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At least 253 records · Page 14Linked to original sources
PubMed1994

Whole body oxygen uptake is not a good indicator of liver allograft function following orthotopic liver transplantation.

Variations of whole body oxygen uptake (VO2) have been studied during orthotopic liver transplantation. Some authors have suggested that the increase in VO2 after revascularization of the graft could be an index of good function of the grafted liver and thus low VO2 an early sign of primary non-function. The purpose of our study was to assess the temporal course of measured respiratory VO2 and to compare the VO2 changes to indicators of hepatic function. We used a metabolic monitor (Deltatrac, Datex Corp. Finland) to measure VO2 in 18 patients during transplantation. Clotting factors II and V at 1, 3, 7, 14 and 21 days post-operatively and peak serum transaminases within the first 3 post-operative days were determined. Variations of VO2 were a decrease during the anhepatic phase and an increase following the reperfusion phase as compared to the VO2 value obtained at the beginning of the procedure. No correlation was found between the increase in VO2 after reperfusion of the graft and either factor II (r = 0.33-0.4), factor V (r = 0.23-0.43) or peak transaminases (r = 0.13). One patient developed a primary non-function of the graft. For this patient VO2 increased far above the pre-anhepatic values. The authors conclude that VO2 is not a reliable sign of graft function.

Adolescent↗
PubMed1994

An evaluation of vesical urodynamics before renal transplantation and its effect on renal allograft function and survival.

This prospective study investigated the urodynamics of the urinary bladder prior to renal transplantation in 57 patients and related this to graft function and transplantation outcome. The study demonstrated a clear deterioration in the pretransplant urodynamic characteristics in all subgroups, with male patients in the hemodialysis group (HD) showing a more substantial decline: 1st sensation volume (ml) in male HD patients = 112 (120) vs. 171 (173) in male CAPD patients, P < 0.05; and corresponding average flow rate for same groups 3 (3) ml/sec vs. 5 (5) ml/sec, P < 0.05. Figures are median (interquartile range). We have identified a subgroup of patients with a small bladder capacity (less than 100 ml) who have a reduced graft survival (55% vs. 92% for bladders larger than 100 ml at 2 years) apparently unrelated to immunological processes.

Adult↗
PubMed1997

Effect of nifedipine on renal allograft function and survival beyond one year.

We previously reported that a calcium channel blocker supplemented immunosuppression produced excellent patient and graft survival rates in cadaveric kidney transplantation. We report here the long term outcome of patients treated with nifedipine-supplemented triple immunosuppression as compared with those of historical controls who were treated similarly without nifedipine. Study subjects included 111 patients transplanted in 1990-1994, treated with nifedipine and triple immunosuppression and with functioning grafts for more than one year (Nifedipine group). The results of cyclosporine (CyA) dose, blood pressure (BP), serum creatinine (Cr), and actuarial graft survival rate (GSR) up to 5 years posttransplant in these patients were compared with those of 52 patients transplanted in 1985-1990, treated similarly without calcium channel blockers (Control group). Donor sources, gender ratio, age distribution, causes of end stage renal disease, incidence of hypertension prior to transplantation and incidence of rejection in the first year between the groups were comparable. Throughout the study period the Nifedipine group had significantly lower serum Cr (1.5 +/- 0.7 vs. 1.8 +/- 0.7 mg/dl) and higher GSR (93.8% vs. 88% at 5 years) than the Control group. BP was comparable despite higher CyA doses in the Nifedipine group (4.3 +/- 1.1 vs. 3.3 +/- 1.1 mg/kg/day). We conclude that nifedipine is beneficial in improving long-term graft function and survival in kidney transplant recipients by mitigating CyA associated renal injury.

Adult↗
PubMed1996

Delayed function reduces renal allograft survival independent of acute rejection.

BACKGROUND: Mechanisms by which delayed allograft function reduces renal allograft survival are poorly understood. This study evaluated the relationship of delayed allograft function to acute rejection and long-term survival of cadaveric allografts. METHODS: 338 recipients of cadaveric allografts were followed until death, resumption of dialysis, retransplantation, loss to follow-up, or the study's end, which ever came first. Delayed allograft function was defined by dialysis during the first week following transplantation. Multivariate Cox proportional hazards survival analysis was used to assess the relationship of delayed allograft function to rejection and allograft survival. RESULTS: Delayed allograft function, recipient age, preformed reactive antibody levels, prior kidney transplantation, recipient race, rejection during the first 30 days and rejection subsequent to 30 days following transplantation were predictive of allograft survival in multivariate survival models. Delayed allograft function was associated with shorter allograft survival after adjustment for acute rejection and other covariates (relative rate of failure [RR]+1.72 [95% CI, 1.07, 2.76]). The adjusted RR of allograft failure associated with any rejection during the first 30 days was 1.99 (1.23, 3.21), and for rejection subsequent to the first 30 days was 3.53 (2.9 08, 6.00). The impact of delayed allograft function did not change substantially (RR=1.84 [1.15, 2.95]) in models not controlling for acute rejection. These results were stable among several subgroups of patients and using alternative definitions of allograft survival and delayed allograft function. CONCLUSIONS: This study demonstrates that delayed allograft function and acute allograft rejection have important independent and deleterious effects on cadaveric allograft survival. These results suggest that the effect of delayed allograft function is mediated, in part, through mechanisms not involving acute clinical rejection.

Acute Disease↗
PubMed2001

Urinary tract infection in patients with urological complications after renal transplantation with respect to long-term function and allograft survival.

Urological complications after renal transplantation (urinary fistula, urinary tract dilatation) are frequently associated with urinary tract infections (UTI). We tried to analyse whether urinary tract infection was one of the factors which participated in the lower allograft survival rates and reduced allograft function in urologically complicated (UC) patients. We observed 77 patients after renal transplantation (Tx) of whom 42 had urinary fistula, 32 had urinary tract dilatation a 3 had both complications (I/1992-XII/1996). 100 patients without urological complications represented a control group (N). Obtained data was statistically evaluated using t-test, chi 2-test, correlation analysis. Graft and patient survival rates were assessed using the Kaplan-Meier method. We have found that UC patients after Tx had a worse renal function compared with patients not suffering from this complication. Using Kaplan-Meier methods we have found that graft survival rate in patients with UC is significantly lower than that in the control group (5-year graft survival 0.6 vs 0.82, p < 0.01). On the other hand there were no differences in the 5-year patients survival rate between the followed groups of patients (0.74 vs 0.83). There was no significant correlation between predicted creatinine clearance and followed indicators of UTI--total time of positive urine bacterial cultivation, number of infectious periods and total time of antibiotic therapy. There were no significant differences in graft survival during 5 years between patients with UTI and without UTI. Our results suggest that patients with UC are at increased risk of urinary tract infection. Our findings are in keeping with the assumption that UTI in patients with UC do not significantly participate in the decreased level of graft function and the shorter graft survival rates.

Creatinine↗
PubMed1996

Effect of use of vasopressors in organ donors on immediate function of renal allografts.

The purpose of this study was to determine whether use of vasopressors in cadaveric donors of renal transplants was associated with an increased prevalence of acute tubular necrosis after kidney transplantation. We compared immediate allograft function in 26 consecutive renal allograft recipients whose donors had been given vasopressors with that in 26 recipients whose donors had nor. The donors treated with vasopressors had been given more than 10 micrograms/kg per minute of dopamine, norepinephrine, or epinephrine, alone or in combination. The groups were matched with respect to donors' age, recipients' disease, and cold ischemic time. The prevalence of immediate allograft function was significantly lower in recipients whose donors had required use of vasopressors (38.5%) than in recipients whose donors had not required vasopressors (65.4%). We conclude that use of vasopressors in kidney donors leads to an increased prevalence of acute tubular necrosis.

Adolescent↗