodies by flow cytometry before the induction of overt sensitization by blood transfusions. In 14 patients the lymphocytotoxic antibodies were not broadly reactive and became undetectable within 5 months. These patients were mostly first transplant candidates who received transfusions prior to the rise of panel antibody reactivity. The remaining 59 patients developed broadly reactive antibodies that persisted for longer than 5 months, regardless of whether or not they were given subsequent blood transfusions. This group was made up almost exclusively of multiparous women or patients who had previously lost a kidney graft. There were 13 patients having no lymphocytotoxic antibodies who developed broad sensitization after blood transfusions. These patients were also multiparous women or previously transplanted patients, suggesting that previous exposure to alloantigens by transplants or pregnancies appeared to be a precondition for blood transfusions to induce broad sensitization. This was confirmed by detecting lymphocyte antibodies by flow cytometry in the pretransfusion serum of 9 of the 13 patients. In contrast, patients who did not make antibodies after transfusions, or those who developed temporary responses, did not have lymphocyte antibodies in their pretransfusion specimens. These findings suggest that patients with low levels of lymphocyte antibodies, not detectable by standard cytotoxicity, are at high risk of developing broadly reactive cytotoxic antibodies after blood transfusions.

Antilymphocyte Serum↗
PubMed1984

Role of regular and leukocyte-free blood transfusions in the generation of broad sensitization.

The factors associated with the development of humoral sensitization were studied prospectively in 30 previously transplanted patients immediately after graft rejection. Lymphocyte antibodies were measured both by conventional cytotoxicity in 30 panel cells and by flow cytometry in up to 10 target cells. Although lymphocyte antibodies induced by graft rejection alone were detected in 12 of 26 patients (46%), lymphocytotoxic antibodies were present in only 2 of 27 patients. Of the 25 patients without lymphocytotoxic antibodies, 13 developed them later. In all cases panel antibody reactivity developed after the patients received blood transfusions. No other factor was associated with the development of lymphocytotoxic antibodies, including transplant nephrectomy. There were 12 patients who remained negative for lymphocytotoxic antibodies even though 5 of them were transfused. The powerful role of blood transfusions in the generation of broad sensitization was further documented in 5 patients who received blood units completely depleted of leukocytes by cottonwool filtration and red cell washing. Four of these patients showed significant increases in the level of lymphocytotoxic antibodies, even when stored blood units were used. One additional patient became broadly sensitized by the transfusion of frozen blood. These results show (A) that broad sensitization may not develop if patients are not transfused after graft rejection; (B) that blood transfusions lead to broad sensitization in most (76%) pretransplanted patients; and (C) that transfusion of leukocyte-free blood may delay, but not avoid, the development of broad sensitization.

Autoantibodies↗
PubMed1984

Planned random donor blood transfusion in preparation for transplantation. Sensitization and graft survival.

Random donor blood transfusions were used to prepare 183 prospective recipients for one-haplotype living-related donor (LRD) grafts or cadaver donor (CD) grafts. Five units of packed red blood cells were administered over a 7-10 day period, and weekly sera were monitored for six weeks. Sensitization was uncommon in men and nulliparous women (8/153), was of low reactivity, and was not a barrier to transplantation. Multiparous women had a 44% frequency of sensitization on presentation and 11/24 initially lacking cytotoxicity developed reactive serum following transfusion. Single-haplotype LRD recipients had 96% one-year graft survival. CD recipients had one-year graft survival of 72%. The rate of transplantation in surviving candidates exceeded 90%, and supports the hypothesis of a protective immune response.

Blood Transfusion↗
PubMed1983

Patterns of recurrence in adenocarcinoma of the rectum and rectosigmoid treated with surgery alone: implications in treatment planning with adjuvant radiation therapy.

This is an analysis of 140 patients with adenocarcinoma of the rectum and rectosigmoid treated with surgery alone at the University of Florida between May 1959 and April 1976. Patients in the study group had a complete resection, as determined by the surgeon and the pathologist, and no evidence of distant metastasis at the completion of the operation. There is a 5 year minimum follow-up. Local-regional recurrence rates were noted to vary with histologic grade, length of the lesion, and pathologic stage. Approximately 60% of local-regional and distant recurrences were noted by 2 years after treatment, and 92-95% were noted by 5 years. Evaluation of patient status at 5 years revealed that 0% (Stage CIS), 0% (A), 17% (B1), 13% (B2), 17% (C1), and 28% (C2) had developed local-regional recurrence without demonstrable distant metastasis. Complications and crude 5 year survival rates are presented and current treatment modifications discussed.

Adenocarcinoma↗
PubMed1981

Liver dysfunction in children and adolescents during hemodialysis and after renal transplantation.

Liver dysfunction is common in patients on hemodialysis or during the posttransplant period. Twelve children in the End-Stage Renal Disease Program at the University of Florida ranging in age from 4 to 18 years, developed persistent, elevated liver enzymes (SGOT or SGPT greater than 100 IU/liter) during hemodialysis in preparation for renal transplantation. Eleven of 12 developed enzyme elevations within six weeks of the initiation of hemodialysis. The other child exhibited enzyme elevations after one year on dialysis while awaiting a second transplant. Most of the children were anicteric and asymptomatic. Potential hepatotoxic drugs were discontinued when serum transaminase elevations were noted. Hepatitis B surface antigenemia was associated with enzyme elevations in one patient; cytomegalovirus seroconversion had occurred in eight patients, but only three had associated enzyme elevations. Liver biopsies were performed in all the patients before or at the time of renal transplantation. The histology was variable and ranged from normal in six patients, mildly abnormal with changes compatible with acute hepatitis in four patients, and granulomatous hepatitis in one patient, to severely abnormal with chronic hepatitis inthe remaining patient. Seven of the 12 children underwent successful transplantation with return of enzyme levels to normal in five and persistent elevations in the others. These findings suggest that evaluation of liver histology provides the only accurate means of assessment of persistent liver dysfunction in children and adolescents on hemodialysis and after renal transplantation.

Adolescent↗
PubMed1981

Hypertension in a pediatric and adolescent population following kidney transplantation.

The post-renal transplant courses of 53 children and adolescents were evaluated for the prevalence and the etiology of hypertension. The blood pressures were averaged over specific time periods following transplantation and converted to percentile ranks according to standards for age. The number of antihypertensives employed to control blood pressure was assessed. Factors such as sex, obesity, race, donor source, antigen match, steroid administration, rejection, recurrent glomerulonephritis, pre-transplant nephrectomy, renal function and proteinuria were assessed as to their importance in producing hypertension or normotension in the post-transplant period. The average blood pressure was well within acceptable range shortly after transplantation. The patients requiring antihypertensives to control blood pressure dropped by two years post transplant. Chronic rejection was by far the most important factor influencing average blood pressure and the need to employ antihypertensives. Alternate-day prednisone and good graft function were important in establishing the normotensive state.

Adolescent↗
PubMed1980

The role of various risk factors in living related donor renal transplant success.

Assessment of living related donor (LRD) survival statistics offers the opportunity to gauge the effects of recipient characteristics without the perturbations of viability, function, and antigen sharing that are inherent in cadaveric organ grafting. From January 1, 1969 to January 1, 1979, 167 LRD grafts were performed. Crude patient survival at one year is 92% and 84% at five years. Graft function at one year is 79%, and at five years it is 64%. One year patient survival has steadily improved: 1969-73: 83%, 1973-75: 91%, 1975-79: 98%. Graft survival improved during the first two periods and has since remained unchanged. HLA identical grafts showed the expected advantage compared with single haplotype grafts (93 vs 74%). Recipient age was without effect until 50 years, all younger subgroups having one-year patient survival of 92-95%, while those older than 50 had a one-year survival of 60%. Juvenile diabetes was associated with a one-year patient survival of 85% and graft survival of 74%. Glomerulonephritis did not affect early graft survival statistics, but there was a greater frequency of graft loss after 2.5 years, with function at five years of 51 versus 68% for recipients with all other diagnoses. Cadaveric graft statistics vary with recipient race when adjusted to exclude older patients and diabetics, white recipient one-year graft survival 74%, black 38%. No meaningful difference exists among LRD recipients as to graft function, but there is a trend toward improved black patient survival. This suggests that there is not an inherent difference in immune response to genetically similar grafts, but that the disparate results with racially mixed donor-recipient combinations rests with other factors.

Adolescent↗
PubMed1977

Prognostic value of angiography in management of severe acute renal transplant rejection.

Angiograms of 34 kidney transplant patients with progressive decrease in renal function after multiple doses of intravenous methylprednisolone (MP) were evaluated retrospectively in regard to the prognostic value of angiography. The following parameters were included in evaluation: prolonged arterial washout time, large vessel vasculitis, presence of arteriovenous shunting, poor cortical perfusion as evidenced by non-filling of cortical vessels, poor definition of cortico-medullary junction, and a poor nephrogram. When 1 to 3 of these abnormalities existed in angiogram, 67% of living related donor transplants (LRD) recovered under continued MP-therapy. With 4-6 angiographic abnormalities the recovery rate was reduced to 30%. The overall recovery rate for LRD transplants was 44%. Cadaveric transplants (CAD) had a statistically significant poorer prognosis as evidenced by only 8% recovery rate under continued MP-therapy.

Acute Disease↗