bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe blunt trauma to a renal transplant
Authors: Vernon Walter B. , Pozniak Myron A. , Sollinger Hans W. , D'Alessandro Anthony M. , Pirsch John D. , Kalayoglu Munci , Kelcz Frederick , Belzer Folkert O.
Published: September 2024

Severe blunt trauma to a renal allograft was observed in 1 of the 1533 recipients of a renal transplant at a single institution over the past 13 years. The presentation was remarkable for the early appearance of renal dysfunction and late appearance of swelling with minimal tenderness. The injured kidney was studied with duplex Doppler ultrasound which established the nature of the injury and documented markedly attenuated blood flow to the graft. Non‐operative conservative management, including withholding cyclosporine, resulted in excellent recovery of renal function. Recent advances in diagnostic imaging and non‐operative management of severe blunt renal trauma are reviewed, with emphasis on the application to the kidney transplant recipient.
Hepatic artery thrombosis following pediatric liver transplantation: Assessment of blood flow measurement in allografts
Authors: Yanaga Katsuhiko , Makowka Leonard , Shimada Mitsuo , Esquivel Carlos O. , Bowman James S. , Todo Satoru , Tzakis Andreas G. , Starzl Thomas E.
Published: September 2024

The purpose of this study was to define parameters which could be predictive of hepatic artery thrombosis, which continues to be a major complicating factor in pediatric liver transplantation. The hepatic blood flow of 14 pediatric liver patients (15 grafts) who weighed less than 15 kg was measured electromagnetically during orthotopic liver transplantation. The results of blood flow determination and the clinical data in 7 patients (8 grafts) who developed hepatic artery thrombosis were compared with those of 7 control patients. All patients with a hepatic arterial flow of less than 60 ml/min developed hepatic artery thrombosis (4/8 vs. 0/7; p<0.05), and the patients with hepatic artery thrombosis exhibited higher total hepatic and portal vein flow per 100 gram of liver tissue (262 vs. 136 ml/ min; p< 0.001 and 222 vs. 80 ml/min; p< 0.025, respectively) as well as longer cold preservation time (384 vs. 326 min; p< 0.025). The results of our study suggest that hepatic arterial flows of less than 60 ml/min are critical for the development of hepatic artery thrombosis, and that portal venous overflow and increased preservation times may contribute to the development of hepatic artery thrombosis.
Renal transplant reparative ex vivo surgery: Prevention of vascular complications
Authors: Benoit G. , Hammoudi Y. , Moukarzel M. , Bellamy J. , Bensadoun H. , Charpenter B. , Fries D.
Published: September 2024

Of 535 renal transplantations performed between 1982 and 1987, 127 ex vivo vascular surgical procedures were performed, consisting mostly of a right renal vein extension. Incidence of vascular complication was higher if right kidneys were transplanted with their entire arterial length, without any venous extension (14.6% versus 8.5%). This work shows that lengthening of the right renal vein facilitates kidney transplantation, prevents arterial kinking and reduces the risk of arterial stenosis. Arterial repair in case of multiple arteries is also a reliable technique. The process of lengthening the renal vein is easier if the right kidney is harvested with an infra‐renal vena caval segment: and we think that this segment should always be included during harvesting.
Multiple venous thrombosis with recurrence of Budd‐Chiari syndrome after liver transplantation for paroxysmal nocturnal hematuria
Authors: Schmid Th. , Sandbichler P. , Pernthaler H. , Vogel W. , Kunz F. , Schmid K. , Margreiter R.
Published: September 2024

A 27‐year‐old female with end‐stage Budd‐Chiari syndrome due to paroxysmal nocturnal hemoglobinuria underwent orthotopic liver transplantation. In order to prevent recurrent venous thrombosis within the graft she was anticoagulated with heparin which, for severe bleeding tendency, had to be given in subtherapeutical doses and was later replaced by dicoumarols. For surgical removal of the t‐tube the patient was switched again to low‐dose heparin. From that time on, she developed venous thrombosis, namely at mesenteric veins requiring right‐side hemicolectomy, at the left lower lobe of the lungs necessitating lobectomy, at her left thigh and finally at the graft, leading to death 3 months after transplantation. From this case and a similar one reported by the Pittsburgh group it is concluded that patients suffering from veno‐occlusive disease due to blood stem cell disorders should not be excluded from liver grafting as a matter of principle. Anticoagulation, however, should not be discontinued whenever possible. To cure the underlying disease, liver transplantation should be followed by bone‐marrow transplantation, which was planned for our patient.
Pre‐transplant bladder rehabilitation in patients with abnormal lower urinary tracts
Authors: Sagalowsky Arthur I. , Kennedy Timothy J. , Dawidson Ingemar , Peters Paul C.
Published: September 2024

A retrospective experience with preoperative lower tract evaluation, bladder rehabilitation and transplant outcome in patients with major abnormalities of the lower urinary tract is presented. From more than 1000 renal transplants during a 23‐year period, 11 patients required either augmentation cystoplasty (7 cases) or supravesical conduit diversion (4 cases) in preparation for transplantation. The causes of bladder abnormality were neurogenic, dysfunctional voiding, posterior urethral valves, congenital atresia, and acquired contracture in 4, 3, 2, 1 and 1 cases respectively. Lower tract evaluation began with voiding history and voiding cystourethrogram. Patients with incontinence or near zero bladder capacity were managed with supravesical diversion. Continent patients were studied further with serial cystometrograms via percutaneous suprapubic catheters during trials of bladder cycling to study bladder compliance. Continent patients with abnormally high bladder pressure (greater than 75 cm water) and/or low bladder capacity (less than 100 ml) underwent augmentation cystoplasty with intestinal segments. To date, 10 renal transplants have been performed in 8 patients with a cumulative graft survival of 70%, with follow‐up of 13 months to 3 1/2 yr. Two patients with bladder augmentation are awaiting transplantation. The final patient died of suspected pulmonary embolus following bladder augmentation and subsequent development of a bowel obstruction. Additional morbidity consisted of 8 episodes of urinary infection in 6 patients and 1 case of bleeding at the augmentation cystoplasty suture line. These results suggest that, with careful lower tract evaluation, patients with major bladder abnormalities may safely undergo renal transplantation into a rehabilitated bladder in most cases, or into a supravesical conduit when necessary, and can achieve satisfactory graft survival and low morbidity. A prospective plan for pre‐transplant lower tract evaluation is offered.
A comparison of single and double pediatric cadaver donor kidneys for transplantation
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

Use of pediatric cadaver kidneys for transplantation is controversial; reports of outcome following pediatric donor transplantation have shown either similar results or worse results than when adult donors are used. Two techniques have been proposed for use of pediatric donor kidneys ‐ transplantation of a single kidney, or transplantation of both kidneys with a common aorta and cava to a single recipient. Single kidney transplants make optimum use of the donor pool; double transplants provide increased renal mass and therefore more functional reserve in the early posttransplant period. No study from a single institution has compared outcome after double versus single pediatric cadaver kidney transplantation. To investigate this issue, we reviewed our experience with 131 pediatric cadaver kidneys (donor age ≤ 10 years) transplanted between 1971 and 1988. We compared outcome of these transplants to outcome of adult donor kidney transplants. Of the group receiving pediatric kidneys, 33 (25%) received double and 98 (75%) received single pediatric kidney transplants. For double pediatric graft recipients, 5 and 10‐yr patient survival rates were 81% and 75%, respectively, whereas for single graft recipients, 5‐ and 10‐yr patient survival rates were 67% and 54% (NS). Graft survival was 78% (1 yr) and 48% (10 yr) in double kidney transplant recipients, but only 61% (1 yr) and 34% (10 yr) in single kidney transplant recipients (p = 0.07). When compared to adult cadaver kidney recipients, double graft recipients had similar short‐ and long‐term outcome (p = 0.6), whereas single pediatric kidney recipients had significantly decreased graft survival (p = 0.03). Pathogenesis for graft loss was similar in double and single pediatric kidney transplants. However, early graft loss (within first 3 months posttransplant) due to rejection was more frequent in single (16%) than in double (3%) pediatric allograft recipients (NS). We conclude that double pediatric cadaver kidneys provide an overall higher patient and graft survival. However, optimal use of the donor pool may be made by the use of single pediatric kidney transplants.
Clinical experience with OKT3 monoclonal antibody for treatment of acute renal allograft rejection based on sequential histological evaluation
Authors: Zlabinger Gerhard J. , Ulrich Walter , Pecherstorfer Martin , Watschinger Bruno , Traindl Otto , Meron Giora , Pohanka Erich , Wolfram Johanna , Kovarik Josef
Published: September 2024

Based on sequential histological evaluation, monoclonal antibody treatment with OKT3 was able to reverse 25 out of 34 (74%) acute rejection episodes treated as first line but only 6 out of 15 (40%) acute rejection episodes treated on a rescue basis in renal transplant recipients. Within the histologically‐defined responder group to OKT3, 25% of the treated patients did not show an improvement of excretory kidney function during or immediately after monoclonal antibody treatment and these were significantly more frequent in the patient group with late acute interstitial rejection. In these patients clinically unapparent chronic cyclosporine‐A nephrotoxicity seemed to have been aggravated by the rejection process so that excretory kidney function did not recover after effective treatment of rejection. Actual graft function 3 to 27 months after initiation of OKT3 therapy was significantly worse in nonresponders than in responders (p<0.001). Significantly more patients not responding to OKT3 therapy were found in the group of graft recipients with no initial transplant function (p = 0.03). Vascular components and signs of severe interstitial acute rejections were the predominant histological lesions in non‐responders to OKT3. A strong correlation could be found between the incidence of both CMV and viral infections in general and the duration of the OKT3 treatment cyclus (p = 0.01). Our findings confirm that OKT3 is effective in reversing acute renal allograft rejection and, additionally, provide evidence that differential indications for OKT3 therapy might exist that may help to maximize control of rejection and to avoid unnecessary side effects due to inadequate courses of treatment.
Deletion of immunosuppressive prophylaxis after marrow transplantation increases hyperacute graft‐versus‐host disease but does not influence chronic graft‐versus‐host disease or relapse in patients with advanced leukemia
Authors: Sullivan Keith M. , Storb Rainer , Witherspoon Robert P. , Weiden Paul L. , Anasetti Claudio , Appelbaum Frederick R. , Beatty Patrick , Buckner C. Dean , Deeg H. Joachim , Doney Kristine , Fisher Lloyd , Loughran Thomas P. , Martin Paul , Meyers Joel , McDonald George B. , Sanders Jean , Shulman Howard , Stewart Patricia , Thomas E. Donnail
Published: September 2024

Sixteen patients < 30 years of age with advanced leukemia who were given unmodified marrow grafts from HLA‐identical siblings without posttransplant immunosuppression were compared to 44 age‐ and disease‐matched controls who received methotrexate (MTX) to prevent graft‐versus‐host disease (GVHD). All 60 patients were prepared with cyclophosphamide (60 mg/kg × 2) and total body irradiation (2.25 Gy daily × 7). Grade 2‐4 acute GVHD developed in all 15 engrafted patients not given immunosuppression compared to 10 of 44 engrafted MTX recipients (p < 0.0001). The onset of Grade 2‐4 GVHD was hyperacute (median d 8) compared to a median onset at d 18 in the MTX group (p = 0.005). Treatment of hyperacute GVHD with prednisone ± cyclosporine or ATG + cyclosporine produced sustained improvement in 6, response with subsequent flare in 4, and no response in 4 patients. Despite the prevalence of hyperacute GVHD in patients not given immunosuppression. there was no statistically significant difference in the probability of chronic GVHD (31% versus 33%), interstitial pneumonia (47% versus 22%), or recurrent leukemia (41% versus 38%) compared to the MTX recipients. Six patients not given immunosuppression and 19 given MTX survive with a median follow‐up of 4.4 (range 3.2‐6.4) yr after transplant. The probability of death from causes other than recurrent malignancy was 58% in the no‐immunosuppression and 34% in the MTX group (p = 0.l). Actuarial 3‐yr relapse‐free survival is 25% and 41%, respectively (p = 0.3). We conclude that deletion of immunosuppression after unmodified HLA‐identical marrow transplantation leads to an increase in hyperacute GVHD without apparent influence on chronic GVHD or relapse. Although nonrelapse mortality was higher and relapse‐free survival was lower in patients not given immunosuppression. differences did not reach statistical significance in this study.
Bone marrow transplantation in children
Authors: Ringdén Olle , Bolme Per , Lönnqvist Berit , Tollemar Jan , Dahllöf Göran , Gahrton Gösta , Groth Carl‐Gustav
Published: September 2024

From 1975 to 1987, 82 children underwent bone marrow transplantation at Huddinge Hospital. In 21 children transplanted for acute leukemia in first remission, or chronic myeloid leukemia in chronic phase with HLA‐identical marrow, the actuarial 5‐year leukemia‐free survival was 85% and the probability of relapse was 15%. These survival figures were better when compared to a 30% probability of relapse‐free survival (p < 0.001) and a 52% relapse rate (p = 0.01) in 27 children undergoing marrow transplantation for leukemia at later stages. Seven out of 9 children with severe aplastic anemia are alive from 3 to 9 yr after transplantation. Successful marrow transplantations were performed in 3 children with Gaucher disease and a child with a T‐cell defect. An attempt to induce tolerance in a patient with Hurler's disease by infusion of mixed T cell‐depleted autologous and allogeneic marrow resulted in autologous recovery. Twenty children received marrow from HLA‐mismatched donors. One out of 2 mismatched recipients with Fanconi anemia is alive and well. Recipients of HLA‐mismatched marrow had an increased death rate by graft‐versus‐host disease (GVHD) (p < 0.01) and a decreased survival (p < 0.001) compared to recipients of HLA‐matched marrow. HLA‐mismatched patients treated with a combination of methotrexate and cyclosporin had a decreased incidence of grade II‐IV acute GVHD (0/7) compared with those treated with either methotrexate or cyclosporin (7/11, p = 0.01). Late side‐effects of total‐body‐irradiation included cataract, delayed growth and puberty, and thyroid gland deficiency.
Short‐ and long‐term graft survival with O antigen‐matched first cadaver renal transplants: A single institution study
Authors: Matas A. J. , Tellis V. A. , Quinn T. , Principe A. , Soberman R. , Mallis M. , Glicklich D. , Veith F.
Published: September 2024

The importance of HLA matching for cadaver kidney transplantation remains controversial. In some studies, matching has been reported to affect both short‐ and long‐term graft survival. We studied the short‐ (cyclosporine and prednisone immunosuppression) and long‐ (azathioprine and prednisone immunosuppression)‐term patient and graft survival for recipients of O antigen‐matched transplants and compared them with survival in those matched for ≥ 1 antigen. All patients were transplanted at the same institution and the HLA typing was done by a single laboratory. For first cadaver kidney recipients (n = 384) there were no significant differences in either short‐ or long‐term patient or graft survival between 0 antigen‐matched and ≥ 1 antigen‐matched recipients. In fact, 1‐year graft survival for the 0 antigen‐matched, cyclosporine‐immunosuppressed recipient was 87%. Our results compare favorably with all reported data on patient and graft survival where matching is used for kidney allocation. We believe that matching should not be given increased importance in kidney distribution.
Renal graft survival in the sensitized patient: Living‐related and cadaveric
Authors: Pyle Jo L. , Hsia Shyuan , Radwin Howard M. , Holzmann Judith , Banowsky Lynn H.
Published: September 2024

Recipients of 271 cadaveric donor (CAD) and 158 living‐related donor (LRD) first‐graft renal transplants from 1977 to 1988 were analyzed independently for graft survival up to 3 years post‐transplant. Prior to transplantation, the presence of panel‐reactive antibodies (PRA) in patients' sera was monitored monthly in order to assess their immunological status. Patients were divided into three groups for analysis: low (0‐10%). moderate (11‐40%) and high (41‐100%) panel reactivity in both historical and current sera. LRD graft survival was not significantly affected by immunological sensitization status either in the past or at the time of transplantation. CAD graft survival, relative to PRA levels only, was significantly reduced among the group with high current PRA levels but not among the group with high historical PRA levels. The effects of different immunosuppressive therapies, Prednisone/Cyclosporin A (P/CsA) versus Imuran/Prednisone (I/P), were also analyzed. It was confirmed that the LRD group demonstrated no significant difference in graft survival relative to PRA levels nor to mode of therapy. Those patients receiving cadaveric grafts with P/CsA therapy again demonstrated significant association (p = 0.015) of reduced graft survival with high current PRA levels, while those with I/P therapy had significantly reduced (p = 0.013) graft survival with high historical PRA levels.
Quality of life in end‐stage renal disease: Influence of renal transplantation
Authors: Christensen Alan J. , Holman John M. , Turner Charlas W. , Slaughter James R.
Published: September 2024

A sample (n = 73) of end‐stage renal disease (ESRD) patients were evaluated on objective (physical) and subjective (psychological) quality of life indices. A comparative assessment was made between three treatment groups: (1) patients with a functioning renal transplant; (2) failed (returned to hemodialysis) transplant patients; (3) untransplanted, in‐center hemodialysis patients. Results for physical well‐being indicated that patients maintaining a functioning graft; reported less restriction in mobility, exhibited less functional impairment, and had a higher rate of vocational rehabilitation than patients in the other two groups. No significant group differences were found on indices of ambulation or body care and movement. In terms of psychological well‐being, successfully transplanted patients reported less anxiety and a higher level of subjective well‐being than the two groups of patients receiving hemodialysis. Similarly, patients with a functioning graft had the lowest depression scores. However, the group of patients experiencing a failed transplant exhibited a significantly greater degree of depression than the untransplanted hemodialysis patients. Clinical implications of the results are discussed, and recommendations are made for future quality of life research in the ESRD population.
MLC in renal pre‐transplantation – An evaluation
Authors: Gordon Cathi , Banowsky Lynn , Hsia Shyuan
Published: September 2024

A total of 49 patients with end‐stage renal disease and their family members were serologically phenotyped; genotypes were assigned when possible. Two‐way mixed lymphocyte cultures were performed on donor‐recipient pairs from 1985 to 1987. One‐year graft survival was analyzed comparing the three haplotype groups. There was no significant difference in graft survival between haplotype groups. Therefore, because of better DR serology and improved immunosuppressive regimens that have increased graft survival, we suggest that the MLC test is not necessary for living‐related renal pre‐transplant evaluation.
Lack of effect of DR matching on five‐year renal allograft and patient survival with cyclosporine
Authors: Hickey David P. , Lutins Jay A. , Lopatin William B.
Published: September 2024

Between August 1, 1981 and September 30, 1983, 283 consecutive renal allograft transplantations were performed at the University of Pittsburgh. Fifty‐three were retransplants. No formal attempt was made to purposely match for HLA‐A, ‐B, or ‐DR. There was no transfusions policy during this period. All patients received cyclosporine and low‐dose prednisone as immunosuppression therapy. DR typing was available on both donor and recipient in 225 cases, and was incomplete in 58. The 5‐year patient survival was 91% for the 0 DR mismatched patients (n = 22), 88% for the 1 DR (n = 84), 88% for the 2 DR (n = 119), and 88% for the patients with incomplete data (n = 58). These differences were not statistically significant. There was no statistically significant difference between these groups for 5‐yr actual allograft survival, the survival being 64%, 55%, 55%, and 59% for 0 DR, I DR, and 2 DR mismatches and incomplete data group respectively. We conclude that, in patients treated with cyclosporine, HLA‐DR matching does not have an effect on intermediate patient or graft survival.
Renal dysfunction following orthotopic liver transplantation
Authors: Poplawski Steven C. , Gonwa Thomas A. , Goldstein Roberts , Husberg Bo S. , Klintmalm Goran
Published: September 2024

One‐hundred‐fifteen patients with no preexisting renal disease underwent orthotopic liver transplantation between December 1984 and February 1988. Immunosuppression was based on cyclosporine and steroids with azathioprine added after treatment for rejection. One‐ and 2‐year patient survival was 88 and 82%, respectively. Glomerular filtration rate averaged 98.4±5.1 cc/min preoperatively and dropped to 54.8±4.2 cc/min 1 month postoperatively. Renal function was stable at 1 and 2 yr postoperatively. A drop in average whole blood cyclosporine levels resulted in better preservation of renal function with no increase in rejection rate or decrease in patient survival. An investigation of factors responsible for the decrease in renal function found no difference in cyclosporine levels, nephrotoxic drugs or events in patients with large or small drops in glomerular filtration rate post‐op. Patients who developed early renal dysfunction (serum creatinine > 2 mg/dl in the first 3 weeks posttransplant) had a significantly lower GFR 1 month and 1 yr post‐op compared with those who did not. There is a predictable decrease in renal function post‐liver transplant and the level of renal function post‐operatively can be predicted by the level of renal function preoperatively. The renal dysfunction appears to be stable at 1 and 2 yr postoperatively.
Treatment of transplant renal artery stenosis: Experience and reassessment of therapeutic options
Authors: Miller Alexander R. , Marsh Christopher L. , Stanson Anthony W. , Torres Vicente E. , Sterioff Sylvester
Published: September 2024

Management of transplant renal artery stenosis has been a controversial issue. The authors have reviewed their experience with 31 such cases which represent 3.1% of a transplant population of 1015 patients. Evidence of chronic allograft rejection was noted in 14 of these patients. Ten patients were treated medically. The remaining patients were managed by either percutaneous transluminal angioplasty (8 cases) or surgery (13 cases). Three patients initially treated by percutaneous transluminal angioplasty later underwent surgical repair. Operative intervention resulted in a significant decrease in mean arterial pressure and the greatest degree of therapeutic success (defined as normal blood pressure without use of antihypertensive agents). In contrast to other reports, use of percutaneous transluminal angioplasty was not successful in a majority of patients. This divergence may reflect differences in criteria for success which, we believe, should be defined more rigorously. Our data indicate that decisions regarding definitive management strategies should be based on the specific characteristics of the lesion with identification of stenoses that may be amenable to surgical rather than angioplastic treatment.
The effect of cyclosporine on prognostic factors in cadaveric renal retransplantation
Authors: Hickey D. P. , Lopatin W. B. , Vivas C. , Shapiro R. , Starzl T. E. , Hakala T. R.
Published: September 2024

Between January 1, 1984 and October 16, 1987, 175 (21.4%) retransplants were performed at the University of Pittsburgh. Ninety seven of these were second transplants who received both kidneys at our center with cyclosporine (CyA) immunosuppression. The mean age was 35.6 years, 36 (37%) were older than 40, 14 (14.4%) were diabetics, 46 (49%) had a peak panel reactive antibody level (PRA) greater than 50% and 14 (14.4%) had a current PRA greater than 50% at the time of transplantation. The 1‐yr patient and allograft survival were 98% and 70% respectively. Neither duration of primary graft function, PRA level, HLA‐DR matching, repetition of HLA‐DR mismatched antigens, or age greater than 40 yr had a significant impact on 1‐yr graft survival. This study suggests that the use of cyclosporine in both transplants diminished the effect of these factors which were strong prognostic indicators of second graft outcome in the prc‐cyclosporine era.
Colonic perforation following cardiac transplantation
Authors: Watson Christopher J. E. , Hutter Jonathan A. , McGoldrick Joseph , Wallwork John , English Terence A. H. , Greatorex Robert , Collier St. John
Published: September 2024

We report four cases of colonic perforation occurring during the first 2 weeks after cardiac transplantation. The treatment of abdominal complications following open heart surgery is discussed with special reference to the immunosuppressed patient following heart transplantation. Close cooperation between the transplant surgeon, general surgeon and anesthetist is essential for the successful management of these life‐threatening complications.
Monocyte function after bone marrow transplantation: Role of Ia+ monocytes in graft‐versus‐host disease
Authors: Bezwoda W. R. , Dansy R.
Published: September 2024

Monocyte function following bone marrow allotransplantation was investigated by studying the Ia reactivity of monocyte populations from the peripheral blood of transplant recipients during early hematologic reconstitution and by studying the ability of chimeric monocytes to stimulate donor lymphoid populations. Significant monocyte‐induced stimulation of lymphocyte proliferation was seen particularly among those who developed clinical evidence of acute graft‐versus‐host disease. Chimeric monocytes stimulated both CD4+ T lymphocytes as well as B cells. These findings suggest an immune regulatory role for monocytes in the immune status after marrow transplantation.
Assessment of retransplantation in the first 60 cases of a liver transplantation program
Authors: Mora N. P. , Turrión V. S. , Herrera J. , Pereira F. , Vázquez J. , de Vicente E. , Ardaiz J.
Published: September 2024

Owing to the non‐existence of artificial hepatic assistance, retransplantation is the only alternative available to patients who have undergone liver transplantation (LT) when irreversible graft failure occurs. Our initial experience with 60 LTs has resulted in a global survival of 71% among those retransplanted. The causes of graft failure and the progress of retransplanted individuals are discussed.
Symptomatic cytomegalovirus infection after bone marrow transplantation
Authors: Paulin T. , Ringdén O. , Ljungman P. , Nilsson B.
Published: September 2024

The actuarial incidence of cytomegalovirus (CMV) infections was 66% among 180 consecutive patients who underwent allogeneic bone marrow transplantation (BMT). Sixty‐three patients had symptomatic CMV infection, of whom 21 had interstitial pneumonitis. In bivariate analysis symptomatic CMV infection was associated with low marrow cell dose, positive recipient serology and high recipient and donor age. In Cox multivariate analysis, low marrow cell dose (p = 0.02) and positive recipient serology (p = 0.002) were significantly associated with symptomatic CMV infection. High marrow cell dose was of no importance in seronegative patients, but was associated with a low incidence of symptomatic CMV infection in seropositive patients (p = 0.05). This association was especially pronounced in patients with acute myelogeneous leukemia (AML), whereas no such trend was found in patients with acute lymphocytic leukemia (ALL) and chronic myelogeneous leukemia (CML) when analyzed as separate groups. Patients with ALL had significantly less symptomatic CMV infections than patients with CML (p = 0.01) and AML (p = 0.03). Cox multivariate analysis showed a correlation between CMV pneumonitis and grade II‐IV acute graft‐versus‐host disease (p = 0.03).
Effect of the initial cooling solution on 24‐hour liver preservation with UW solution
Authors: Sundberg Ralf , Ar'RaJab Aamer , Ahrén Bo , Bengmark Stig
Published: September 2024

It is a common practice in multiple organ procurement to use a solution with a simple composition for the initial washout. This is then followed by a second flush on the backtable with another solution, the preservation medium. Though the effects of the preservation medium have been studied in detail, the effects of the first solution are less well‐established. We therefore investigated the effects of different first‐flush solutions on rabbit livers subsequently preserved in UW solution for 24 hours. The first‐flush was performed in situ through the portal vein with 75 ml of either chilled UW solution (Group 1, n = 6), Perfadex (Group 2, n = 5), Eurocollins (Group 3, n = 6), or Ringer's lactate (Group 4, n = 6). A second flush was then performed on the backtable with the same volume of UW solution. After 24 h cold storage, reperfusion was performed in vitro using an isolated perfusion circuit (IPL). The rcpcrfusion medium consisted of an oxygenated Krebs‐Henseleit bicarbonate solution with additives including 3.5% Dextran 60 for oncotic support. There was weight loss in all groups during preservation. This was most prominent in group 1, where the weight decreased by 14.4 ± 3.0% (Mean ± S.D.). The corresponding figures in groups 2–4 were 10.3 ± 3.3, 9.1 ± 2.8, and 6.6 ± 1.9%, respectively. Livers first flushed with UW solution (group 1), produced significantly more bile during IPL reperfusion (16.4 ± 1.0 ml/2h/100g) than livers in the other groups (8.7 ± 1.4, 8.5 ± 2.1, 9.6 ± 0.7, respectively, p<0.05). The amount of ASAT released into the perfusate, measured after perfusion for 60 and 120 minutes showed no difference between the groups. Based on the results of bile production, it is concluded that the best preservation quality is obtained when the liver is washed out in situ with UW solution. Furthermore, the lower organ weights after preservation of livers first flushed with UW solution suggest that hypothermia‐induced cell swelling during the first flush is prevented by UW solution but not by the other solutions tested. Consequently, initial hypothermia‐induced cell swelling caused by the other solutions may prevent the effective distribution of UW solution during the second backtable flush and, hence, may reduce the effectiveness of this preservation fluid.
Value of Hannover's classification of acute cardiac allograft rejection
Authors: Lozano M. D. , Pardo‐Mindán F. J. , Herreros J.
Published: September 2024

We have studied 353 heart allograft biopsies from 29 patients, applying a slightly modified Hannover's classification of acute rejection (AR). Each biopsy was studied by 2 pathologists without knowledge of clinical data. Identical morphological diagnoses by both pathologists was reached in 328 biopsies (92.91%). Disagreement was highest in biopsies with resolving AR. Subsequent biopsy, after diagnosis of AR, showed improvement in 64.07% of the patients, similar lesions in 17.96% and deterioration in 17.96%. Of 29 transplanted patients, 24 are alive after an average follow‐up of 18 months. We conclude that classification of AR in biopsies of heart allografts in four degrees in easily applicable and reproducible and permits an adequate management of heart transplant patients.
Subcutaneous mycobacteriosis in renal transplant patients
Authors: Harris Gary J. , Bowers Victor D. , Corry Robert J.
Published: September 2024

Nontuberculous mycobacterial infections are caused by opportunistic organisms that primarily affect immunocompromised individuals. While these infections usually produce systemic manifestations, subcutaneous and/or cutaneous mycobacteriosis, either in association with disseminated disease or as an isolated finding, does occur and may be the only manifestation of the disease in the transplant population. The presence of a new subcutaneous mass on a patient receiving immunosuppression should be evaluated by biopsy for histologic examination (to rule out malignancy) and culture and sensitivity. Once the diagnosis of mycobacterial disease is made, and disseminated disease ruled out, initial treatment by reduction of immunosuppressant dosages should be instituted with close observation. Development of disseminated disease and/or allograft failure should be treated by the reduction of immunosuppressants as well as with antimicrobial agents to which the organism is susceptible. This report describes two renal allograft recipients who presented with biopsy‐proven, isolated, nontubcrculous, subcutaneous mycobacteriosis while receiving conventional azathioprine and prednisone therapy. The literature concerning subcutaneous and cutaneous mycobacteriosis in renal allograft recipients is reviewed.
Vascular complications in adult liver transplant patients. Value of post‐operative doppler ultrasound screening and the surgical management of hepatic arterial thrombosis
Authors: Sayage L. H. , Husberg B. S. , Klintmalm G. B. , Goldstein R. M. , Gonwa T. A.
Published: September 2024

This retrospective study of 155 orthotopic liver transplanted patients (Dec 1984‐May 1988) reveals an incidence of 5.8% of early hepatic artery thrombosis (1–13 days), 1.3% of late hepatic artery thrombosis (5 months‐3 years), and 1.9% of late hepatic artery stenosis. Different underlying causes were found in the early and late complication groups. The sensitivity of early postoperative doppler ultrasound employed for screening of vascular complications was 100%, and its positive predictive value was 75%. Immediate thrombectomy and reconstruction of the arterial anastomosis was found to yield satisfactory long‐term results as compared to retransplantation as a traditional management choice.
Effects of initial cyclosporine dose and timing on long‐term creatinine levels in cadaver renal transplantation
Authors: Canafax Daniel M. , Min David I. , Matas Arthur J. , Amend William J. C. , Ptachcinski Richard J. , Hakala Thomas R. , Grevel Joachim , Houghton Denise , Kahan Barry D. , Simmons Richard L. , Najarian John S. , Cipolle Robert J.
Published: September 2024

We undertook this study to determine the current immunosuppressive drug dosing trends and the resulting creatinine levels in a group of successful cadaver renal allograft recipients. We evaluated 320 patients, 80 from each of four centers, who were transplanted from 1985 through 1988. We found that initial cyclosporine doses differed between the four centers (17.5, 14, 12, and 8 mg/kg/day), but after the 1st year posttransplant, average cyclosporine doses were almost identical (6.0, 5.5, 5.2, and 5.5 mg/kg/d). Initial prednisone doses varied between 2 and 0.5 mg/kg/d, but after the 1st yr posttransplant the average doses were essentially identical. Two centers used azathioprine and antilymphoblast globulin and delayed the administration of cyclosporine by approximately 5 d. The average creatinine levels at 1 yr were 2.1, 1.9, 1.8 and 1.6 mg/dl and were highest at the two centers that gave large initial cyclosporine doses and began cyclosporine on the day of transplantation. Unexpectedly, the creatinine levels remained higher at these centers even though the cyclosporine doses were reduced. In conclusion, it appears that either the initial high cyclosporine doses and cyclosporine administration in the 1st week posttransplant caused elevated creatinine levels, or the added immunosuppression with azathioprine and antilymphoblast globulin produced greater antirejection efficacy and thus lower creatinine levels.
Cadaver renal transplantation in children: Results with long‐term cyclosporine immunosuppresion
Authors: Ettenger Robert B. , Rosenthal J. Thomas , Marik Jennifer , Nelson Pauline , Malekzadeh Mohammed , Grimm Paul C. , Kamil Elaine S. , Salusky Isidro B. , Fine Richard N.
Published: September 2024

The records of 74 children who received cadaver renal transplants and cyclosporine (CsA) immunosuppression from August 1984 to August 1989 were reviewed and data analyzed on: 1) prednisone dosage; 2) CsA dosage; 3) 12‐hour serum trough CsA levels; 4) serum creatinine levels; 5) total serum cholesterol levels; 6) linear growth: 7) weight gain. The 74 patients were grouped according to age: Group 1: 0‐12 years old (N = 30); Group 2: 13‐15 yr old (N = 20); Group 3: 16 yr old and above (N = 24). For comparison, similar data were evaluated in 15 children on azathioprine and prednisone who maintained cadaver graft function for at least 3 yr. The use of CsA was associated with significantly improved graft survival in recipients of both first and retransplants; results were best in patients receiving CsA in the context of sequential therapy, with primary transplant recipients having actuarial graft survivals of 94 ± 3% and 91 ± 4% at 1 and 2 yr, respectively, and recipients of retransplants having 1 and 2 yr actuarial graft survivals of 82 ± 8% and 70 ± 10%. In each of the 3 groups of CsA recipients, there was a slow rise in serum creatinine levels over the 2 yr post‐transplant of 0.4–0.6 mg/dl, but this trend was not significant; a similar trend was seen in the comparison patients receiving azathioprine and prednisone. At 3 and 6 months post‐transplant, the CsA dosages used in Group 1 patients were significantly higher than those in Group 2 or 3, but by 2 yr there was no difference between groups. Trough serum CsA levels declined in a stepwise fashion over time, with significant late deviations, because of late rejection in the older age groups. In the 1st post‐transplant yr, prednisone dosages in the CsA‐treated patients under the age of 12 were significantly lower than in similarly aged patients receiving only azathioprine as maintenance immunosuppression. For each age range, the mean serum cholesterol values were generally at or greater than the 90th percentile values for a normal pediatric population. Sixty percent of Group 1 patients followed for at least 1 yr showed some improvement in their standard deviation scores (SDS) for height; moreover, growth in children less than 12 yr of age on CsA was dramatically better than that observed in recipients of similar age on azathioprine, as assessed by changes at 1 and 2 yr in their height SDS. SDS for weight improved uniformly in all age groups. Although the outlook for pediatric cadaver renal allograft recipients is generally bright, truly optimal rehabilitation will be achieved only when the problems of progressive renal dysfunction, hypercholesterolemia, suboptimal growth and weight gain out of proportion to height gain are successfully addressed.
Cyclosporine in multi‐drug therapy in living‐related kidney transplantation
Authors: Monaco Anthony P. , Sahyoun Anthony I. , Madras Peter N. , Shaffer David , Etienne Thomas , Simpson Mary Ann , Williams Mark , Kaldany Antoine , D'Elia John
Published: September 2024

This report describes our experience with 146 living‐related kidney transplantations performed at our institution between January 1981 and December 1989. The results obtained in patients immunosuppressed with triple therapy consisting of azathioprine, prednisone, and cyclosporine are compared with those of patients treated with azathioprine and prednisone only. The effects of renal disease etiology (diabetic versus non‐diabetic) and HLA match on patient and graft survival are also evaluated. The addition of cyclosporine to azathioprine and prednisone had no significant effect on patient survival in any group. However, cyclosporine‐treated recipients showed increased graft survival in the overall (88% vs 73% at 5 years), diabetic (87% vs 75% at 5 yr) and non‐diabetic (93% vs 72% at 5 yr) groups when compared to similar groups treated with azathioprine and prednisone only. Recipients of HLA‐identical transplants achieved excellent results with double therapy (85% 5‐yr graft survival); addition of cyclosporine improved graft survival (93% at 5 yr), but this was not statistically significant. Similar findings were observed when the subgroups of diabetic and non‐diabetic HLA‐identical recipients were studied. In contrast, 5‐yr graft survival in HLA non‐identical recipients was significantly improved in those patients who received cyclosporine (85%) when compared to those who received only azathioprine and prednisone (64%). Improved graft survival was also observed when diabetic and non‐diabetic recipients of HLA‐mismatched grafts were studied separately. Immunosuppressive requirements, renal function and serum lipids of patients on double and triple therapy were compared. No differences in the amounts of prednisone and/or azathioprine required were noted in any group. Diabetics on cyclosporine were found to require higher daily cyclosporine doses, but nevertheless showed lower blood cyclosporine levels than non‐diabetics. Creatinine levels at 4 yr were slightly lower in cyclosporine‐treated patients (1.4 vs 1.8) as were serum lipids in both diabetic (cholesterol = 204 vs 274; triglycerides = 155 vs 229) and non‐diabetic (cholesterol = 219 vs 290; triglycerides = 202 vs 284) patients. In conclusion, we believe these results show that cyclosporine controls chronic rejection better than azathioprine and prednisone alone, does not produce significant chronic nephrotoxicity at 4 or 5 yr post‐transplant, and significantly improves graft survival in HLA‐mismatched living related transplantation.
Low‐dose ciclosporin mizoribine and prednisolone in renal transplantation: A new triple‐drug therapy
Authors: Kokado Yukito , Ishibashi Michio , Jiang Hongsi , Takahara Shiro , Sonoda Takao
Published: September 2024

To ensure a beneficial synergistic effect on the acceptance of human transplants and to avoid the nephrotoxicity of CsA, a new triple‐drug therapy using low‐dose ciclosporin (CsA), mizoribine (Mzr) and prednisolone (Pred), has been developed. The results obtained from this new procedure were compared to those of other procedures. Forty‐two living‐related recipients and 12 cadaveric recipients, who received transplants between 1 July, 1987 and 30 June, 1989, were given the new triple‐drug therapy with CsA, Mzr and Pred (group 3). The other patients (73 living‐related and 29 cadaveric) were given a triple (CsA + Aza + Pred, group 2) or double therapy (CsA + Pred, group 1). The 1‐yr actuarial patient survival was 98.6% in group 1, 96.7% in group 2, 100% in group 3, respectively. There were no significant differences. The graft survival rate at 1 yr in group 3 was 91.6%; this was higher compared with 88.9% in group 1 and 90.0% in group 2 (Fig. 1). Among the patients with a functioning graft at 12 months, the mean serum creatinine level was 1.82 $pM 0.13 mg/dl in group 1, 1.85 $pM 0.12 mg/dl in group 2 and 1.53 $pM 0.09 mg/dl in group 3. In group 3, the mean creatinine level was lower than in the other groups. This differences was statistically significant (Fig. 2). There was no differences in the incidence of rejection episodes during the initial 3 months among the three groups (Table 2). However, 24 patients in group 3 had at least one episode of acute rejection, and 19 patients (46.3%) required ALG and/or OKT3 for treatment of steroid‐resistant rejection. Although CsA had to be discontinued or decreased in 12 patients of group 1 and a switch to a new triple‐drug therapy by stopping Aza and starting Mzr was required in 8 patients in group 2 because of complications, only 1 patient in group 3 had to abandon Mzr and increase the dose of CsA because of ileal perforation. This study shows that the new triple‐drug therapy produces greater graft survival without severe complications. The serum creatinine was lower with the new regimen than with other regimens. However, immunosuppression was less powerful. We obtained a beneficial synergistic effect with the new triple‐drug therapy in almost one‐half of the patients in group 3. The new regimen may be considered one of the most beneficial CsA treatment programs.
Fulminant necrotizing pancreatitis after cardiac transplantation
Authors: Sauter Edward R. , Van Meter Clifford H. , Hussey John L. , Hayes Daniel H.
Published: September 2024

General surgical complications after cardiac transplant surgery occur in up to 28% of cases. Acute pancreatitis has been reported as the most common general surgical complication. Postoperative necrotizing pancreatitis carries an 85% mortality rate (18 collected series). We discuss the etiology, preoperative screening and management of this disease in a patient who developed pancreatitis after cardiac transplantation. Several etiologic factors have been proposed to explain pancreatitis: low perfusion, splanchnic vasoconstriction secondary to vasopressors, mesenteric ischemia due to atherosclerosis, medications, and infections. Our patient had a long bypass time (over 100 minutes), hypotension below 40 mmHg requiring two doses of an alpha agonist, central line sepsis, and peritonitis. His known atherosclerotic cardiac disease placed him at high risk for peripheral vascular disease including mesenteric vessel narrowing and resulting ischemia. A survey of the literature indicates that the few survivors of this disease underwent laparotomy with aggressive mobilization, debridement, and drainage of the necrotic pancreas. Nonoperative management uniformly led to death. Our patient required subsequent operations to further debride necrotic tissue. Potential cardiac allograft recipients should be screened for abdominal problems with adequate histories and directed work‐ups. Surgical therapy before transplantation must weigh the patient's cardiac risk for surgery, the severity of the gastrointestinal symptoms, and the possible consequences after transplantation. For patients with necrotizing pancreatitis to survive requires aggressive debridement of devitalized tissue and drainage of the products of pancreatitis.