bluuebunny/crossref_metadata_2025 huggingface dataset:
Quadruple immunosuppression in 305 consecutive cadaver renal allografts
Authors: Deierhoi Mark H. , Sollinger Hans W. , Kalayogtu Munci , Belzer Folkert O.
Published: September 2024

Three hundred five consecutive patients receiving cadaver renal allografts using quadruple immunosuppressive therapy are reported. Quadruple immunosuppression consisted of prednisone, imuran, antilymphocyte globulin, and cyclosporine. Prednisone, azathioprine, and antilymphocyte globulin were administered immediately postoperatively, and cyclosporine was started when the serum creatinine had fallen to 3.0 mg/dl. Maintenance immunosuppression consisted of imuran, cyclosporine, and low‐dose prednisone. Graft survival in the primary transplant group was 87% at 1 yr and 85% at 2 yr. Graft survival in the retransplant group was 58% at 1 and 2 yr. Only 5 patient deaths were due to infectious complications, indicating that quadruple immunosuppression does not increase the risk for life‐threatening sepsis. We conclude that quadruple immunosuppressive therapy is effective in patients receiving primary cadaver allografts.
Delayed function of cadaver kidney transplants: Influence of cyclosporine on ultimate function
Authors: Ito Toshinori , Iwaki Yuichi , Terasaki Paul I.
Published: September 2024

Because nephrotoxicity is of major concern in cyclosporine therapy, we analyzed the effect of cyclosporine immunosuppression on the long‐term function of grafts which functioned poorly in the immediate post‐transplant period. Cyclosporine had no statistically significant effect on the incidence of grafts showing delayed function, with recovery by 1 month, or on permanent non‐function. Cyclosporine significantly diminished the incidence of permanent graft failure overall. Interestingly, cyclosporine had a greater beneficial effect on kidneys with delayed function (21% improved function for first grafts. 12% for regrafts) than those with immediate function (11% for first grafts, 2.8% for regrafts). The only subgroup which seemed to suffer from cyclosporine treatment were those grafts showing delayed function after machine preservation. Such grafts had an inferior graft survival rate as compared to cold‐storage grafts. This may be because cyclosporine acts synergistically on the initially damaged grafts preserved by machine. Machine pcrservation, however, did not increase the failure rate in CsA‐trcated patients with immediate function. Interpretation of the results must take into account that in such a study of 8000 cadaver transplants various adjustment in immunosuppressive dosage and timing may have taken place at the transplant centers themselves to compensate for perceived problems in clinical management.
Cholestasis after azathioprine administration in renal transplant recipients: Report of 7 cases
Authors: Loiseau Didier , Degos Françoise , Degott Claude , Carnot Françoise , Kreis Henri
Published: September 2024

Azathioprine, an immunosuppressive drug daily administered in renal transplant recipients was previously suspected of hepatotoxicity. We report the observations of 7 patients, treated by AZ and low doses of steroïds during 33 to 88 months who developed severe intrahepatic cholestasis: bilirubin from 156 to 597 micromoles/liter, alkaline phosphatases N × 2 to 7, ALAT N × 2 to 11. Histological liver biopsy study disclosed in all cases a centrilobular cholestasis (with bile accumulation in the centrilobular areas) associated to fatty liver (5/7) and sinusoïdal dilation (3/7). AZ therapy was interrupted 1 to 4 months after the onset of jaundice and clinical and laboratory manifestations disappeared within 1 month in the 7 patients; histological improvement was observed in 3 patients. Increased serum creatinine due to AZ withdrawal led to reintroduction of the drug in 3 patients. Clinical, laboratory and histological disorders similar to those observed during the initial episodes were observed for all patients within 1 month. The above observations and a review of the literature strongly argue for an hepatotoxic role of AZ. The mechanism of hepatotoxicity remains unclear since no clinical or biological sign of an immunologic process was observed. However the fact that steroïds were always administered together with AZ might alter immunologic manifestations. The long interval between the beginning of treatment with the drug and the onset of jaundice is an argument for a dose‐related impairment. Furthermore, patients developing hepatotoxicity might metabolize AZ at an unusually rapid rate, leading to a high concentration of toxic derivatives.
Modification in orthotopic heart transplantation: Surgical technique
Authors: Cabrol C. , Gandjbakhch I. , Pavie A. , Bors V. , Dalous P. , Baud F.
Published: September 2024

From April 1968, the date of our first human heart transplantation in Europe, to September 1986 we performed 265 heart transplantations. In order to reduce the longer ischemic time due to usual distant procurement in the last 170 patients we modified our previous technique inspired by the pioneers of the method, R. R. Lower and N. E. Shumway. The main modification consisted in doing the aortic anastomosis immediatly after the left atrial suture and to umclamp the aorta in order to permit an early reperfusion of the donor heart.
Cyclosporins monitoring by RIA and HPLC in liver transplantation: clinical correlation
Authors: Wallemacq Pierre E. , Lesne Michel , Otte Jean‐Bernard
Published: September 2024

Cyclosporine concentrations monitoring in hepatic transplantation is particularly difficult because the amount of cyclosporine metabolites increases during periods of impaired liver function. We have determined serum cyclosporine trough levels simultaneously and daily by radioimmunoassay (RIA) and liquid chromatography (HPLC) in 12 pediatric patients following liver transplantation. We have correlated the ratio of HPLC measurements of cyclosporine to RIA measurements (HPLC/RIA ratio) with the bilirubin levels during the 2 postoperative wk and the graft rejection periods. During periods of normal hepatic function we have observed HPLC/RIA ratio around 0.5. This ratio decreases significantly when serum bilirubin values exceed 50 mg/l. As long as the toxicity and the immunosuppressive activity of the cyclosporine metabolites are not better defined, cyclosporine monitoring should be performed by both RIA and HPLC methods during the 1st month posttransplantation.
Transmission of hepatitis B by renal transplantation despite active immunization with hepatitis B vaccine
Authors: Landreneau Michael D. , DeVault George A. , Rohr Michael S. , Kilpatrick J. Stephen , King John W. , Rhynes Vernon K. , Gonzalez Enrique , McDonald John C.
Published: September 2024

A chronic hemodialysis patient without clinical or serological evidence for previous hepatitis B virus (HBV) exposure was successfully vaccinated against HBV. After developing antibodies to HBV the patient received a renal allograft from her HLA haploidentical sister who was hepatitis B surface antigen‐positive (HBsAg +). Within the subsequent 3 months the allograft recipient developed hepatitis B antigenemia and associated liver disease. It is known that active immunization against HBV with development of anti‐HBV antibodies ordinarily confers protection against hepatitis B. This report establishes that such immunity is insufficient to protect against the innoculum of a positive HBV kidney.
Plasmapheresis and RATG‐induced serum sickness
Authors: Leunissen K. M. L. , Kootstra G. , Mooy J. M. V. , Loonen P. M. van den Berg‐van , van Hooff J. P.
Published: September 2024

Patients with serum sickness after rejection treatment with RATG were randomly allocated in 2 groups. Group I (n = 8) was treated with analgesics and group II (n = 7) with plasmapheresis. In group I, serum sickness lasted for ± 10–14 days. Only a slight beneficial effect of analgesics was observed. Six of 8 patients from group I developed decreased renal function, which gradually improved thereafter. The maximal rise in serum creatinin was 226.1 ± 115.6 μmol/1. After the plasmapheresis, an immediate relief of fever, arthralgias and arthritis occurred in group II. Two days after starting plasmapheresis, serum sickness had completely disappeared. During serum sickness, 5 of the 7 patients showed an increased serum creatinin (maximal increase: 137.4 ± 108 μmol/l). After plasmapheresis, serum creatinin decreased in 2–3 d to base values. There were no adverse effects of plasmapheresis. In conclusion, plasmapheresis is a safe and very effective treatment of RATG‐induced serum sickness.
Renal function and morphology in cyclosporin A‐treated liver transplant recipients
Authors: Keating John , Neuberger James , Clarke Martin , Barrett John , Dische Frederick , Calne Roy , Williams Roger
Published: September 2024

Twenty‐four patients who had undergone orthotopic liver grafting and had received cyclosporin (CSA) for period up to years were evaluated for evidence of nephrotoxicity using 99mTc‐DTPA scanning and, in some cases, renal biopsy. Abnormalities of the Tc‐DTPA renal scan were apparent in all but one and, when a renal scan score was used to assess the degree of functional renal impairment, a correlation with duration of CSA use was apparent over the first 2 years. Reduction in renal perfusion, as assessed by the perfusion index method, was in general found earlier, preceded a rise in serum creatinine and did not correlate with duration of CSA therapy. Serum creatinine, was elevated in 14 of the 24 patients at time of scanning and hypertension had developed in 8 (33%). Patients switched to CSA after an initial period of Prednisolone and Azathioprine tended to have better renal function overall including less reduction in blood flow. Renal histology in 6 patients showed features of glomerulosclerosis and arteriopathy, changes similar to those observed in ischaemia. Thus, the changes of CSA toxicity are compatible with the concept that the renal impairment is consequent upon the early reduction in renal blood flow which may be an important factor in the renal damage found.
Effect of perioperative recipient management on initial renal allograft function
Authors: Shackleton Christopher R. , Schechter Martin T. , Landsberg David N. , Scudamore Charles H.
Published: September 2024

To study the effect of perioperative management on initial renal allograft function, we identified 22 consecutive cadaver donor kidney pairs in which one kidney was transplanted at one local institution (group I) while the contralateral kidney was transplanted at a second local hospital (group II). Donor‐derived and harvest parameters were uniform for each pair. The two institutions employed similar immunosuppressive protocols, but markedly different perioperative recipient management protocols including: a) maximal volume repletion, perioperative hemodynamic monitoring, and a parameter‐determined volume replacement protocol in group I; b) donor organ chilling during revascularization in group I; c) different intraoperative diuretics; d) different volume replacement solutions; and e) different immediate postoperative nursing settings. Rewarm times were significantly longer for group I grafts than for their group II contralateral counterparts (51 ± 10 min versus 29 ± 8 min; p < 0.001). Despite this, group I grafts produced significantly larger initial 24‐hour urine volumes than group II (6.4 ± 4.2 l versus 3.7 ± 2.9 l; p = 0.02). Mean change in serum creatinine in the initial 24 h was also significantly greater in group I than group II (–6.0 ± 2.6 mg/dl versus –2.6 ± 3.1 mg/dl; p = 0.003). None of the 22 grafts in group I manifested poor initial function while 9 of their 22 (45%) counterparts in group II did (p = 0.001). A total of 5 group II recipients required dialysis during the first 5 post‐transplant days while no group I patient was dialysed during this period (p = 0.05). We conclude that, given uniform donor organs, perioperative recipient management protocols appear to significantly influence initial urine volume, rate of fall of serum creatinine, and the incidence of ischemic injury in cadaveric renal allografts. In addition, the potentially deleterious effects of rewarm times greater than 45 min may be surmountable, in many cases, by perioperative interventions such as those utilized in group I recipients in the present study.
Excess immunosuppression following renal transplantation – Predictive value of T‐cell subsets, platelets, and leukocyte counts
Authors: Lobo Peter I. , Spencer Clinton E. , Stewart John
Published: September 2024

Infectious complications after renal transplantation continue to be a problem despite normal levels of circulating leukocytes. It therefore became important to determine the value of monitoring for inverted T‐lymphocyte subset ratios, (i.e. ratios less than one) leukopenia and thrombocytopenia in predicting excess immunosuppression. Immunosuppression therapy consisted of azathioprine or cyclosporine and prednisone. Rejections were managed with increased steroids and occasionally with antithymocyte globulin. Serial evaluations of leukocytes, platelets and T‐lymphocyte subsets were performed in 62 recipients. Seventy to eighty percent of the 27 patients with infectious complications had thrombocytopenia and/or inverted T‐cell ratios for at least 1 wk prior to the infective complication. In contrast, only 15–20% of stable patients had these abnormalities. The simultaneous presence of thrombocytopenia and inverted T‐subset ratios was ominous, as 100% of such recipients developed serious infections. Conversely, platelet levels above 105/mm3 and T‐lymphocyte subset ratios of above one were highly specific in excluding the possibility of excess immunosuppression. Inverted T‐lymphocyte subset ratios complemented the predictive value of thrombocytopenia, as it was the sole indicator of excess immunosuppression in 8 of the 27 recipients with infections. There was a strong association between the development of thrombocytopenia and inverted T‐subset ratios and a preceding cytomegaloviral infection. Our data would indicate that simultaneous use of platelet quantitation and T‐lymphocyte subset ratios is useful in monitoring patients for excess immunosuppression post‐renal transplant.
Low morbidity and mortality from infection following cardiac transplantation using maintenance triple therapy and low‐dose corticosteroids for acute rejection
Authors: Hosenpud Jeffrey D. , Norman Douglas J. , Pantely George A. , Cobanoglu M. Adnan , Starr Albert
Published: September 2024

Infection is reported to be a leading cause of death early following cardiac transplantation. At the Oregon Health Sciences University, 42 patients have undergone 44 cardiac transplant operations from December 1985 through October 1987. Medications utilized for immunosuppression following cardiac transplantation included prednisone, cyclosporine, and azathioprine. Treatment of acute rejection utilized oral prednisone 5 mg/kg for 5 days tapered to maintenance over 3 d only within the 1st month following cardiac transplantation. Thereafter acute rejection was treated with prednisone 1.5 mg/kg for 3 d with a 3‐ or 7‐d taper depending on the histologic severity. Treatment of resistant rejection utilized OKT*3 or antithymocyte globulin. There has been 1 death from acute rejection. There have been 8 bacterial, 1 fungal, 12 viral and 2 parasitic infections in the patients to date. Only 12 patients have required hospitalization (3 during their initial transplant hospitalization) and there have been no deaths from infection. The low incidence and lack of mortality from infection is probably due to low doses of multiple immunosuppressive agents with minimally overlapping side effects (“triple therapy”), and the modest prednisone doses to treat acute rejection.
Uric acid calculus complicating renal transplantation
Authors: Dieckmann K.‐P. , Schwarz A. , Klän R. , Offermann G.
Published: September 2024

One case of urinary calculus causing anuria in a renal transplant recipient was observed among 630 renal transplantations (0.2%). The stone was composed exclusively of uric acid. Percutaneous nephrostomy reestablished urine excretion. Peroral alkalization therapy resulted in a reduction of stone size. The residual concrement was finally passed with the urine. No obvious lithogenic factor was found in this 21‐year‐old man. Hyperuricemia secondary to ciclosporine A administration is considered as a possible etiological mechanism.
A rapid quantitated viability test for transplant kidneys – Ready for human trial
Authors: Yin Larry , Terasaki Paul I.
Published: September 2024

A simple tetrazolium reduction test employing a small kidney biopsy is described by which ischemic damage produced by 10‐ to 30‐minute room temperature ischemia was readily detected. Four photometric measurements were taken 10 seconds apart and the linear reduction of the dye was plotted. The slope of the line produced after room temperature ischemia was significantly less than kidney biopsies taken in successive 10‐min intervals up to 1 hour (p < 0.001). The experiments were done in 5 mouse and 6 dog kidneys. Ischemia at 0, 10, 20, 30 and 37°C were also tested at 10, 20, 30, 60 min. Statistically significant differences were also noted at each of the temperature intervals. The tetrazolium test is therefore considered to be sensitive enough to measure damage to human kidneys which currently are transplanted with various cold and warm ischemia times.
Hepatic artery thrombosis after orthotopic liver transplantation: Clinical presentation and possible etiologic factors
Authors: Hesselink E. J. , van Schilfgaarde R. , Grond J. , Gouw A. S. H. , Klompmaker I. J. , Slooff M. J. H.
Published: September 2024

To determine the incidence, clinical presentation and possible etiology of hepatic artery thrombosis (HAT), 52 patients who underwent 60 orthotopic liver transplantations (8 re‐OLT's) were angiographically controlled. Angiography was done irrespective of the presence of clinical signs of HAT. For the repair of the arterial blood flow to the livergraft during OLT, two arterial anastomoses were necessary in 11 patients because of the complex anatomy. Immunosuppression consisted of prednisone and azathioprine in 46 OLT's while cyclosporine‐A was added in the last 14 OLT's. Rejection control was achieved by means of serial liver biopsies. HAT was present in 12 of the 60 OLT's. Six patients died, 3 were retransplanted while 3 are alive without re‐OLT despite HAT. HAT was associated with 3 clinical patterns: Early HAT, within 2 months post‐OLT, resulted in massive infarction and fulminant hepatic failure (3 patients). Late HAT caused relapsing septic episodes due to biliary tract obstruction and liver abscesses (6 patients). In the 3 patients who were not retransplanted, clinical symptoms were mild or even absent. As etiologic factor, only repeated rejection periods had a positive correlation with HAT (p < 0.05, χ2 test), while surgical technique and form of immunosuppression had no significant influence. We conclude that the clinical picture of HAT after OLT and its treatment are time‐dependent. Re‐OLT is the only chance for patients with early HAT; late HAT can even be without symptoms.
Relatively depressed serum β2 microglobulin levels in cyclosporine‐treated renal transplant patients with graft rejection
Authors: Kootte Antoinette M. M. , Henny Felix C. , Moolenaar Abraham J. , Dijkmans Ben A. C. , van Es Leendert A. , Paul Leendert C.
Published: September 2024

Serial serum β2 microglobulin (β2M) levels were measured in 50 renal transplant patients on different immunosuppressive regimens as well as in 5 patients with rheumatoid arthritis treated with cyclosporine‐A (CsA). Since the glomerular filtration rate determines the level of serum β2M, the measured level was compared to the expected level using the formula: Log, β2M (mg/l) = 3.834–5.96y + 2.94 y2–0.476 y3 + 0.0252 y4, where y represents Logc serum creatinine (mg/l). The median value of the observed/expected ratios per patient in groups of renal patients with or without rejection was used for data analysis; no differences were found for patients on azathioprine with or without rejection episodes and CsA‐treated patients without rejection episodes (range 0.52–3.94), including patients with CsA nephrotoxicity or CMV infections. In CsA‐treated patients who experienced acute rejection episodes the ratios were lower compared with all other groups (range 0.28–0.92) (p < 0.05). The fractional excretion (FE) of β2M in the CsA‐treated patients prior to or during periods of graft rejection (n = 5) was higher than in CsA‐treated patients without rejection episodes (n = 6) (6%–91% and 0.8%–12.6%, respectively). The relatively low serum β2M level in the CsA‐treated renal transplant patients with rejection episodes may reflect a tubular dysfunction induced by the combined effects of rejection and CsA resulting in an urinary β2M leak.
Successful management of fulminant cytomegalovirus‐induced acute lung injury following double‐lung transplantation
Authors: Fischel Richard J. , Freise Christopher E. , Bonser Robert S. , Hertz Marshall I. , Jamieson Stuart W. , Dunn David L.
Published: September 2024

Cytomegalovirus (CMV)‐induced acute lung injury following heart and lung transplantation carries a substantial mortality and morbidity. This report documents the successful management of a fulminant episode of cytomegalovirus infection occurring I month after double‐lung transplantation. Over a period of 36 hours the recipient progressed from a mild febrile illness without exertional dyspnea to a state requiring mechanical ventilation with 100% oxygen and almost complete opacification of lung fields on chest radiograph. Treatment with dihydroxypropoxy‐methylguanine (DHPG) resulted in rapid defervescence and recovery of gas exchange. Cytomegalovirus hyperimmune globulin was also used. After 5 days of treatment, clinical and radiological deterioration occurred that was consistent with an episode of rejection which was treated with bolus corticosteroids. Following this, the patient made a steady recovery and is well 3 months after the initial infection with near normal lung function studies and normal arterial blood gases. It is concluded that DHPG may be a life‐saving therapy in such cases. The relationship between CMV infection and rejection and further possible sequelae is discussed.
Transplantation with a past positive crossmatch and cyclosporine immunosuppression: A 5‐year experience
Authors: Matas Arthur J. , Tellis Vivian A. , Glicklich Daniel , Soberman Robert , Veith Frank J.
Published: September 2024

Transplantation of the highly sensitized patient continues to be a major problem. Since 1981, patients with a positive crossmatch using historical sera, but negative using current sera, have been accepted for transplantation. Initially, serum samples were required to be negative for 18 months preceding transplantation; this period has been reduced to 6 months. All patients received pretransplant transfusions; kidneys were transplanted to the ABO‐compatible recipient who was longest on the waiting list. Between January 1983 and January 1988, 230 adult recipients underwent cadaver transplantation and were immunosuppressed with prednisone and cyclosporine. Outcome was compared between those with (n = 64) and those without (n = 166) past positive crossmatches. There was no difference in HLA or DR matching. Patients with past positive crossmatches had significantly higher (p < .05) peak and current PRA. There was no difference in actuarial patient or graft survival for those with and without past positive crossmatches for both first transplants (past pos n = 47; all neg n = 149) and retransplants (past pos n = 17; all neg n = 17). Similarly, there was no difference in need for dialysis in the 1st week, graft loss in the 1st month, or mean current creatinine level. Interestingly, first transplant recipients without past positives had a higher incidence of rejection in the first 2 wk (p < .05). We conclude that renal transplantation with a past positive but current negative crossmatch is compatible with good patient and graft survival.
Near fatal cyclophosphamide pericarditis: Report of a survivor
Authors: Maloof John A. , Leon Carlos A. , Short H. David , Fehir Kim M. , Young James B.
Published: September 2024

Cyclophosphamide in addition to total body irradiation is commonly used as preconditioning chemotherapy in patients undergoing bone marrow transplantation, but it may have deleterious consequences including myocardial failure and cardiac tamponade. Prior reports suggest that cardiac tamponade is usually fatal, and occurs approximately 2 weeks after initiation of therapy. Pericardiocentesis has previously been reported not to be beneficial. We describe the first case of hemodynamically documented cardiac tamponade after cyclophosphamide therapy that responded favorably to pericardial drainage. One should not be unduly discouraged, therefore, if this complication is suspected. Aggressive diagnosis and treatment seems indicated.
Successful transplants across T warm‐positive crossmatches due to IgM antibodies
Authors: Iwaki Yuichi , Lau Marie , Terasaki Paul I.
Published: September 2024

Thirteen kidney transplants and 1 heart transplant were success fully performed across T warm‐positive crossmatches due to IgM antibodies. Such IgM antibodies were clearly distinguished from IgG antibodies by using dithiothreitol (DTT). Among 149 sensitized recipients, 39 (26%) appeared to have such DTT‐sensitive antibodies, that is, their PRA fell by more than 20% after the DTT treatment. DTT‐sensitive antibodies were found more in non‐transplanted patients, in less transfused recipients, in male patients, in aged patients, in SLE patients, and in patients awaiting organ transplantation for less than 1 year. These patients should be crossmatched using DTT‐treated sera and could be encouraged to undergo transplantation if crossmatch is negative after the treatment.
Transplantation of cadaver kidneys from pediatric donors
Authors: Brown M. W. , Akyol A. M. , Bradley J. A. , Briggs J. D. , Junor B. J. R. , Macpherson S. G.
Published: September 2024

Information from the UKTS database regarding the outcome of 492 kidney transplants from cadaver donors less than 10 years old was analyzed. When a subgroup of donors under 5 yr old was considered. significantly better 1‐yr graft survival was found in recipients under 10 yr than in adult recipients (86% v 59% p < 0.05). Graft survival in adult recipients was similar for all donor age groups greater than 12 months. When the details from our own center of 79 adult recipients of cadaver kidneys from donors under the age of 16 yr were analyzed and compared with a similar group of recipients of adult donor kidneys, no significant difference was found in 1‐yr graft survival between any of the donor age groups, although there was an increased incidence of technical complications in recipients of kidneys from the younger donor groups. Other than a reduced creatinine clearance at 1‐wk post‐transplant in the under‐5 donor group, creatinine clearance was similar for all groups. The findings reported in this study suggest that kidneys from young donors should be transplanted to recipients of similar age whenever possible, but if no suitable pediatric recipient is available, an adult recipient should not be excluded.
Heart‐lung transplantation in cystic fibrosis – Overview
Authors: Fiel Stanley , Baldwin John , Rosenstein Beryl J. , Beall Robert J.
Published: September 2024

Lung transplantation was first attempted in 1963. It was not until 1981 that the technique of heart‐lung transplantation became an accepted form of treatment for end stage cardiopulmonary disease. In 1983 the first patient with cystic fibrosis was transplanted. Since then 54 patients with cystic fibrosis have been transplanted with survival up to 3 years. The initial concern in transplanting patients with CF is infection and the multisystem nature of the disease. These patients can and are being transplanted – with results comparable to those in patients without cystic fibrosis.
Prophylactic use of rabbit ATG vs horse ALG in heart‐transplanted patients under Sandimmun (CyA) therapy: Clinical and immunological effects
Authors: Ippoliti Giovanbattista , Rovati Bianca , Graffigna Angelo , Minoli Lorenzo , Origlia Cecilia , Di Franco Lucia , Martinelli Luigi , Minzioni Gaetano , Intili Aldo , Ascari Edoardo , Viganó Mario
Published: September 2024

To identify whether prophylactic use of ATG is advantageous when compared with ALG in heart‐transplanted patients, a retrospective analysis of clinical and laboratory results was performed. Sixteen patients who received prophylactic rabbit ATG were compared with 36 receiving prophylactic horse ALG. Postoperative monitoring included endomyocardial biopsy, infection surveillance and peripheral lymphocyte identification with a panel of monoclonal antibodies. The ATG‐treated group, when compared with ALG‐treated, showed a marked suppression of peripheral lymphocyte count. Moreover, patients on ATG therapy, when compared with those receiving ALG, showed a statistical and prolonged (up to 30 days) decrease of CD2, CD3, CD4, CD8, CD20, CD25 and T‐5.9 (a CD4 subpopulation) positive cells. The incidence of rejection was lower in the first 3 months in ATG‐treated group and the overall incidence of infection was also significantly decreased. Thus, our results indicate that the use of prophylactic ATG is beneficial in heart‐transplanted patients since it may reduce rejection episodes without increasing the infection rate, despite the greater immunosuppression.
Sympathetic reflex algodystrophy following kidney transplantation
Authors: Morel D. , Potaux L. , Lafage M.‐H. , Seniuta P. , de Precigout V. , Merville P. , Dehais J. , Aparicio M.
Published: September 2024

Between January 1985 and December 1987, 5 out of 109 cadaver‐kidney transplant recipients developed an algodystrophy involving knees and ankles. Pain hindering movements occurred during the 3rd month following transplantation. Radiographic findings demonstrated epiphysical demineralization and bone‐scanning revealed increased uptake of a radioisotope in the affected joints. Calcium and parathormone levels were either normal or subnormal. Recovery was always achieved after calcitonin or griseofulvin therapy. Different factors possibly promote the occurrence of this pathology: preexistent renal osteodystrophy with secondary hyperparathyroïdism and pelvis surgery might have played underlying but not determinant roles with regard to the 500 patients who underwent kidney transplantation before January 1985 and who never experienced algodystrophy. The only difference between the two groups of patients was the introduction of cyclosporin‐A therapy after 1985. We suggest that this drug might contribute to the onset of algodystrophy by its vasoconstrictive action on the peripheral vessels, by its neurotoxicity and/or by an increased bone‐remodelling effect.
Individualization of high‐ and low‐risk HLA‐DR incompatibilities in renal transplantation
Authors: Vereerstraeten P. , Andrien M. , Dupont E. , Pauw L De , Kinnaert P. , Toussaint C.
Published: September 2024

Possible influences of donor (D)/recipient (R) HLA‐DR antigen disparities on graft survival were studied in 310 renal cadaver transplantations performed at one center from January 1980 to July 1988. For each DR1 to DR7 specificity, four combinations were considered according to the presence (pos) or the absence (neg) of the antigen in the D and in the R. Logistic regression analysis was used to study graft survival during two postoperative periods: A (month 1 to 3) and B (month 4 to 24). The following combinations exerted a beneficial effect on survival: DR5 and DR7 Dpos/Rneg for period A, DR4 Dpos/Rneg and DR5 Dneg/Rpos for period B. In contrast, the following combinations appeared detrimental: DRw6 and DR7 Dneg/Rpos for period A, DR1 and DR2 Dpos/Rneg, DR2 and DRw6 Dneg/Rpos for period B. Graft survival at 2 years was similar (83%) in HLA‐DR‐identical pairs and in recipients with beneficial and no detrimental HLA‐DR disparities, contrasting with poorer outcome in patients with either mixed beneficial and detrimental HLA‐DR disparities (67%) or detrimental (and no beneficial) HLA‐DR disparities (55%). The use of relevant D/R HLA‐DR disparities for predicting graft outcome could yield results similar to those currently reported with the best HLA‐DR‐matched pairs, thus providing an alternative for recipient selection in cadaver kidney transplantation.
Effect of change to cyclosporin on chronic renal allograft rejection
Authors: Rowe Peter A. , Foster Michael C. , Morgan Anthony G. , Burden Richard P.
Published: September 2024

Eleven patients with deteriorating renal allograft function and histological features of chronic rejection were converted from azathioprine to cyclosporin. The effect of the change was assessed by a microcomputer method which detected alterations in the slope of the plot of reciprocal creatinine concentration against time. In 9 patients there was a significant beneficial change in slope (p < 0.01) which occurred at a median of 27 (range 1 to 95) days after conversion and caused an increase in predicted graft survival ranging from 66 to 688 (median 341) d. The exact cause of the improvement in rate of loss of renal function attributable to cyclosporin is uncertain, but it is likely to be due to a combination of immunological and hemodynamic mechanisms. Conversion was not associated with any morbidity. Cyclosporin should be considered in place of azathioprine in patients who have deteriorating graft function due to chronic rejection.
Renal transplantation in pediatric patients with special reference to long‐term cyclosporin treatment in childhood
Authors: Offner Gisela , Pichlmayr Rudolf , Hoyer Peter Friedrich , Bunzendahl Hartwig , Ringe Burckardt , Wonigeit Kort , Brodehl Johannes
Published: September 2024

Organ grafting in children has to consider chances and degree of rehabilitation over decades. In order to evaluate whether these parameters were improved by the use of cyclosporin (CyA), we analyzed the follow‐ups of 74 children after kidney transplantation. They received 13 living related donor grafts (LD) and 61 cadaveric donor grafts (CD) and were treated with CyA and low‐dose prednisolone. The patient's survival after 1 and 5 years was 100% after LD grafting and 98% after CD grafting. The graft survival rate was also 100% for LD, and 88% after 1 yr and 71% after 5 yr for CD. The mean growth rate was 7 cm/yr in boys and 6 cm/yr in girls for the 1st yr after grafting, but declined to 3 cm/yr and 2.5 cm/yr, respectively, after 5 yr. The rate of hypertension increased during the first 5 yr from 63% to 83%. Graft function estimated as calculated creatinine clearance declined from 50 ml/min/1.73 m2 38 ml/min/1.73 m2. Thus, whilst patients' and graft survival as well as growth rate were improved significantly in CyA treatment, the continuous decrease of graft function over several years points to uncertainty as to the real long‐term outcome.
Neuropathy complicating renal transplantation
Authors: O'Flanagan S. J. , Hickey D. , Glacken P. , Byrne J. , Hanson S. , Murphy D.
Published: September 2024

A small number of neuropathies affecting branches of the lumbar plexus, occurring post‐renal transplant, have been reported. We reviewed a consecutive series of 454 renal transplants to determine the incidence, clinical significance and possible etiology. We found 42 cases (9.4%) of neuropathy affecting the lateral cutaneous nerve of thigh and 9 cases (2%) affecting the femoral nerve. All occurred ipsilateral to the transplant. Femoral neuropathy was frequently disabling but 90% resolved in a period of 8 months. Neuropathy of the lateral cutaneous nerve was never a problem and all resolved quickly. Compression from blades of self‐retaining retractors is the probable etiology.
Segmental spontaneous sternal luxation: A rare complication of renal transplantation
Authors: Hernández‐Marrero D. , Hernández‐Siverio N. , Mandía F. , Torres A.
Published: September 2024

The spontaneous luxation of sternal joints is an uncommon event. We report the case of a patient with a functioning renal graft and severe persistent hyperparathyroidism, who suffered spontaneous luxation of the inferior joint (xiphosternal) without any other known cause, 11 months after transplantation. She had received high doses of corticosteroids. Possible pathogenetic mechanisms are discussed.
Cyclosporine‐associated diabetes mellitus in renal transplants
Authors: Mejia Gonzalo , Arbelaez Mario , Henao Jorge E. , Arango Jorge L. , Garcia Alvaro
Published: September 2024

Between August 1973 and August 1988, 463 non‐diabetic patients received renal transplants at our Hospital. Of them, 187 (40.4%) were immunosuppressed with cyclosporine plus steroids or plus steroids and azathioprine (Group 1), and 276 (59.6%) were treated with prednisolone plus azathioprine (Group 2). In Group 1, 21 (11.2%) developed diabetes mellitus (two different determinations of serum glucose > 11.1 mmol/1) as compared to 9 (3.3%) in Group 2 (p=0.0031). For Groups 1 and 2, respectively, the following data were obtained: diabetes started 4.4 ± 1.6 (SEM) and 23.3 ± 9.6 months post‐transplant (p = 0.0075), number of rejections was 0.14 ± 0.08 and 1.33 ± 0.53 (p = 0.0028), total dose of methylprednisolone was 1.7 ± 0.13 and 3.3 ± 0.8 g (p = 0.0015), total dose of prednisolone until diagnosis of diabetes was 2546 ± 648 and 9420 ± 2514 (p = 0.0054), and dose of prednisolone at the time of diagnosis was 0.51 ± 0.1 and 0.52 ± 0.2 mg per kilo (NS). There was no significant difference in age, time on dialysis prior to transplant, duration of diabetes, number of patients cured, mortality, renal function at diagnosis, or length of follow‐up between the two groups. There was a significant but unexplained predominance of males in Group 1 (19 vs. 3; p = 0.0031). Our data practically exclude steroid‐induced diabetes mellitus as a likely explanation for this complication of our patients. We conclude that immunosuppression with cyclosporine in renal transplant patients may induce or be associated with the development of diabetes mellitus; possible mechanisms could be peripheral insulin resistance, impaired insulin secretion due to beta‐cell degeneration and/or a summation of the effects of cyclosporine and steroids.
Chronic lymphocytic leukemia treated successfully by syngeneic marrow transplantation
Authors: Spitzer T. R. , Cottler‐Fox M. , Jacobson R. J. , Torrisi J. , Cahill R. , Deeg H. J.
Published: September 2024

Marrow transplantation is a potentially curative treatment for patients with lymphohematopoietic malignancies. We report here a case of syngeneic transplantation in a 39‐year‐old male with chemotherapy‐resistant progressive chronic lymphocytic leukemia. Following conditioning therapy with fractionated total body irradiation, etoposide and cyclophosphamide and transplantation from a monozygotic twin brother, the patient achieved a complete remission and remains disease‐free 15 months after transplant. This observation indicates that, in principle, chronic lymphocytic leukemia is a disease curable by marrow transplantation.
Origin of lymph node‐derived lymphocytes in human hepatic allografts
Authors: Fung John J. , Zeevi Adriane , Demetris A. Jake , Starzl Thomas E. , Markus Bernd , Chen Kangnian , Marrarri Marilyn , Duquesnoy Rene J.
Published: September 2024

Hepatic allograft‐derived lymph nodes were examined in the post‐transplant period on order to determine the origin of lymphocytes and structural elements of the lymph node. Histologic assessment and immunohistochemical studies verified that T‐cell infiltration of donor lymph nodes by recipient‐derived lymphocytes occurred early in the post‐transplant period. These T cells bore T‐cell activation markers, e.g. TAC receptor and HLA‐DR antigens. In addition, functional analysis demonstrated alloreactive T cells in secondary proliferation assays. The pattern of alloreactivity in these assays was dependent upon the phenotypic makeup (and therefore origin) of the lymphocytes within the lymph node. A gradual shift in predominance of donor‐derived lymphocytes to recipient‐derived lymphocytes occurred, but even late in the post‐transplant course the stromal elements and a residium of lymphocytes within the lymph nodes continued to bear donor HLA antigens. The possible role of these “passenger” lymphocytes in allograft immunity is discussed.
Renal transplantation in patients with polycystic kidney disease: A single‐center experience
Authors: Tzardis Periclis J. , Gruessner Rainer W. G. , Matas Arthur J. , Fryd David S. , Payne William D. , Dunn David L. , Sutherland David E. R. , Najarian John S.
Published: September 2024

During the 25‐year period from 1963 to 1988, 127 patients with end‐stage renal failure (ESRF) secondary to autosomal dominant polycystic kidney disease (ADPKD) received a total of 143 renal transplants. The average follow‐up time was 116 months (range 3 to 300 months). Mean age (45.8 yr) was significantly higher than the average age in our transplant population (31 yr) (p< 0.001). No correlation was found between ADPKD and HLA‐A or ‐B antigen frequency among the patients. Overall patient and graft survival was 90% and 73% at 1 yr, 74% and 53% at 5 yr, 55% and 36% at 10 yr, and 37% and 28% at 15 yr, respectively. When death with a functioning graft was excluded as a cause of graft loss, 15‐yr graft survival was 57%. The most common causes of death were cardiovascular complications (46%) and infections (34%), while graft loss was mainly due to patient death (50%), or rejection (38%). Multivariable analysis showed patient survival to be influenced by the level of panel reacting antibodies at the time of transplantation (PRA) (p = 0.002), while graft survival was affected primarily by the donor status (living related vs. cadaver) (p = 0.02). Outcome in transplant patients with ADPKD was compared to outcome in two matched control groups: diabetic and nondiabctic transplant recipients. There was a lower patient survival rate for the diabetic group (p = 0.0003). Graft survival, however, was similar among the three groups, with the exception of diabetics treated with azathioprine, , ALG and prednisone who appeared to have a lower graft survival rate (p = 0.0002). The cause of patient death and graft loss overall did not differ among the three groups studied; however, ADPKD and diabetic patients showed an increased death rate due to cardiovascular episodes for the time period between the 1st and 5th posttransplant years (p = 0.02). We conclude that, although ADPKD patients are older at the time of transplantation, they are excellent transplant candidates.
The use of mesenteric venous cannulation for portal access during venovenous bypass in orthotopic hepatic transplantation
Authors: Ryckman Frederick C. , Noseworthy John , Penn Israel , Alexander J. Wesley
Published: September 2024

Venovenous bypass has become a widely used technique during the anhepatic phase of orthotopic hepatic transplantation to avoid the detrimental consequences of vena caval and portal vein interruption. The end‐on portal vein cannulation used in conventional portosystemic bypass has the disadvantage of cannula instability as well as the need to terminate portal decompression at the time of the portal anastomosis. An alternative procedure for establishing venovenous bypass through direct mesenteric venous cannulation for portal vein access is described. Twenty‐one patients have undergone 26 orthotopic transplant procedures using this method of cannulation. Adequate portal venous decompression was achieved with venovenous bypass flow rates of 0.87 to 2.2 liters/meter. There was no difference in flow requirements in individuals with acute hepatic failure (1.42 1/nr) vs those with chronic hepatic failure (1.64 1/m2). Adequate portal decompression and hemodynamic stability was achieved in all cases. Improved cannula stability and continuous portal decompression throughout the anhepatic phase of transplantation offer additional safety to the transplant procedure by using this technique.
Thyroid function in potential organ donors. Influence on myocardial damage
Authors: Benito Pedro , Montero Jose A. , Avila Luis , Mallol Jesús , Blanco Alfonso , Rodriguez Magdalena , Alvarez Francisco , Concha Manuel
Published: September 2024

Thyroid function before and after brain death, and triiodothyronine (T3) bioavailability of the retrieved donor heart, were studied in potential organ donors to evaluate the therapeutic possibilities of using T3 to improve cardiac performance after heart transplantation. Before brain death, T3 levels were lower (0.81 ± 0.18 nmol/1) than those of controls (1.78 ± 0.27 nmol/1, p<0.01), reverse T3 (rT3) levels were significantly higher (2747.36 ± 762 pmol/1 vs 205.66 ± 59 pmol/1, p< 0.001), and TSH levels increased following TRH stimulation test. After brain death, T4 and rT3 levels decreased (p< 0.001), whereas T3 levels remained unchanged and the TSH response to TRH was abolished. Occupied T3 receptors were lower in the retrieved donor heart (3 receptors/3 μm2), than in healthy myocardium (15 reccptors/3 μm2). Thus, before brain death, potential organ donors seem to have a “low T3 syndrome” with increased production of rT3 for metabolic adaptation of the thyroid axis to their illness. In these cases T3 treatment is not required. On the other hand, after brain death patients become hypothyroid, reducing the tissue bioavailability of T3 (diminished occupied receptors) on the retrieved donor heart. Taking into account the importance of this hormone in myocardial function, T3 treatment seems justified in these patients after brain death in order to improve the transplanted heart performance.
Long‐term experience in primary cadaver renal transplants using cyclosporine
Authors: Amend W. , Soskin T. , Vincenti F. , Tomlanovich S. , Garovoy M. , Melzer J. , Feduska F. , Husing B. , Salvatierra O.
Published: September 2024

Outcomes in primary cadaver‐kidney transplant patients receiving long‐term cyclosporine (CSA) and prednisone were compared to patients receiving azathioprine (AZA) and prednisone. The CSA‐associated 20‐25% improvement in 1‐year graft survival in nondiabetic patients and a 30% improvement in diabetic patients continued to be noted at 3 and 5 yr with parallel kidney transplant loss rates in all groups. The mean serum creatinines in all (four) patient groups were comparable and showed no deterioration to the 5‐yr follow‐up period. Hypertension (incidence of 70‐80%) and hypercholesterolemia was common but was similar in both CSA‐ and AZA‐treated populations. Inevitable progression of CSA nephrotoxicity is not noted in our experience when CSA is used for 5 yr following cadaver kidney transplantation.
Obstructive uropathy due to ureteral candidiasis in a renal allograft
Authors: Ratner Lloyd E. , Clayman Ralph V. , Hanto Douglas W.
Published: September 2024

Obstructive uropathy due to ureteral candidiasis is a rare occurrence. Typically it is associated with systemic candidiasis in debilitated patients, and generally offers a grave prognosis. We report a case of a renal transplant recipient who was successfully treated for recurrent ureteral fungus balls by percutaneous and endourologic techniques and systemic and local antifungal therapy. Treatment and features of this disease and previously reported cases are discussed.