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At least 199 records · Page 11Linked to original sources
PubMed2001

Persistent post-transplant autonomous hyperparathyroidism despite 23 years of excellent renal allograft function.

Hyperparathyroidism is a common problem for patients on renal replacement therapy programs. Many long-term dialysis patients require parathyroidectomy while on dialysis. Some patients, however, despite severe renal osteodystrophy, are transplanted, and in these a large proportion show a slow resolution of bony problems, in the context of the removal of the uremic stimulus to abnormal bone metabolism. A proportion of these patients become hypercalcaemic after renal transplantation, sometimes with symptoms. There is not a consensus on how these patients should be managed, with opinions varying from early parathyroidectomy to later parathyroidectomy and to conservative treatment. We present the case of a lady who underwent 23 years of conservative management of her post-transplant hyperparathyroidism. She was hypercalcaemic for almost all of that period, despite excellent renal transplant function. Finally, after 23 years she underwent surgical parathyroidectomy with autografting with prompt sustained resolution of her symptomatic hypercalcaemia.

Adult↗
PubMedDate not supplied

Prolonged improvement of total pancreatic allograft function by previous intrathymic bone marrow cell injection in rats.

Donor-specific induction of tolerance was previously achieved in the diabetic rat by intrathymic injection of pancreatic islets. It allowed a secondary islet graft in any site without immunosuppression. Since total pancreatic graft in man is metabolically more proficient than islet graft, we attempted tolerance induction for total vascularized pancreas transplantation in diabetic BN recipient rats by an intrathymic bone marrow cell (BMC) injection from Lewis donor rats, associated to an antilymphocyte antibody (ALS) administration. Control groups consisted of isogenic grafts, allogenic grafts without tolerance induction and allogenic grafts with ALS alone. In all grafted groups, mean blood glucose and plasma insulin were normalised within 24 h. Graft rejection (clinically suggested by diabetes recurrence and later confirmed by histology) appeared at 18 +/- 2 postoperative days in the absence of intrathymic BMC injection and at 36 +/- 8 days in the group with BMC injection (p < 0.05). Intrathymic bone marrow graft was successful in delaying rejection in our study.

Animals↗
PubMed1990

Bile acid profile as early indicator of allograft function during orthotopic liver transplantation.

Orthotopic liver transplantation was performed in 20 pigs. Serum total bile acids (STBA) were determined and their profile compared with standard early function parameters: total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactic acid. In phase I, the STBA level was 32.89 +/- 1.29 mumol/l. In phase II, STBA accumulated to 84.46 +/- 15.25 mumol/l (p less than 0.01), followed by hepatic clearance in phase III (63.61 +/- 9.71 mumol/1; NS). Between phase III and 6- and 12-hour samples, STBA decreased progressively, reaching values of 33.63 +/- 7.05 mumol/l at 24 h. AST was elevated in phases I, II, III, and at 6, 12 and 24 h (p less than 0.001), as was ALT (but with insignificant differences). Thus, STBA and their profile appear to be earlier and more specific indicators of early graft function than conventional parameters.

Alanine Transaminase↗
PubMed2005

Factors associated with improvement in deceased donor renal allograft function in the 1990s.

The decade of the 1990s saw an improvement in cadaveric renal graft function and dramatic reduction in the acute rejection (AR) rate. The purpose of this study was to determine whether the reduction in rejection rate was the primary cause of the improvement in graft function seen and whether this improved long-term graft survival. All adult patients who received a cadaver renal transplant between 1991 and 2000 and had graft survival of at least 6 mo and complete data for creatinine at 6 mo, HLA mismatch, delayed graft function, and acute rejection (AR) were identified in the United Network for Organ Sharing database. A total of 40,164 cases that met the inclusion criteria were identified. The mean Modification of Diet in Renal Disease GFR at 6 mo improved from 49.94 ml/min per 1.73 m2 in 1991 to 54.59 ml/min per 1.73 m2 in 2000 (P < 0.001). The improvement in GFR was not gradual but occurred over a 4-yr period between 1994 and 1997, coinciding with the introduction of new immunosuppressive agents mycophenolate mofetil and tacrolimus into maintenance immunosuppression regimens. The improvement was seen in all subgroups of patients, even patients without clinical AR or delayed graft function. The magnitude of improvement in patients without clinical AR was similar to that seen in patients with AR. The drop in clinical AR rate accounted for a minority of the improvement in graft function in the 1990s. Other factors, such as reduced drug toxicity and improved control of subclinical rejection, seem to account for the majority of the improvement. This improvement in graft function at 6 mo did not translate into improved long-term graft survival, however.

Acute Disease↗
PubMed1989

Do donor age and cold-ischemia time have a detrimental effect on early pancreas-allograft function?

To study the impact of donor age and cold-ischemia time (CIT) on early graft function, we retrospectively divided the donors of 51 pancreas transplants performed between 1979 and 1987 at Innsbruck University Hospital into four groups according to donor age (greater than 45 yr and less than 15 yr) and CIT (greater than 8 h and less than 3 h). All organs were perfused with Eurocollins solution and stored at 4 degrees C. Fasting blood glucose levels and total amount of pancreatic juice produced over the first 3 postoperative days were recorded to assess graft function. No statistically significant difference was found between groups 1 and 2 and between groups 3 and 4. From these data, it is concluded that with the preservation method used, CIT can without a doubt be extended to at least 12 h, and a maximum donor age similar to that for the kidney can be adopted. This might not only enlarge the donor pool but also facilitate distant organ procurement.

Age Factors↗
PubMed1992

Serum bile acid monitoring as an early indicator of allograft function in canine orthotopic liver transplantation.

This study was undertaken to elucidate the correlation between early graft function and serum bile acids profile in canine orthotopic liver transplantation (OLT). The recipient dogs were categorized into four groups: group A (n = 5); bile output over 10 ml during initial 6 hours, group B (n = 4); bile output less than 1 ml during the same period, group C (n = 5); transplanted immediately after graft harvesting, and group D (n = 5); transplanted after 7-hour ice-cold preservation in lactated Ringer's solution. In all cases serum total bile acid (TBA) was markedly elevated during anhepatic phase, the value being 49.4 +/- 48.5 mumol/L. However, in group A, TBA decreased promptly after revascularization, the value at 4-hour being 14.7 +/- 12.7 mumol/L. In contrast, the corresponding TBA level in group B was 62.3 +/- 27.5 mumol/L 4 hours later (p < 0.01 vs group A). In group C, TBA also decreased immediately after reperfusion. Furthermore, in comparison between groups C and D, TBA level was significantly different 4 and 6 hours after reperfusion (p < 0.01). In the reduction rate of TBA (value at each time point after reperfusion the value immediately before reperfusion), the significant difference was observed after 2 hours between groups A and B (p < 0.05). In addition, significant difference was recognized at 30 minutes between groups C and D (p < 0.05). Although the changes of most bile acid fractions were proportional to the changes of TBA in all four groups, the detection of lithocolic acid at 6 hours was characteristic of both groups B and D. In conclusion, there was strong correlation between the TBA level and the graft function during early postoperative period. Therefore, TBA will be a specific and early indicator to differentiate the quality of the transplanted grafts in OLT.

Animals↗
PubMed2006

Increase in renal vascular resistance after intake of cyclosporin A and tacrolimus and reversal by nitroglycerin spray: a study in patients with stable renal allograft function.

PURPOSE: Acute effects of drug administration on renal arterial resistance index (RI) are still discussed controversially. In our study we investigated the immediate effects of cyclosporin A (CyA) and tacrolimus (FK-506) on renal arterial resistance indices in patients with stable graft function after renal transplantation. Additionally we studied the effects of nitroglycerin spray on resistance indices. METHODS: RI was measured by color Doppler sonography at baseline, at 1 and 2 hours after intake of medication and 30 minutes after administration of nitroglycerin spray which followed the 2-hour measurement. 34 renal transplant recipients were examined. 16 patients received CyA, 18 patients received FK-506. Whole blood levels of calcineurin inhibitors were taken at each time point. Arterial blood pressure and heart rate were measured to assess possible systemic hemodynamic effects. RESULTS: Mean RI values increased significantly in both groups 1 hour after calcineurin inhibitor intake and remained still significantly elevated after 2 hours. There was no significant increase of mean arterial blood pressure nor was there any correlation between whole blood levels of calcineurin inhibitors and mean RI. 30 minutes after administration of nitroglycerin spray, mean RI values decreased significantly to a level even below baseline. Mean arterial blood pressure also decreased after administration of nitroglycerin. CONCLUSION: Renal RI values are markedly influenced by a recent intake of calcineurin inhibitors and vasoactive substances such as nitrates. This demonstrates the necessity of keeping standardized conditions when using RI as a tool in followup investigations after renal transplantation.

Adult↗