bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of cystoscopically‐directed biopsy in human pancreaticoduodenal transplantation
Authors: Perkins James D. , Engen Donald E. , Munn Stephen R. , Barr Darlene , Marsh Christopher L. , Carpenter Herschel A.
Published: September 2024

Currently in pancreas transplantation, only indirect evidence of graft dysfunction is used as the mainstay of diagnosing a rejection episode. However, histologic specimens obtained by open surgical procedures are required for diagnostic dilemmas. After demonstrating the safety and efficacy of a cystoscopically‐directed biopsy technique to obtain adequate histologic specimens in a canine pancreaticoduodenal allograft model, we began using a similar technique in our human recipients. Between December 1987 and January 1989, 16 patients received a pancreaticoduodenal allograft with a duodenocystostomy at the Mayo Clinic. Cystoscopically‐directed needle biopsy specimens of the pancreas were obtained at the time of graft dysfunction (hypoamylasuria) and at 10 days after transplantation. The biopsy procedure consisted of obtaining pancreatic core tissue specimens with an 18‐gauge Menghini biopsy needle introduced through a rigid side‐viewing néphroscope that had been inserted transurethrally through the urinary bladder into the transplanted duodenal segment. The specimens were identified to be adequate histologically if acinar tissue was present. Each biopsy procedure was followed closely by clinical and ultrasonic examinations and serum amylase determinations. In 12 recipients, we performed 23 cystoscopically‐directed biopsies and 14 specimens (61%) were adequate. However, of our last 13 biopsy specimens, 12 (92%) were adequate. The follow‐up time per biopsy was an average of 103 d (range, 4 to 290 d). We had only two complications. Both were episodes of moderate hematuria that resolved with less than 24 hours of urinary catheter drainage. No fistulae, pseudocysts, hematomas, episodes of pancreatitis, or infections related to the biopsy procedure were documented. We have demonstrated that the cystoscopically‐directed biopsy technique is a safe procedure in human pancreaticoduodenal transplantation. This procedure can be used to differentiate the many causes of graft dysfunction.
Pediatric donors – A risk factor in renal retransplantation
Authors: Gruessner Rainer W. G. , Matas Arthur J. , Lloveras Goncal , Fryd David S. , Dunn David L. , Payne William D. , Sutherland David E. R. , Najarian John S.
Published: September 2024

Between January 1971 and February 1988, 1121 cadaver donor kidney transplants were performed at the University of Minnesota. Of these, 873 (77.9%) were from adult (> 15 years of age) donors, 117 (10.4%) from adolescents (> 10, < = 15) and 131 (11.7%) from pediatric (< = 10) donors. Of the last group, 25% of the patients received double and 75% single pediatric cadaver kidney transplants. We compared outcome of pediatric, adolescent and adult donor transplants. There was no difference in patient survival between recipient groups. One‐ and 5‐yr graft survival was 74% and 54% for recipients of adult kidneys, 68% and 53% for recipients of adolescent kidney, and 65% and 46% for recipients of pediatric cadaver kidneys (p = 0.03). Interestingly, the entire difference could be explained by a subgroup – adult or adolescent retransplant recipients of single pediatric kidneys. There was no statistical difference between any groups when primary transplants alone were considered. For pediatric retransplant recipients, there was no difference in outcome if the graft came from a pediatric or adult donor. For the adult or adolescent retransplant recipient most of the difference in graft survival occurred within the first 3 months after transplantation and this difference was maintained throughout the entire follow‐up. Analysis of graft loss within the first 3 months revealed that both acute and chronic rejection were more frequent in recipients of pediatric donor kidneys (p = 0.008). We conclude that the single pediatric kidney is associated with significantly worse graft survival in the adult retransplant recipient.
Diagnosis of liver rejection by bile cytology: A case report
Authors: Reinholt Finn P. , Kubota Keiichi , Barkholt Lisbeth , Ericzon Bo‐Göran
Published: September 2024

Cytological evaluation of the bile is presented as a potential new tool in the morphological diagnosis of liver rejection. The method is illustrated by a case report where increased cell density and signs of immunoactivation were found in the bile during a rejection episode diagnosed by clinical signs, blood chemistry tests and fine needle aspiration cytology. Our findings indicate that bile cytology may add to our diagnostic arsenal in monitoring liver allografts.
A review of long‐term cyclosporine use in renal transplantation
Authors: Lewis Richard M. , Van Buren Charles T. , Kerman Ronald H. , Conley Susan B. , Radovancevic Branislaw , Frazier O. Howard , Kahan Barry D.
Published: September 2024

This review addresses the following issues pertinent to the long‐term use of cyclosporine‐A (CsA) in the treatment of renal and cardiac allograft recipients: 1) the evolution of renal allograft and native renal function beyond the 1st year, 2) causes and incidence of late renal allograft loss, and 3) hypertension, severe hyperlipidemia, and growth in pediatric renal allograft recipients. Longitudinal analyses of mean serum creatinine levels (Crs), reciprocal Crs (1/Crs) values, and mean slopes of 1/Crs vs. time curves were not consistent with a uniform pattern of accelerated loss of native kidney or renal allograft function consequent to a progressive, toxic nephropathy. The data suggest that cardiac transplant recipients exerienced a significant decline in aggregate, native renal function over the first 6 post‐transplant months which subsequently stabilized with no evidence of further decline in aggregate function over a 3‐ to 4‐yr follow‐up. Renal transplant recipients demonstrated an aggregate trend of slowly declining allograft function which was comparable to Pred‐Aza historical controls and consistent with the effects of chronic immunologic injury. With regard to graft attrition, the beneficial impact of CsA immunosuppressive therapy on 1‐yr renal allograft survival persisted to 6 yr of follow‐up. In addition, long‐term immunosuppressive therapy utilizing CsA‐Pred was associated with a lower rate of both CAD and haploidentical LRD graft attrition beyond 1 yr vs. pooled, multicenter results in Pred‐Aza historical controls. The incidence of, and risk factors for, severe hyperlipidemia in the CsA‐Pred era did not differ substantially from those associated with Pred‐Aza immunosuppressive therapy. Growth patterns recorded in CsA‐Pred treated pediatric renal allograft recipients were also similar to those observed historically in association with Pred‐Aza therapy. In contrast, at 1 yr and 2 yr following renal transplantation, dual CsA‐Pred therapy was associated with an increased prevalence of hypertension vs. concurrent Pred‐Aza controls. The data do not support an indication for routine conversion from CsA to Azathioprine following successful cardiac or renal transplantation.
Predictive factors for graft functional survival following pancreas transplantation: Results of multivariate statistical analysis at a single institution
Authors: Viste Asgaut , Moudry‐Munns Kay , Sutherland David E. R.
Published: September 2024

A multivariate analysis of predictive factors for graft function was performed on patients having a pancreas transplant at the University of Minnesota between 25 July 1978 and 31 October 1987. The analysis was performed on 163 patients and all had follow‐up of at least 1 year. The following variables were studied: transplant yr, age at transplant, sex, type of donor, (cadaver, living‐related mismatched, living‐related identical HLA), donor mismatch at the HLA, A,B loci, donor mismatch at the DR loci, preservation time, kidney association (pancreas alone, pancreas and kidney simultaneously, pancreas after kidney), whole vs. segmental pancreatic transplant, graft duct management technique (polymer injection, enteric drainage, bladder drainage) and immunosuppression. By stepwise logistic regression analysis we found that the following factors were predictive for 1‐yr graft function: pancreatic duct management (p = 0.006), donor mismatch DR (p = 0.01) and kidney association (p = 0.05). For donor mismatch at the DR loci we found an odds ratio for success of 2 for 0 versus 1 mismatch and 5.2 for 0 versus 2 mismatch. For pancreatic duct management we found odds ratios of 2.2 for bladder drainage versus enteric drainage and 2.8 for enteric drainage versus duct injection (both of borderline statistical significance). The odds for success for bladder drainage versus duct injection were 6.2. With pancreas transplant alone as baseline the odds for success were 6.0 for pancreas and kidney transplant simultaneously, 3.2 for pancreas after kidney (same donor) and 1.2 for pancreas after kidney (other donor). When technically successfull cases only were considered, the same three factors; kidney relation, duct management technique and donor mismatch at the DR loci, were of importance in predicting graft survival.
Remission of pancreatic graft failure by intensive insulin treatment
Authors: Andersen Helene Bryde , Christiansen Erik , Burcharth Flemming , Rasmussen Knud , Christensen Niels Juel , Madsbad Sten
Published: September 2024

Remission of pancreatic graft failure was obtained by intensive insulin treatment. Eleven months after pancreas transplantation for type 1 diabetes mellitus the patient developed hyperglycemia with fasting blood glucose level about 12‐13 mmol/l. After normoglycemia through 3 weeks by intensive insulin therapy, fasting blood glucose level remained normal after cessation of insulin treatment. C‐peptide measurements during a mixed meal test before and after treatment demonstrated that the insulin secretory capacity of pancreatic β‐cells was increased after insulin treatment compared with the period before initiation of treatment. Further, improved glycemic control probably reduced insulin resistance. The patient had a second episode of pancreatic graft failure 8 months later, and was again treated with multiple insulin injections resulting in a new remission, which until now has been sustained for 8 months. It is concluded that aggressive insulin therapy may induce remission in pancreatic graft failure.
Harvesting of liver and kidney grafts with different storage solutions from a single donor: Description of surgical technique
Authors: Bechstein W. O. , Steffen R. , Blumhardt G. , Keck H. , Neuhaus P.
Published: September 2024

Preservation of liver and kidney grafts is usually carried out with one single preservation fluid for all organs. If the kidney transplant team insists on using another solution than the liver team, perfusion of both types of organs can successfully be performed by the described technique. This technique is based on the usual direct portal perfusion and an arterial perfusion of the liver graft via the gastroduodenal artery, similar to techniques used in regional arterial hepatic chemotherapy. The kidneys are perfused via the aorta. The surgical approach is described in 2 cases where this method was successfully employed.
Serum levels of soluble interleukin‐2 receptor (sIL‐2R) fail to correlate with the occurrence and degree of rejection in heart transplant patients
Authors: Ippoliti Giovanbattista , Vinante Fabrizio , Rovati Bianca , Di Franco Lucia , Martinelli Luigi , Goggi Claudio , Vigano Mario , Pizzolo Giovanni
Published: September 2024

Acute rejection episodes are commonly observed in heart transplant patients. This phenomen is mediated by an immune response against the allograft, including the activation of lymphoid cells following the recognition of Class I, Class II and non‐MHC foreign antigens. T‐cell activation is associated with a number of molecular modifications which,in vivo, include the expression and release of the p55 chain of the interleukin‐2 receptor (IL‐2R). In this study we investigated the pattern of serum levels of the soluble form of IL‐2R (sIL‐2R) in 52 patients submitted to orthotopic cardiac transplant in order to reveal any correlations with the occurrence and degree of rejection episodes. For this purpose, and using an immunoenzymatic method, we measured the serum concentration of sIL‐2R in samples taken before transplant and at regular intervals after the transplant. The results showed that sIL‐2R values are significantly increased early after transplant as compared to pre‐transplant levels (1197±330 vs 596±256; p < 0.01), with a subsequent progressive decrease during the following weeks. The pattern of increase was not related to the presence or absence of acute rejection. On the contrary, sIL‐2R levels seem to be related, to some extent, to the type of prophylactic immune suppression (ALG vs ATG). We conclude that sIL‐2R docs not seem to be a useful marker to monitor or predict rejection occurrence. However, it might have some usefulness in evaluating the effectiveness of pharmacological immune suppression.
Advantages of bladder drainage in pancreas transplantation: A personal view
Authors: Sollinger Hans W. , Pirsch John D. , D'Alessandro Anthony M. , Kalayoglu Munci , Belzer Folkert O.
Published: September 2024

Excorine drainage of the pancreas into the bladder has become the most frequently used exocrine drainage procedure after pancreas transplantation since we described this technique in 1982. The advantages of bladder drainage are technical simplicity associated with a low infection rate and a low incidence of surgical complication. Selected centers around the world have reported 1‐year graft survival exceeding 80% with the use of bladder drainage. Disadvantages of this technique include urinary problems such as hematuria, dyauria, and urinary tract infections. The number of centers using bladder drainage as the preferred drainage technique has steadily increased since 1984, and now more than two‐thirds of all pancreas transplants are performed with exocrine drainage to the urinary bladder. A further advantage of bladder drainage is the fact that rejection episodes can be diagnosed by determination of urinary amylase, which seems to be particularly important in isolated pancreas transplantation in pre‐uremic patients or sequential pancreas transplantation in patients who have previously received a kidney transplant.
Organ preservation: Experience with University of Wisconsin solution and plans for the future
Authors: Belzer Folkert O. , Kalayoglu Muncl , D'Alessandro Anthony M. , Pirsch John D. , Solllnger Hans W. , Hoffmann Robert , Boudjema Karim , Southard James H.
Published: September 2024

Transplantation of organs continues to be a primary therapeutic modality for treatment of end‐stage organ disease, and 1‐year graft survival rates show increasing improvements for most organs. A number of transplant centers show 1‐yr graft survival rates approaching 90% or more for the kidney, liver and pancreas. Rejection continues to be the major cause for loss of organs and there is still a major shortage of organs for transplantation. Additionally, many organs show delayed graft function (or primary nonfunction) which may be related to either donor factors or preservation factors. The University of Wisconsin solution for organ preservation has increased the safe time of preservation for the liver, kidney, and pancreas and helped to increase the quality and number of organs available for transplantation. However, the long‐range goal of organ preservation (unlimited preservation) is still far from being reached. In the past, preservation could accurately be categorized as an art and preservation solutions were developed based upon theoretical rationales about the mechanisms of organ injury at hypothermia and what agents would suppress injury. The utility and success of this approach is exemplified by the developments of Collins solution and the UW solution. However, further developments in methods to increase the quality and duration of preservation of all transplantable organs would appear to be dependent upon defining, systematically, how organs are injured and what can be done to suppress the injury. In this overview we will discuss our clinical results with the UW solution for organ preservation and present a discussion of future directions for organ preservation.
Value of endomyocardial biopsy in the diagnosis of lymphoma after heart transplantation: A case report
Authors: Lozano M. D. , Mindán F. J. Pardo , Mejuto F. Contreras , Flórez I. , Herreros J.
Published: September 2024

Patients treated with cyclosporine have an increased incidence of lymphoproliferutive disorders. Malignant lymphomas have been estimated to occur in allotransplant recipients with a frequency 350 times that seen in the general population. The median time of onset was 4.4 months after transplant. We present a case of a 55‐yr‐old male who underwent heart transplantation and died 4 months later after many episodes of severe AR that did not respond to treatment. At autopsy a disseminated B‐cell lymphoma was diagnosed. Phenotype of infiltrating lymphocytes in the last EMB, taken 11 days before death, shows a clear predominance of tumor B cells, instead of the acute rejection‐related T cells that presented in previous biopsies. For this reason, we believe that immunohistochemical studies with T‐ and B‐cell markers in EMB of patients with persistent AR could be of help in diagnosing unsuspected lymphomas.
Effect of immunosuppression on the incidence of lymphoma formation
Authors: Legendre Christophe , Kreis Henri
Published: September 2024

Since 1969, a high incidence of lymphomas has been reported to be associated with transplantation. This phenomenon has been markedly amplified during the eighties. This article analyzes some of the most contributive references on the topic. The major risk factors are duration of immunosuppression, dosage of immunosuppressive reagents and, most importantly, the number of immunosuppressive agents used either together or sequentially.
Severe vasculitis and autoimmune hemolytic anemia in two patients immunosuppressed for orthotopic liver graft
Authors: Actis G. C. , Ottobrelli A. , Marzano A. , Torrani‐Cerenzia M. R. , Lavezzo B. , Verme G.
Published: September 2024

Out of 77 patients whom we followed for up to 7 years after orthotopic liver transplant, 2 cases (2.5%) have recently shown clinically overt autoimmunity, presenting with hemolytic anemia and with severe vasculitis, respectively. Both patients responded dramatically to a pulse of high‐dose steroids. These observations suggest that the immune system of patients treated with conventional schedules of immunesuppressors is far from controlled and can mount strong erroneous responses. When clinically overt, as in our 2 cases, these complications may be life‐threatening and require costly hospitalization.
Liver transplantation after post‐transfusion purpura
Authors: Taaning Ellen , Dickmeiss Ebbe , Keiding Susanne , Kirkegaard Preben , Thorsgaard Niels
Published: September 2024

This report describes a case of liver transplantation performed in an HPA‐la‐negative woman who had just suffered from post‐transfusion purpura (PTP) due to anti‐HPA‐la (anti–Zwa). Although the patient received multiple transfusions of blood products from random donors and the liver donor was found to be HPA‐la‐positive, there was no recurrence of PTP. An anti‐HPA‐la of only subclass IgGl was demonstrated in the patient's serum with the platelet‐ELISA technique. This is in accordance with our previous finding, where destruction of autologous platelets in HPA‐1 immunized individuals was associated with the presence of anti‐HPA‐1 antibodies of the IgG3 subclass. The HPA‐1 antigens are also expressed on endothelial cells and, recently, anti‐HPA‐la has been described in connection with rejection process to a cadaver kidney. In this case, however, the patient showed no sign of rejection of the liver during the first 4 months after transplantation.
Clinical and pathologic changes in the liver of brain‐dead patients maintained with vasopressin and catecholamine infusion
Authors: Sugimoto Tsuyoshi , Yahata Kohei , Kinoshita Yoshihiro , Yoshioka Toshiharu , Onishi Shunzo
Published: September 2024

Functional and morphologic changes in the liver during the rust 2 weeks after brain death were studied in 25 patients with isolated head injury maintained by the combined administration of arginine vasopressin (ADH) and catecholamine. Histopathologically, hepatocytes appeared normal during the study period except for transient fatty metamorphosis during the first few days after brain death. Serum GPT concentration remained normal or slightly elevated. APTT remained within normal limits, and the serum Ch‐E concentration decreased slowly but remained within normal limits, while the serum albumin concentration decreased and was abnormally low by day 14. Thus liver cell function and morphology was preserved, although the patients appeared to suffer malnutrition. Changes in the PT were attributable to Vitamin K deficiency. The most important changes in liver function after brain death were daily increase in the serum Alp, Lap, γ‐GPT and bilirubin concentration. Concomitantly histopathologic studies of liver biopsy specimens showed that cholestasis and inflammatory cell infiltration in Glisson's sheath increased gradually after 5 to 7 days. Abdominal ultrasonography demonstrated gallbladder dilatation in all patients. Furthermore caerulein (ceruletide diethylamine) infusion in 6 patients failed to simulated gallbladder contraction. Vagal dysfunction, caused by brain death, induced biliary stasis by disrupting the coordination between biliary contraction and relaxation of the sphincter of Oddi. Thus a neurogenic effect of brain death was the immediate cause of cholestasis leading to cholangitis.
Restoration of exocrine pancreatic function following pancreas‐liver‐kidney transplantation in a cystic fibrosis patient
Authors: Stern Robert C. , Mayes James T. , Jr Fredrick L. Weber , Blades Edmond W. , Schulak James A.
Published: September 2024

Pancreatic transplantation for endocrine replacement is well‐established for insulin‐dependent diabetes mellitus. Exocrine pancreatic function after pancreas transplantation has been maintained after orthotopic cluster transplants for malignancy, and restoration of adequate exocrine function in a previously deficient patient has been reported in a patient with chronic pancreatitis who developed labile diabetes and steatorrhea after pancreatectomy. We performed a triple organ transplant (pancreas, liver and kidney) in a patient with exocrine pancreatic insufficiency and insulin‐dependent diabetes related to cystic fibrosis (CF) after he developed hepatic and renal failure. Pancreatic exocrine secretions were drained enterically to the jejunum. At 24‐month follow‐up. malabsorption is absent. The 3‐day stool fat, stool trypsin and chymotrypsin are normal. Serum carotene is within the normal range. Exocrine pancreatic insufficiency in CF patients can be corrected by pancreas transplantation. However, routine use in CF is precluded by the risks of surgery and immunosuppression. For diabetic patients with pancreatic exocrine insufficiency who require another organ transplant (e.g., lung, liver, or kidney), simultaneous pancreas transplantation with the exocrine secretions directed into the upper gastrointestinal tract should be considered.
Management of the renal allograft recipient: Immunosuppressive protocols for long‐term success
Authors: Delmonico Francis L , Tolkoff‐Rubin Nina , Auchincloss Hugh , Williams Winfred W. , Fang Leslie T. , Bazarl Hasan , Farrell Mary Lin , Cosimi A. Benedict
Published: September 2024

To determine the benefits of long‐term cyclosporine (CsA) immunosuppression, renal allograft recipients were randomly assigned to a protocol of either: CsA + azathioprine (Aza) +prednisone (TD), or to a protocol in which CsA was discontinued from the regimen of Aza + prednisone (CsA D/C). With a mean follow‐up of nearly 7 years since transplantation, 30/47 (64%) CsA D/C and 27/45 (60%) TD had functionign allografts. Although long‐term survivals were similar, hazards of the CsA D/C protocol were evident (40% rate of acute rejection following CsA D/C). Conversely, continued CsA in the TD protocol provided the opportunity for prednisone reduction, or even complete prednisone withdrawal in selected patients. A TD protocol which can provide equivalent long‐term success, and eventually lower or omit prednisone, is preferable to a protocol of CsA D/C.
Hepatic failure due to massive iron ingestion successfully treated with liver transplantation
Authors: Kozaki Koichi , Egawa Hiroto , Garcia‐Kennedy Richard , Cox Kenneth L. , Lindsay James , Esquivel Carlos O.
Published: September 2024

A 3‐year‐old female had fulminant hepatic and renal failure due to massive iron ingestion, despite gastric lavage, deferoxamine administration, hemodialysis and continuous arteriovenous hemofiltration. She underwent a successful emergency liver transplantation on 5th day after ingestion and was discharged 25 days later with excellent liver and renal function.
Primary varicella in adult renal transplant recipients: A report of three cases plus a review of the literature
Authors: Parnham Alan P. , Flexman James P. , Saker Barry M. , Thatcher Geoffrey N.
Published: September 2024

Disseminated primary varicella zoster infection in renal transplant patients can result in severe and often fatal illness. The disease tends to be much more severe in adults with an 80% mortality in the only reported series (1). We report 3 cases of severe disseminated varicella zoster in adult renal transplant patients who all survived. Early diagnosis, institution of intravenous acyclovir 10 mg/kg tds, zoster immunoglobulin, cessation of azathioprine treatment and aggressive supportive care may improve an otherwise bleak prognosis.
The optimal immunosuppressant after liver transplantation according to diagnosis: Cyclosporine A or FK506?
Authors: Mueller Andrea R. , Platz Klaus‐Peter , Blumhardt Gerhard , Bechstein Wolf‐Otto , Steinmüller Thomas , Christe Walter , Hopf Uwe , Lobeck Hartmut , Neuhaus Peter
Published: September 2024

Since we may soon be able to choose between primarily CSA‐ or FK506‐based immunosuppression, it is important to establish the superior immunosuppressive agent for the individual patient. In the present study, 121 patients, 61 randomly assigned to FK506‐ and 60 assigned to CSA‐based immunosuppression, were analyzed according to the primary diagnosis for liver transplantation. One‐year patient survival was similar in all groups. However, the incidence and severity of acute rejection within the 1st year after transplantation was significantly higher in patients transplanted due to HCV disease who were receiving FK506 (58.8%) compared with those patients receiving CsA (27.8%; p≤0.05). Furthermore, the incidence of moderate and severe neurotoxicity was significantly higher during the 1st month after LTX in patients transplanted owing to HCV disease treated with FK506 (35.3%) compared with those patients receiving CSA (16.7%; p<0.05). Irrespective of the immunosuppressive regimen, the incidence of early postoperative neurotoxicity was significantly lower in patients transplanted owing to HBV disease, alcoholic cirrhosis and various other liver diseases summarized than in patients transplanted due to HCV disease receiving FK506 therapy. During the 1st year, the incidence and severity of rejection in patients transplanted due to alcoholic cirrhosis and PBC was significantly lower in patients treated with FK506 (11.1% for both groups) compared with those patients receiving CSA (54.5% and 60.0%, respectively; p<0.05). Furthermore, this was accompanied by a lower incidence of toxicity. Therefore, our results indicate that morbidity, according to the incidence and severity of rejection and neurotoxicity, was significantly higher in patients transplanted owing to HCV discase treated with FK506 compared with those patients receiving CSA. FK506 demonstrated superior immunosuppressive potency in patients transplanted because of alcoholic cirrhosis and PBC regarding incidence and severity of rejection, as well as incidence of neuroand nephrotoxicity.
Effect of cyclosporine on renal function in kidney transplant recipients: a 12‐year follow‐up
Authors: Matas Arthur J. , Almond P. Stephen , Moss Adyr , Gillingham Kristen J. , Sibley R. , Payne William D. , Dunn David L. , Gruessner Rainer W. G. , Sutherland David E. R. , Manivel Carlos , Najarian John S.
Published: September 2024

Nephrotoxicity remains a concern for patients on long‐term cyclosporine. We have previously reported on renal function in a cohort of kidney transplant recipients followed up to 10 years posttransplant. The current study extends the analysis to 12 years. We find no evidence of cyclosporine‐induced renal failure.
Behavioral distress, fear, and pain among children hospitalized for bone marrow transplantation
Authors: Rodrigue James R. , Graham‐Pole John , Kury Susannah , Kubar Wendy , III Russell G. Hoffmann
Published: September 2024

This study assessed the extent of behavioral distress, fear, and pain of 10 children hospitalized for bone marrow transplantation. Parents and nurses completed bi‐daily ratings of the child's level of behavioral distress, fear, and pain, while children completed bi‐daily ratings of their fear and pain. Analyses showed high parent‐nurse agreement on ratings of children's behavioral distress, but generally low interrespondent agreement on ratings of children's fear and pain. Results also indicated significant changes over time for ratings of children's fear and pain, but not for ratings of behavioral distress.
Immediate function and cost comparison between static and pulsatile preservation in kidney recipients
Authors: Light Jimmy A. , Gage Fred , Kowalski Anne E. , Sasaki Truman M. , Callender Clive O.
Published: September 2024

During a 1‐yr period between September 1993 and September 1994, 74 patients received cadaveric kidney transplants at our institution. Thirty nine (39) kidneys were cold stored (CS), while 35 received pulsatile preservation (PP) on the Water's Mox system using U.W. Machine Preservation Solution. A perfusionist maintained pressure, flows, pH, and osmolality, within accepted ranges. Vasodilators (Regitine, Stelazine, Verapamil) were routinely added to the machine preservation solution. Most kidneys on PP were from marginal donors, or were imported and had associated long ice storage times. The CS kidneys, however, were from “ideal donors” where immediate function (IF) was expected. The kidneys were transplanted using a common protocol by a variety of surgeons. PP was associated with higher IF rates, shorter hospital stay and decreased overall costs. The function of those kidneys was also compared with the mate kidneys, obtained through a telephone survey of the various transplant centers throughout the country. PP was again associated with higher immediate function rates.
Value of plasma P‐selectin for vascular complications in liver transplantation
Authors: Fábrega Emilio , Casafont Fernando , Merino Jesús , de la Peña Joaquín , Crespo Javier , Amado Jose Antonio , Pons‐Romero Fernando
Published: September 2024

Recent data suggest that plasma P‐selectin, an adhesion molecule, may be a clinically useful marker for thrombosis. Hepatic vessel thrombosis is one of the most serious complications following liver transplantation. To assess the contribution of the soluble P‐selectin to this complication, we measured plasma P‐selectin levels in 32 orthotopic liver transplantations, pre‐, intra‐, and post‐operatively. We found that levels of circulating P‐selectin were not different between cirrhotic patients and healthy subjects. Of the 32 patients, 8 had vascular complications. We found a significant increase in the plasma P‐selectin concentration in the thrombotic group in early postoperative period compared with the non‐thrombotic group (p<0.002). It measurement may facilitate the diagnosis of thrombosis in the early postoperative period after liver transplantation, and therefore the management of these patients.
Evidence that ursodeoxycholic acid prevents steroid‐resistant rejection in adult liver transplantation
Authors: Clavien Pierre‐A. , Sharara Ala I. , Camargo Carlos A. , Harland Robert C. , Fitz J. Gregory
Published: September 2024

Steroid‐resistant rejection continues to be a serious problem in liver transplantation. Since ursodeoxycholic acid (UDCA) is beneficial in several cholestatic disorders and possessesin vitroimmunomodulatory and immunosuppressive effects, we have tested in a pilot study the effects of adjuvant UDCA in the prevention of steroid‐resistant rejection. Fifty consecutive liver transplant patients were treated with a standard cyclosporine immunosuppressive regimen. Treatment with UDCA (10 mg/kg/d) was initiated in each patient who developed biopsy‐proven rejection or biochemical evidence of cholestasis. Clinical and laboratory features were monitored for evidence of rejection. Data were analyzed after at least a 10‐month follow‐up period was available in each patient. Seven patients died during the study period, all within 4 wk of surgery. No evidence of rejection was documented in these patients. Twenty three of the 43 survivors 53% (23/43) developed an episode of rejection, and UDCA was initiated in each of them. Only one patient had a second episode of rejection, which responded to intravenous methylprednisolone therapy; no patient required antilymphocyte therapy. There was no evidence of toxicity for UDCA. These data suggest that UDCA can be given safely following OLT and may contribute to prevention of steroid‐resistant rejection in liver transplant recipients.
The potential pool of non‐heart‐beating kidney donors
Authors: Daemen Jan‐Willem H. C. , Oomen Arno P. A. , Kelders Willem P. A. , Kootstra Gauke
Published: September 2024

One of the ways to fight the growing organ shortage in transplantation is by procuring organs from non‐heart‐beating (NHB) donors. In order to determine the NHB kidney donor pool and evaluate its significance for renal transplantation, the potential is estimated in this study by retrospective death chart review.

All 200 in‐hospital deaths aged 3‐65 yr reported at the University Hospital Maastricht in 1994, including 25 deaths at the Emergency Department (ED), were analyzed. After exclusion of deaths by computerized ICD‐9‐ CM codes, 109 charts were abstracted and reviewed by experts. As a result a potential of eight brain dead, heart‐beating (HB) donors and 56 NHB donors were identified. Medical suitability and logistic availability were scored in an attempt to quantify the likelihood of the donation to proceed towards successful organ procurement. These scores resulted in a range of potential NHB donors from 4.5 to 9.2 per 100 in‐hospital deaths. Including rates of refusal to consent, as well as rates of technical failures, 24.0‐49.6 kidneys were calculated to be realistically available annually, 2‐4.5 times the projected number of kidneys from HB donors. With this increase of available grafts, at least growth of the renal waiting list would be prevented.

This estimate shows that the potential of NHB kidney donors is large, and its impact on organ shortage would be considerable. Since 68% of potential NHB kidney donors, and also 70% of the medically most suitable donors, were found in ED, ICU, and CCU, focusing on these hospital units. for implementation of routine procurement of kidneys from NHB donors is probably most effective. We therefore plead for the introduction of NHB kidney procurement protocols in EDS, ICUS, and CCUS.
Primary shunt perfusion detected by colour flow doppler imaging and its impact on liver allograft survival
Authors: Zülke Carl , Anthuber Matthias , Krämling Hans‐Joerg , Berger Hermann , Jauch Karl‐Walter , Schildberg Friedrich Wilhelm
Published: September 2024

Primary dysfunction (PDF) and eventual primary nonfunction (PNF) of liver allografts have been characterized by various clinical and laboratory parameters reflecting graft function, cellular integrity and extrahepatic influence following orthotopic liver transplantation (OLT). During the past 6 yr we have been able to demonstrate that this potentially devastating condition is routinely accompanied by a pathological initial perfusion pattern detected by colour flow doppler imaging (CFDI) within hours following OLT. In the majority of PDF cases (n=30) CFDI revealed increased vascular resistance in regard to arterial blood flow to the malfunctioning graft, with a resulting 1‐yr graft survival rate of 80% following the institution of early prostaglandin therapy in this group of patients. A completely different perfusion pattern was noticed by CFDI in a total of 13 cases with grossly decreased arterial resistance, resulting in an apparently supranormal arterial blood supply together with a reduced portal inflow in comparison to primarily functioning grafts. The presence of this pathologic graft perfusion was explained by the formation of arterio‐portal shunts within the graft during conservation and reperfusion, leading to a 1‐yr graft survival of merely 46.1%.
Intraoperative Doppler ultrasound in liver transplantation
Authors: Cheng Yu Fan , Huang Tung Liang , Chen Chao long , Lee Tze Yu , Chen Tai Yi , Chen Yaw Sen , Liu Po Ping , Chiang Yuan Cheng , Eng Hock Liew , Wang Chih Chi , Cheung Hok Kim , Jawan Bruno , Goto Shigeru
Published: September 2024

The purpose of this study was to determine the utility of intraoperative Doppler ultrasound for the diagnosis and reduction of the vascular complications in liver transplantation. This study included 19 pediatric and 5 adult patients. In the pediatric group, 12 patients received living related liver transplantation (LRLT), two splitting liver transplantation (SLT), three reduced‐size liver transplantation (RLT) and two full‐size pediatric liver transplants (FPLT). The hemodynamics and waveform of the hepatic vein, portal vein and hepatic artery were evaluated by intraoperative Doppler ultrasound (US) after reperfusion of the graft. Unsatisfactory hemodynamics was identified in nine cases, including decrease hepatic venous flow (6‐9 cm/s) with non‐pulsative flat waveform (adults, n = 2 and LRLT, n = 2); portal vein thrombosis (LRLT, n = 1); decrease portal flow (8 mL/min/kg) (LRLT, n = 1); occlusion of the portal vein (SLT, n = 1); poor arterial flow with dampened artery waveform (FPLT, n = 2). These abnormalities were all successfully re‐reconstructed by surgical procedures and achieved a graft survival rate of 100%. Two late vascular complications including hepatic venous thrombosis and recurrent portal vein stenosis with splenorenal shunt were discovered 1 month later. They were treated effectively by surgical thrombolectomy and percutaneous balloon dilatation and metallic coils embolization respectively. Three patients died of non‐vascular complications and all patients who underwent LRLT survived with a resultant 87.5% overall survival rate. In conclusion, intraoperative Doppler US is efficient in detecting abnormal hepatic hemodynamics, which permits early intervention and hence a better prognosis for the patients. Re‐reconstructive procedures were monitored closely under Doppler US guidance until proper flow and waveform were established. This reduces post‐transplant vascular complications and thereby eliminates the likelihood of a lethal complication that might call for re‐transplantation.
Antiproteinuric efficacy of fosinopril after renal transplantation is determined by the extent of vascular and tubulointerstitial damage
Authors: Lufft Volkmar , Kliem Volker , Hamkens Annette , Bleck Jörg S , Eisenberger Ute , Petersen Ruth , Ehlerding Götz , Maschek Hansjörg , Pichlmayr Rudolf , Brunkhorst Reinhard
Published: September 2024

Background

angiotensin converting enzyme (ACE) inhibitors have been successfully used for treatment of proteinuria after renal transplantation (RTx). Factors possibly responsible for the great interpatient variance of the antiproteinuric effect (APE) have not yet been investigated in renal‐transplanted patients.

Methods

28 patients after RTx with a persistent proteinuria of more than 1.25 g/d were treated prospectively with doses of fosinopril (10‐ 15 mg/d) which were not effective on systemic arterial blood pressure. Prior to initiation of fosinopril, renal graft biopsy was performed in all patients and renal graft artery stenosis was excluded by duplex ultrasound. Serum creatinine and proteinuria were measured prior to, as well as 3 and 8 months after initiation of ACE inhibition, mean arterial pressure was controlled via 24‐h measurement and repeated spot measurements. Reduction of proteinuria was correlated with renal histology, serum creatinine, creatinine clearance, mean arterial blood pressure, sodium excretion before therapy and the relative changes of these parameters during therapy respectively.

Results

therapy had to be stopped in 8/28 patients due to side effects including rise of serum creatinine (n = 4). Three patients were excluded due to non‐compliance. In the remaining patients (n = 17) proteinuria was reduced from 2.94±1.66 to 1.82 ± 1.39 and 2.48 ± 3.05 g/d after 3 and 8 months respectively, in the mean ± SD. There was a significant inverse correlation between the APE and the extent of benign nephrosclerosis, interstitial fibrosis and tubular atrophy. No correlation of the APE to any of the other parameters could be demonstrated.

Conclusions

fosinopril can be administered effectively in a subgroup of proteinuric renal transplant recipients. However, because of a high proportion of patients developing side effects, careful monitoring is obligatory. Our results show that the lesser the degree of chronic morphological injury, the greater is the antiproteinuric effect. Thus, the degree of pre‐existing histologically proven damage of the graft may serve as an indicator for the antiproteinuric efficacy of ACE inhibitor therapy after RTx.
Polyclonal/monoclonal ratio in kidney and bone marrow transplanted patients treated with cyclosporine
Authors: Capone D , De Marino V , Caso N , Stanziale P , Fontana R , Imperatore P , De Marino V , Pisanti N
Published: September 2024

On 296 blood samples obtained from 22 bone marrow and 21 kidney transplanted patients, the concomitant measurements of polyclonal and monoclonal cyclosporine (CSA) were performed and the relative polyclonal/monoclonal (P/M) ratios were calculated. Biochemical profiles of kidney and liver functions were also determined in all patients.

For each type of transplant, biochemical data were divided into two subgroups on the basis of P/M ratio: A) data obtained in patients with P/M ratio > 3.0; B) data obtained in patients with P/M ratio ≤ 3.0. While in kidney transplanted patients no difference of biochemical profiles was found between two subgroups, in bone marrow transplant recipients the subgroup A showed a worsening of hepatic function parameters as compared to subgroup B.

Therefore, it appears that P/M ratio could represent in bone marrow transplantation an index of hepatic CSA toxicity.
Glucose homeostasis standards for pancreas transplantation
Authors: Nankivell Brian J , Chapman Jeremy R , Bovington Karen J , O'Connell Philip J , Allen Richard DM
Published: September 2024

Simultaneous pancreas and kidney transplantation (SPK) is capable of achieving normoglycemia, as assessed by oral glucose tolerance tests (OGTT), in the majority of diabetic recipients with end‐stage renal disease. Despite its success over the last decade, standard ranges for OGTT after SPK are not available for comparison between studies and techniques. We examined 327 prospectively performed OGTT, undertaken in insulin‐free bladder‐drained SPK recipients, between 1 month and 10 yr after transplantation. Ranges of values for glucose, insulin and C‐peptide were derived and areas under the time concentration curves calculated. The normal range of 2‐h glucose values from SPK recipients was comparable to WHO criteria for the diagnosis of diabetes mellitus in a normal population; however, the fasting glucose fell below these levels. Fasting and area‐under‐the‐curve (AUC) glucose were remarkably stable with time after SPK, although insulin fell with time after pancreas transplantation. These ranges may allow clinical evaluation of the endocrine function in individual SPK recipients, provide standards for comparison between different centers and techniques, and provide targets for islet transplantation.
The Use of Riboflavin for the Inactivation of Pathogens in Blood Products
Authors: Goodrich Raymond P.
Published: September 2024

Background and Objectives:

In recent years, the desire to develop methods to inactivate pathogens in blood components has continued to grow. Several of these proposed approaches have been introduced or are currently in clinical studies. The use of chemical inactivating agents must be considered in terms of the current safety of the blood supply and the potential risks that the introduction of new chemical entities into blood components may carry. The impact which these treatment procedures have on the in vitro and in vivo performance of these products must also be considered relative to the potential benefit of the pathogen inactivation potential they offer. This paper will discuss one possible approach for inactivating pathogens in blood using vitamin. B2, Riboflavin, and light.

Materials and Methods:

We have used Riboflavin for treating plasma and platelets and evaluated protein quality and platelet function in vitro. Initial toxicology tests to assess the impact of infusion of photoproducts generated in these processes have also been conducted in rodents. Cytotoxicity evaluations have been used to assess the possible impact of photoproduct toxicity in vivo. Virus and bacteria spiking studies using a variety of human and animal model pathogens have been conducted in order to asses the efficacy of this process.

Results:

Initial toxicology assessment of the photoproducts of Riboflavin generated under the proposed treatment conditions have been favorable. Virus and bacteria clearance studies have demonstrated efficacy of the procedure against a wide range of human and animal pathogens, including intracellular HIV‐ 1. Studies with platelet and plasma function indicated reductions in vitro comparable to other proposed treatment approaches.

Conclusion:

The use of Riboflavin in a photochemical decontamination process for blood components shows promise.
Silicon, An Emergent Strategy to Lighten the Effects of (A)Biotic Stresses on Crops: A Review
Authors: Pereira Sandra , Monteiro Ana , Moutinho‐Pereira José , Dinis Lia‐Tânia
Published: September 2024

Silicon (Si) has emerged as a pivotal element influencing various aspects of plant growth and development. This review explores the multifaceted effects of Si on plants, encompassing both biotic and abiotic dimensions. Si, primarily absorbed by plants in the form of orthosilicic acid, demonstrates a diverse range of roles in enhancing plant resistance to environmental stresses. Biotic stresses, including pathogen attacks and insect infestations, are notably mitigated by the deposition of Si in plant tissues, fortifying cell walls and triggering defence mechanisms. Furthermore, Si plays a crucial role in alleviating abiotic stresses such as drought, salinity and metal toxicity, imparting resilience to plants in challenging environments. The interaction between Si and plant physiology involves intricate mechanisms, impacting nutrient uptake, photosynthesis and hormonal regulation. As research in this field advances, a comprehensive understanding of the nuanced effects of Si on plants emerges, paving the way for innovative agricultural practices and the development of stress‐resistant crop varieties. This review delves into the contemporary knowledge surrounding the effects of Si on plants, underscoring its significance in promoting plant resilience and sustainable agriculture.