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At least 1,189 records · Page 66Linked to original sources
PubMed1976

Apparent recurrence of progressive systemic sclerosis in a renal allograft.

A young woman with progressive systemic sclerosis (PSS) and renal failure who received a renal transplant from her mother suffered accelerated loss of allograft function in the absence of hyperacute rejection or severe hypertension. A biopsy specimen and pathologic examination of the transplanted organ showed a fluorescent antibody pattern and vascular changes that were indistinguishable from those in the patient's native kidneys. This clinical sequence is a departure from the relative success of renal transplantation in the few previously reported cases of PSS where it has been used as therapy for renal failure.

Acute Disease↗
PubMed1994

Renal allograft preservation: a comparison of University of Wisconsin solution and of hypothermic continuous pulsatile perfusion.

A study was performed to compare early allograft function in kidneys preserved with University of Wisconsin (UW) solution to kidneys preserved by hypothermic pulsatile perfusion. The study consisted of two sets of data. The first set was a donor-paired study (matched data) of 30 heart-beating, hemodynamically stable donors. After removal from the donor each cooled kidney was individually prepared for preservation. One kidney was flushed with +/- 500 ml of UW solution and stored in UW solution on slushed ice. The other kidney was continuously perfused with cooled (4-6 degrees C) cryoprecipitated plasma. The kidneys were transplanted into suitable recipients in a random sequence. Twelve donors were excluded from the study because one or both kidneys were transplanted into recipients who had previously been transplanted. The remaining 36 kidneys were implanted into two similar groups after a mean of 19 hours in the pulsatile perfusion group and 18 hours in the UW solution group. The second set of data consisted of all the kidneys preserved in UW solution (n = 62) at our institution and of 57 kidneys preserved by hypothermic continuous pulsatile perfusion during the same period (mixed data) and was used to evaluate the effect of prolonged preservation (longer than 24 hours) on delayed graft function. Both of these groups were also comparable. Acute tubular necrosis (ATN) was defined as the need for dialysis during the 1st week after transplantation, and delayed function as the delayed clearance of creatinine during the early post-operative phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1993

The analysis of benefit and risk of combined pancreatic and renal transplantation versus renal transplantation alone.

Currently, diabetes mellitus is the most common cause of renal failure in adults. However, combined pancreatic and renal transplantation (PRT) remains controversial when compared with renal transplantation alone (RTA) in diabetic recipients. We analyzed the results and morbidity in four age-matched groups--31 patients with Type I diabetes undergoing PRT before dialysis, 30 patients with diabetes who are dependent of dialysis undergoing PRT, 31 concurrent and historic patients with Type I diabetes undergoing RTA and 31 concurrent patients without diabetes undergoing RTA. All patients received cadaver donor organs and were managed with cyclosporine and prednisone immunosuppression with selective OKT3 induction. The four groups were comparable with respect to age, weight, gender, duration and severity of diabetes, dialysis type, number of retransplants, degree of sensitization, preservation time and matching. The groups differed with regard to duration of dialysis and period of follow-up evaluation, pretransplant blood transfusions, racial distribution and OKT3 induction therapy. PRT was associated with a greater morbidity rate as evidenced by a slightly higher incidence of rejection, infections and reoperations. The number of readmissions and hospitalization period during the first 12 months was also greater after PRT versus RTA. However, none of these differences were significant. No detrimental effect was noted on renal allograft function at one year; patient and graft survival was actually higher in the PRT groups. Quality of life was improved in nearly 90 percent of PRT recipients. Although the improved results after PRT may be attributed to selection bias, only lesser differences were noted among the four study groups. The aforementioned data suggest that appropriate patient selection can overcome the morbidity associated with PRT, resulting in excellent patient and graft survival with the potential for complete rehabilitation.

Actuarial Analysis↗
PubMed1993

Superior mesenteric arteriovenous fistula in vascularized whole organ pancreatic allografts.

Despite improved results in vascularized pancreatic transplantation, the incidence of technical complications continues to be high. Vascular complications are an important source of morbidity. Previously undescribed is the occurrence of an arteriovenous fistula (AVF) in the transplanted mesenteric bundle. We have identified this unusual complication in three of 90 consecutive recipients of pancreatic transplant. The first patient presented with severe and protracted endocrine insufficiency, which was effectively reversed by direct surgical ligation of the AVF. The second patient presented with hematuria, which likewise, resolved with correction of the AVF. The third instance was diagnosed immediately after transplant and was successfully corrected by direct surgical ligation. The operative approach with establishment of proximal vascular control differed in each instance. Clinical presentation was variable and diagnosis was suggested by physical examination, duplex ultrasonography and radionuclide perfusion scanning. Arteriography was confirmatory. Mesenteric AVF can be easily identified and corrected at the time of reoperation without compromising allograft function.

Adult↗
PubMed1993

Complications of proximal femoral allografts in revision total hip arthroplasty.

Four revision hip arthroplasties using a well-described surgical construct involving a large frozen femoral allograft to replace a deficient proximal femur developed six major complications related to the use of the allograft or of the surgical construct. These cases represent three consecutive cases using this surgical construct performed by the senior author and one postoperative referral that used the same construct. The complications included three allograft fractures, two nonunions at the host-allograft junction, and one postoperative infection. All four of the patients previously had cemented revisions before the allograft procedure, and all had deficient proximal femurs at the time of the allograft procedure. All three of the fractures occurred at the tip of the femoral prosthesis within the allograft. The unacceptably high fracture rate, three of four, was associated with the allograft functioning as an unsupported load-bearing element in this study.

Bone Transplantation↗
PubMedDate not supplied

Erythrocytosis after renal transplantation. A prospective analysis.

A prospective analysis of all cyclosporine treated renal transplants performed between 1987 and 1990 was performed to determine the incidence and etiologic factors of post transplant erythrocytosis (PTE) and its effect on short-term outcome. PTE developed in 25 (8.1%) recipients (mean age, 41 +/- 10 years). PTE occurred more frequently in men (12.8%) than women (1.6%) (p < 0.001), diabetic patients (22.9%) than nondiabetic patients (6.2%) (p < 0.001), and rejection-free recipients (11%) compared with those with early rejection (4%) (p < 0.05) but was independent of recipient race and donor source. Sixteen patients in whom PTE subsequently developed had pretransplant hematocrits above 30%. PTE occurred most frequently in the first year posttransplant (range, 2-29 months). Serum erythropoietin levels were inappropriately elevated in all patients (mean, 24 +/- 2.2 mU/ml), but serum iron, folate, and B12 levels were all normal. Mean serum creatinine and creatinine clearance were 1.7 +/- 0.5 mg/dl and 58 +/- 20 ml/min, respectively. Twenty-three patients underwent phlebotomy (mean, 3.5 +/- 0.5 units) and six had PTE-related complications. In 14 patients, PTE persisted with hematocrit of 53 +/- 1.5% (range, 51-56) compared with 57 +/- 2.6% (range, 54-64) at the time of PTE onset. In conclusion, PTE occurs primarily in the first year posttransplant and is characterized by inappropriate elevation of erythropoietin. Predictors for PTE include male gender, diabetes mellitus, pretransplant hematocrit above 30%, absence of rejection, and excellent renal allograft function.

Adult↗
PubMedDate not supplied

Role of humoral immunity in acute cardiac allograft dysfunction.

To elucidate the pathogenic mechanisms of acute allograft dysfunction that is not caused by acute cellular rejection, we have studied the clinical and immunopathologic characteristics of 11 heart transplant recipients who had acute allograft dysfunction in the absence of interstitial mononuclear cell infiltrates on endomyocardial biopsy samples. Six of eleven patients (54%) had a striking increase in levels of anti-HLA antibodies in close temporal proximity with the episode of acute allograft dysfunction. Cardiac allograft function improved in all patients with intensification of immunosuppression.

Adult↗
PubMed1993

Long-term outcome following total parathyroidectomy in patients with end-stage renal disease.

Long-term follow up (mean 3.8 years), following elective total parathyroidectomy in thirteen patients with end-stage renal disease is described. Nine patients are alive and all except two have measurable levels of intact parathyroid hormone (PTH). One patient is mildly hyperparathyroid with PTH levels of 143 pg/ml (normal 10-65 pg/ml). All patients did well as far as their bone and mineral metabolism were concerned and there were no fractures, bone pain or metastatic soft tissue calcification. Lumbar spine bone mineral density (BMD) increased above the baseline value and femoral neck bone density was significantly greater than a matched control group of non-parathyroidectomized dialysis patients (1.097 +/- 0.140 versus 0.811 +/- 0.148 g/cm2, Z-score 1.98 +/- 1.64 versus -0.79 +/- 1.07, p < 0.001). Two of the nine patients have been transplanted, both have good allograft function and show increases in BMD. We believe that these findings justify the complete removal of all parathyroid tissue for selected patients with chronic renal failure where medical therapy has failed and aluminium bone disease has been excluded. They also raise the possibility that PTH is necessary for bone loss to occur.

Adult↗
PubMed1993

Nutritional consideration for patients with organ transplants.

The immune response of the recipient and the therapeutics of immunomodulation significantly alter the relationship between allograft function and the composition and quantity of substrate. Successful management of nutrition along with post-transplant complications and drug therapy is of critical importance.

Energy Metabolism↗
PubMed1995

[Stress reaction of pulmonary artery pressure in the early and chronic phase after heart transplantation: comparison with healthy control probands].

The pulmonary artery pressure response to exercise frequently reflects ventricular diastolic properties. The aim of this study was to determine noninvasively cardiac allograft function and pulmonary artery pressure response to stress in the early and late phases after heart transplantation (HTX). Ten patients in the early postoperative phase (3.7 +/- 1.6 months postoperatively, group I) and ten patients at least 2 years after HTX (34.3 +/- 8.3 months postoperatively, group II) were studied by two-dimensional (2 D-), M-Mode, and Doppler echocardiography during supine graded bicycle exercise (25, 50, 75, 100 watts). The patients' data were compared to those obtained in eight normal controls. The peak pressure gradient between the right ventricle and right atrium during systole was derived from saline contrast-enhanced Doppler echocardiography of the tricuspid regurgitant jet and used as an estimate of pulmonary artery systolic pressure. In group I- and group II-patients, resting and exercise left ventricular diameters as well as systolic function were normal. The right ventricle was enlarged (3.2 +/- 0.4 cm/3.0 +/- 0.6 cm in group I/group II versus 2.1 +/- 0.3 cm in normal controls, p < 0.05). During exercise, heart rate increased less in heart transplant recipients (+26%/+36% in group I/group II, p < 0.05) than in normals (+67% at 100 watts, p < 0.05). Resting pulmonary artery pressures were similar in heart transplant recipients in the early and late postoperative stage and in normals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[A study on serum soluble interleukin-2 receptor level in the diagnosis of acute rejection in renal transplantation].

A total of 114 samples of serum soluble interleukin-2 receptor levels (sIL-2R) were dynamicly measured with enzyme linked immunosorbent assay (ELISA) in 24 patients with renal allografts. Serum sIL-2R levels in patients with uremia were evidently higher than those in normal control group and it was markedly reduced after recovery of allograft function. The elevation of serum sIL-2R was evident in acute rejection episode and was found as early as 3-8 days before elevation of serum creatinine. Patients with cyclosporine nephrotoxicity, acute tubular necrosis and stable renal function without rejection did not have a comparable rise in sIL-2R. These data show that the level of serum sIL-2R is regarded as an important parameter for the early diagnosis of acute rejection episode. It was noted that pre-operation level of serum sIL-2R in uremic patients may foretell the possible occurrence of acute rejection episode and the prognosis after renal transplantation. It was specially emphasized that serial assay with change of sIL-2R level and comparison of the level with that before transplantation are more important than a single serum sIL-2R level assay for the early diagnosis and differential diagnosis of acute rejection.

Acute Disease↗
PubMed1996

En bloc transplantation of kidneys from pediatric donors.

PURPOSE: Cadaveric kidneys from pediatric donors represent an important resource for human allotransplantation. We report 7 cases in which a new technique was used for en bloc transplantation of pediatric cadaver kidneys into adult recipients. MATERIALS AND METHODS: Paired cadaveric kidneys obtained from donors younger than 6 years (mean age 26 months) were transplanted en bloc into 2 children (mean age 12.5 years) and 5 adults (mean age 50 years) using en bloc extraperitoneal interposition of the donor aorta and vena cava into the recipient external iliac artery and vein. RESULTS: All patients had excellent perfusion immediately following transplantation on 99mtechnetium-pentetic acid perfusion scans. Serum creatinine decreased to its nadir an average of 7 days post-transplantation in all but 1 patient. In 3 patients glomerular filtration rate increased 3 to 5-fold at 3 months and 6 months after transplantation. No patient had venous or arterial thrombosis postoperatively and 2 had ureteral leaks. In 3 patients moderate to severe biopsy proved acute rejection episodes were successfully reversed by intensifying immunosuppressive treatment and recovery episodes were successfully reversed by intensifying immunosuppressive treatment and recovery of allograft function was excellent following antirejection therapy. Grafts were lost due to chronic rejection at 10 years in 1 patient and noncompliance in 1. Currently, 5 patients are well with normal serum creatinine values at 3 months to 1 year of followup. CONCLUSIONS: En bloc transplantation of small pediatric kidneys using a new technique averts the complication of vascular thrombosis and provides adequate mass to achieve a normal level of renal function.

Adolescent↗
PubMed1995

Long-term use of cyclosporine A does not adversely impact on clinical outcomes following renal transplantation.

The present review summarizes thirteen selected studies addressing the impact of cyclosporin A (CsA) on long-term outcomes following successful renal transplantation. Together, the data reflect the clinical courses of over 4,000 CsA-treated renal allograft recipients followed from one to ten years from the time of transplantation. Seven of the studies provided historical control data from more than 10,000 patients treated with azathioprine and prednisone. Graft survival beyond one year in CsA-treated recipients was consistently as good as or better than that achieved in the pre-CsA era. Underscoring the graft survival data, severe forms of the afferent arteriolopathy described as pathognomonic for 'CsA nephropathy' have become very uncommon and highly unlikely to be a cause of early or late graft loss. Retrospective analyses of longitudinal changes in aggregate serum creatinine concentrations did not demonstrate any differences in the long-term rate of attrition of allograft function between CsA- and non-CsA-treated patients. Similarly, prospective studies of serial glomerular filtrate rates did not reflect accelerating loss of function in association with long-term CsA use. CsA may be used for up to 10 years following successful renal transplantation without jeopardizing clinical outcomes. Graft arteriopathy (that is, chronic rejection), not progressive nephrotoxicity, is the dominant obstacle to achieving more uniformly successful long-term graft survival in the CsA era.

Animals↗
PubMed1996

Pharmacokinetic profile of cyclosporine A after conversion to Sandimmun Optoral: influence on ambulatory blood pressure in renal transplant patients.

The aim of the present study was to investigate whether the pharmacokinetic profile of cyclosporin A under Sandimmun Optoral compared to Sandimmun has an effect on blood pressure in patients with stable renal allograft function. Twenty-eight patients were randomized into two groups. Two pharmacokinetic profiles (I, II; time interval 7 days) were obtained in each group. One group (n = 18) was switched from Sandimmun to an equal dose (1:1) of Sandimmun Optoral after the first kinetic and the other (n = 10) received Sandimmun for both kinetics. Eight blood samples were taken during each kinetic and cyclosporine values were measured. Ambulatory blood pressure measurement was performed during each kinetic. There were no differences in the pharmacokinetic parameters between kinetics I and II in the control group but significant differences in the switched group with increased Cmax (+64%), AUC (+44%), C0 (+17%) and decreased Tmax (-39%) in kinetic II compared to kinetic I. Correlation of C0 with AUC was stronger for Sandimmun Optoral (r = 0.792) than for Sandimmun (r = 0.718). Correlation of C0 with Cmax was similar for Sandimmun Optoral (r = 0.53) and Sandimmun (r = 0.56). Mean 12 h blood pressure of kinetic II tended to be lower than that of kinetic I in the control group, but the opposite was true for the switched group. When blood pressure levels around Tmax +/- 1 h were analyzed only, RR (syst/diast) in mmHg was 135 +/- 3.7/89 +/- 2.2 (kinetic I) and 130 +/- 2.8/85 +/- 2.8 (kinetic II) for control as compared to 134 +/- 2.4/85 +/- 2.9 and 137 +/- 3.1/86 +/- 2.8 for the switched group, respectively. Sandimmun Optoral shows an improved pharmacokinetic profile. However, higher blood concentrations of cyclosporine under Sandimmun Optoral tend to increase slightly systemic blood pressure as compared to that under Sandimmun.

Adult↗
PubMed1996

Renal hemodynamics in hypertensive renal allograft recipients: effects of calcium antagonists and ACE inhibitors.

Hypertension present in more than 50% of successfully renal transplanted patients and its prevalence has slightly increased since the introduction of cyclosporine A. Twenty patients, 9 women and 11 men aged from 30 to 58 years, with stable cadaveric renal allograft function and moderate to severe hypertension, were included in the study. Renal artery graft stenosis causing hypertension were excluded. All patients were given triple drug immunosuppressive treatment with methylprednisolone, azathioprine and cyclosporine A (CsA) and their hypertension was treated with a nifedipine dose of 20 mg twice daily. To evaluate the effect of ACE inhibitors on renal hemodynamics and hypertension, a 4 mg/daily dose of perindopril was added to the above regimen for two months. Effective renal plasma flow (ERPF) decreased from 208 +/- 54 to 168 +/- 61 ml/min and renal vascular resistance (RVR) increased from 75 +/- 12 to 88 +/- 17 mm Hg/ml/min (P < 0.05 and P < 0.01, respectively). Mean blood pressure was significantly (P < 0.001) reduced by the combination of both agents in comparison to the blood pressure control by monotherapy with nifedipine. It is suggested that the combination of both antihypertensive agents was more effective than monotherapy with nifedipine in controlling blood pressure, but less favorable on the renal hemodynamic response in hypertensive renal transplant patients who were maintained on CsA.

Adult↗
PubMed1995

Changing demographics in renal transplant recipients: the 30 year Cleveland Clinic experience.

While it does appear that the most recent era of transplantation has not resulted in significant improvement in long-term allograft function, this appears to be due, at least in part, to the transplantation of increasing numbers of high-risk patients. It is noted that the improved results accomplished over prior eras of transplantation have been maintained despite the inclusion of these high-risk patients. Patients currently undergoing transplantation are more likely to be older, diabetic, obese or African American. All of these subgroups have poorer patient survival in the most recent transplant era and thus, death with a functioning graft has become a significant contributor to graft loss. Recipients were more likely to receive kidneys from cadaveric donors in the most recent era and within the live-donor groups, sibling donation has decreased. Hopefully, the recent trend of increased live-donor transplants (especially living, unrelated transplants) will continue. Cadaveric recipients were at higher risk for posttransplant ATN which, for the first time in the current era, had a significant adverse impact on graft survival. Long-term survival appeared to be associated with particular characteristics (optimal age at transplantation, optimal donor age, live donor, etc.), and can be achieved despite known risk factors, such as rejection or delayed graft function.

Adolescent↗
PubMed1996

Application of artificial neural networks to clinical pharmacology.

Drug dosages and drug choices are determined by a knowledge of the drug's pharmacokinetics and pharmacodynamics. Often, insufficient information is available to determine the pharmacokinetics of a drug or which drug will have a desired effect for an individual patient. We propose that a form of nonlinear regression, an artificial neural network, can be used. We have demonstrated this use with 2 examples. In the first example we use a neural network to predict gentamicin peak and trough concentrations from routine therapeutic drug monitoring. In the second example we predict delayed renal allograft function as a guide for induction of immunosuppression therapy. Predictions were made using a multilayer feedforward perceptron and compared to nonlinear mixed effect modeling (NONMEM) and logistic regression. Neural network peak and trough gentamicin predictions were more precise and less biased than control predictions made using NONMEM. Prediction error for peak serum concentrations averaged 16.5% for the neural networks and 18.6% for NONMEM. Prediction error for trough concentrations were 48.3% for neural networks and 59.0% for NONMEM. When used for the prediction of delayed graft function, the neural network correctly predicted immediate graft function 73% of the time and delayed graft function 65% of the time. For those patients predicted to develop delayed graft function, alternate induction using anti-lymphocyte globulin may be indicated. These 2 examples demonstrate how an artificial neural network may be applied to predictions in clinical pharmacology.

Anti-Bacterial Agents↗