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At least 1,729 records · Page 96Linked to original sources
PubMed1988

[Function and morphology of intraperitoneal segmental pancreas allotransplants with cyclosporin monotherapy in the dog--a comparison of 4 drainage procedures of exocrine secretions].

Dogs which had received cyclosporine A for immunosuppression were investigated to elucidate functionality and morphological alterations in pancreas allografts, with enteral, vesical, peritoneal or occluded exocrine drainage. None of the animals with enteral drainage survived the first four postoperative weeks, with lethal infections being responsible for allograft failure. Full functionality three months from transplantation was recorded from three of seven transplants with ductal occlusion and unobstructed drainage into the abdominal cavity. Ductal occlusion was repeatedly accompanied by pancreatitis and pseudo-cysts. Fibrotisation of the organ and loss of endocrine islets of pancreas were recordable from these cases just as from grafts with unobstructed drainage into the abdominal cavity. Drainage of exocrine secretion into the bladder yielded good success in one of seven animals and was morphologically and functionally characterised primarily by occlusive metaplastic ossification along the transition to the anastomosis.

Animals↗
PubMed1989

[Cytomegalovirus pneumonitis in renal transplantation--a case report].

Cytomegalovirus pneumonitis is a severe complication of renal transplantation. It usually occurs in the first 3-4 months after transplantation. Herein, we describe a 21 year-old male patient with chronic renal failure who received a successful cadaveric renal transplantation after regular hemodialysis three times per week for 3 years. Cyclosporin A and Methylprednisone were used for immunosuppressants after operation. The allograft kidney function improved gradually in two weeks. Serum BUN and creatinine were lowered to 25 mg/dl and 1.7 mg/dl respectively. Bacterial pneumonia developed on the 16th postoperative day. The control of pneumonia rapidly improved after the use of broad spectrum antibiotics. However, bilateral diffuse pulmonary infiltrations developed 21 days later. He received transbronchoscopic diagnostic procedures including TBLB without definite diagnosis. The final diagnosis was obtained by open lung biopsy, in which intranuclear inclusion body was found. The patient expired on the 55th postoperative day despite adjustment of immunosuppresant dosage and use of antiviral therapy.

Adult↗
PubMed1989

Tertiary hyperparathyroidism after renal transplantation: operative indications.

A retrospective analysis of our renal transplant population between 1981 and 1987 was undertaken to study the natural history of posttransplant hypercalcemia and to review indications and recommendations regarding the timing of parathyroidectomy. During this period, 1158 renal transplant procedures were performed in 1025 patients, with 819 allografts (71%) functioning currently. Posttransplant hypercalcemia greater than 10.5 mg/dl was associated with a longer duration of dialysis and developed in 227 patients, with onset of hypercalcemia occurring in 90% of these patients by 1 year. In 69% of these patients, spontaneous resolution of the hypercalcemia occurred between 6 months and 7 years after transplantation. A total of 42 patients with asymptomatic hypercalcemia are currently being followed up, with a mean serum calcium level of 11.0 +/- 0.41 mg/dl and a mean follow-up interval of 3.3 +/- 1.6 years since transplantation. Nine symptom-free patients with moderate hypercalcemia (12.0 to 12.4 mg/dl) more than 1 year after transplantation were identified. Five of these patients had spontaneous resolution of the hypercalcemia between 2 and 7 years. Fifteen patients with posttransplant hyperparathyroidism (6.6%) required parathyroidectomy--11 for symptomatic and four for asymptomatic hyperparathyroidism. One patient had symptomatic hyperparathyroidism despite the presence of normocalcemia. One symptom-free patient with significant hypercalcemia (serum calcium level, 14.7 mg/dl) underwent parathyroidectomy 3 months after transplantation. The remaining three symptom-free patients had serum calcium determinations of greater than or equal to 12.5 mg/dl more than 1 year after renal transplantation. Patients with pretransplant and posttransplant hypercalcemia required parathyroidectomy more frequently than did patients with only posttransplant hypercalcemia (18% versus 3.0%; p less than 0.001). An unusual finding was the occurrence of a single adenoma in two patients, which represents sporadic primary hyperparathyroidism in the patient undergoing renal transplantation rather than tertiary hyperparathyroidism. We recommend a conservative approach to posttransplant hypercalcemia, with surgery reserved for patients with symptomatic disease and patients with asymptomatic persistent hypercalcemia greater than or equal to 12.5 mg/dl more than 1 year after transplantation.

Follow-Up Studies↗
PubMed1989

Current status of pancreas transplantation.

Pancreas transplantation for the treatment of diabetes mellitus is being done with increasing frequency. Refined operative techniques, an improved immunosuppression regimen, and an earlier recognition of rejection have led to dramatic increases in both graft and patient survival rates. Preliminary data suggest that a functioning pancreatic allograft may arrest or reverse most of the complications of diabetes, although the effects on retinopathy remain controversial. Patients also acquire a strong sense of well-being after successful pancreas transplantation.

Diabetes Mellitus↗
PubMed1989

Tendinitis--a common complication after renal transplantation.

A group of 170 patients having functional renal allografts were evaluated at least six months after renal transplantation. They were assessed for symptoms and signs of tendinitis in the Achilles and Supraspinatus tendons. Of the 170 patients, 34 had tendinitis. Four patients (11.8%) had spontaneous rupture of the Achilles tendon one week to 72 months after transplantation. All of the symptomatic patients had received steroids, and 81% of these had been treated with methylprednisolone. Of the asymptomatic patients 89% received steroid and 69% received methylprednisolone. There was a significant correlation between symptoms of tendinitis and the cumulative steroid dose. The number of matching HLA loci of the donor kidney and the length of time on dialysis were also related to the incidence of tendinitis. Unlike a previous study (1) we could not find significant differences between the 34 patients with tendinitis and controls with reference to the levels of serum phosphate, alkaline phosphatase, albumin adjusted calcium, or cholecalciferol therapy prior to transplantation. Our data confirm that tendinitis is surprisingly common in patients after renal transplantation (20.0%).

Achilles Tendon↗
PubMedDate not supplied

Polypeptide composition and histopathologic changes in endomyocardial biopsies from transplanted human hearts.

Sequential postoperative samples of 43 human right ventricular endomyocardial biopsies from four heart transplant patients were evaluated histopathologically to assess microscopic parameters of rejection. Selected pieces of these myocardial biopsies were weighed and homogenized in low ionic strength buffer containing Triton X-100 to extract and to quantitate cardiac actin. Aliquots of the soluble fractions were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Residual pellets were solubilized and also underwent SDS-PAGE. Electrophoretograms were analyzed densitometrically. Actin from biopsies from transplanted human hearts accounted for approximately 40% of Triton X-100 soluble polypeptides. Actin and myosin heavy chain content in the pellet fractions was unchanged as a function of allograft duration. A polypeptide band resolved between 14,000 and 21,000 daltons in the Triton-soluble fraction of four fresh samples correlated with histopathologic changes of moderate acute allograft rejection. A similar band was noted in 11 frozen endomyocardial biopsy specimens without changes of acute rejection. Small actin differences may be found in the transplanted heart, but they do not correlate with rejection. The presence on SDS-PAGE of the polypeptide band found between 14,000 and 21,000 daltons may correlate with proteolysis of cytoplasmic proteins either from rejection or possibly from autolysis after freezing.

Actinin↗
PubMed1986

Surgical treatment of diabetic nephropathy with simultaneous pancreatic duodenal and renal transplantation.

Twenty consecutive patients with diabetes who were dependent upon insulin underwent simultaneous pancreatic-duodenal and renal transplantation at our center between March 1984 and August 1985. Eighteen patients are alive, 17 have functioning renal allografts and 13 have normal fasting blood sugar levels and are free of insulin use. Pancreatic graft loss was secondary to venous thrombosis in four instances and inadequate perfusion in one. Graft versus host disease occurred in three patients with composite pancreatic and splenic grafts, which led to a policy of not including the spleen as part of the graft. Serum creatinine levels were a more sensitive indicator of rejection than blood sugar levels which represent a distinct advantage of the simultaneous pancreatic and renal procedure, as compared with pancreatic transplantation after renal transplantation. Duodenal intestinal anastomosis appeared to be a satisfactory way of establishing exocrine pancreatic drainage. As results of pancreatic transplantation continue to improve, this procedure should no longer be considered as experimental.

Actuarial Analysis↗
PubMed1979

Handling of phosphate by the transplanted kidney.

Maximal tubular phosphate reabsorption capacity corrected for changes in glomerular filtration rate (TmP/GFR) was taken as a measure of renal phosphate handling in patients with good and stable functioning kidney allografts. TmP/GFR values were within the normal range in only one-fifth of the patients. Eighty per cent had an abnormally low renal phosphate threshold concentration. Persistent hyperparathyroidism was the causative factor of this diminished tubular reabsorption in less than half of these patients, the majority of them showing an iPTH independent phosphate leak. Although glucocorticoids, azathioprine and tubular damage of the graft in the perioperative phase may contribute to this iPTH independent phosphate wasting, no single causative factor could be identified. Cases with hypophosphataemia should be treated in order to avoid symptoms of phosphate depletion. Active Vitamin D metabolites would be the therapy of choice by suppressing the parathyroid glands ("chemical PTX") and by directly enhancing tubular phosphate reabsorption. In persistent hyperpathyroidism with hypercalcaemia, surgical parathyroidectomy must be considered. Therapy with phosphate salts is only symptomatic and should be used only as an adjunct.

Azathioprine↗