bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of CMV urinary isolation?
Authors: Bowers Victor D. , Sommer Bruce G. , Henry Mitchell L. , Ferguson Ronald M.
Published: September 2024

Human cytomegalovirus (CMV) has been associated with many clinical disease syndromes and can affect a variety of organ systems. CMV has been an especially troubling clinical problem for the immunosuppressed transplant patient. In an attempt to elucidate the clinical significance of positive CMV urine cultures in renal transplant patients, a retrospective review was undertaken of 114 transplant patients at the Ohio State University from March 1983 through March 1987 who had either isolated or recurrent urine cultures post‐transplant positive for CMV. Sixteen of these 114 grafts were lost during the study period (86% overall graft survival) and 3 of the 114 patients died during this same period (97% overall patient survival). These figures compare favorably to an analysis recently completed at our institution of the renal transplant population (cadaveric and Iiving:related) during this same time period. This study showed a patient survival rate of 90% and, graft survival rate of 81%, among the group of non‐excretors (p value $gt 0.1). Of the variables examined, neither rejection episodes nor seroconversion was mandatory for CMV urinary excretion. Individuals who experienced recurrent rejection episodes were noted to have an increased incidence of recurrent CMV urinary excretion with the majority of viruria episodes being detected either between the rejection episodes or after all rejection episodes (97%). Most importantly, we conclude from our study that CMV isolation from the urine post‐renal transplant has no long‐term detrimental effect on patient or graft survival compared to the general renal transplant “non‐excretor” population.
Subcapsular hepatic necrosis after liver transplantation
Authors: Sandbichler P. , Vogel W. , Dietze O. , Schmid Th. , Pernthalar H. , Margreiter R.
Published: September 2024

Three cases of subcapsular liver necrosis are reported in orthotopic liver allografts in 2 female recipients, one of whom developed the same lesions again in her second transplant. These fatal lesions were preceded by a sudden and unusual rise of transaminases. Macroscopic appearance of all 3 liver grafts revealed extensive necrotic areas in a maplike distribution in subcapsular regions but also in the central parts near the hilum and equally distributed over both lobes. Histologically, either confluent necrosis of zones II and III or multiacinar necrosis corresponding to the macroscopically identifiable areas was found. Typical signs of either cellular or vascular rejection were not detectable. Portal vein and hepatic artery and veins were found to be patent. Other mechanical causes such as compression of the graft or its vessels were not identified. The exclusion of immunological, vascular or mechanical causes makes a hemodynamic etiology most likely. Renal insufficiency and intractable hypertension followed by hypotensive periods were the only common factors in both patients. An adverse reaction of the hepatic vasculature to these hemodynamic abnormalities due to denervation of the graft remains the only plausible explanation for the occurrence of this unusual type of necrosis.
A critique of pancreas transplantation
Authors: Pyke D. A.
Published: September 2024

There are three possible indications for pancreas transplantation** 1. to correct the diabetic state; 2. to cure or ameliorate the complications of diabetes or to delay or diminish their deterioration; 3. to prevent the complications. The diabetes we are considering here is type 1 or insulin‐dependent diabetes, a disorder in which there is more or less complete insulin deficiency. No one has suggested pancreas transplantation for type 2, non‐insulin dependent diabetes. This article questions the rationale of pancreas transplantation. It maintains that the value of the procedure has not been established.
Quality of life in diabetic recipients of kidney transplants is better with the addition of the pancreas
Authors: Corry Robert J. , Zehr Pamela
Published: September 2024

The present study is an evaluation of the quality of life of 32 patients following successful pancreatic transplantation. These patients were studied at from 6 months to 5 years post‐transplantation. Over one‐half of them were beyond the 2$f12‐yr mark. A questionnaire was developed that focused on symptoms of neuropathy, enteropathy, and retinopathy. All of the patients evaluated had completely normal carbohydrate metabolism, as evidenced by normal fasting blood sugars and hemoglobin A1C levels. Twenty‐one of the 32 patients had symptomatic neuropathy pre‐operatively, and 11 of these reported substantial subjective improvement. Eight remained unchanged and 2 became worse. Twenty‐four patients had symptoms of enteropathy and 23 noted improvement post‐transplantation. Retinopathy symptoms were not improved, but there was a suggestion that after 3 or 3$f12 yr progression did not occur as rapidly as earlier. Virtually all of the patients had mood improvements and considerably less fatigue. We have determined that the risk of the procedure when receiving simultaneous renal and pancreas grafts is not significantly greater than that associated with a kidney transplant alone. Patients who are not uremic, either those with a successful kidney graft or those preuremic patients, are better candidates if symptoms are present. The risk of immunosuppression is insignificant in those patients who already have a successful renal transplant and are already on immunosuppressant drugs. Pancreatic transplantation can substantially improve the quality of life in diabetic patients, and should be considered as a therapeutic measure.
Renal allograft survival: An assessment on the age of current serum for final crossmatch
Authors: Murphey Cathi , McFarlin Linda , Morrisey Jerry , Banowsky Lynn
Published: September 2024

This study reviews renal allograft survival with respect to the age of the current serum used in the final crossmatch. Patients' sera were divided into two categories according to the age of the current sera used in the final crossmatch, ranging from < 2 days to 28 d. Several parameters were examined: 1‐ and 2‐year graft survival rates, delayed graft function rate and the number of acute rejection episodes. After assessing the different parameters, we conclude that, barring any sensitizing event during this time, 3‐week‐old current sera is acceptable to use in the final crossmatch with no deleterious results to the patient.
Implications of monitoring OKT3 therapy in kidney‐grafted patients
Authors: Zlabinger Gerhard J. , Maurer Dieter , Pohanka Erich , Ulrich Walter , Kovarik Josef
Published: September 2024

Monitoring of OKT3 therapy was performed in kidney graft recipients who were given the monoclonal antibody because of histologically proven acute rejection episodes. Non‐responders to OKT3 presented with a marked delay in the increase of serum OKT3 levels during the first days of monoclonal antibody treatment compared to the responder group. The difference in serum OKT3 levels was significant on d 2 (p = 0.033) and 3 (p = 0.007) after initiation of OKT3 therapy. Occurrence of host anti‐OKT3 antibodies of the IgG class was detected in 26 (67%) and of the IgM class in 15 (38%) of 39 patients. Eight of 39 patients (21%) did not present with human anti‐mouse Ig antibodies throughout the observation period. Evidence for the presence of anti‐idiotypic antibodies to OKT3 was obtained in 18 of the 39 treated graft recipients (46%). During this first treatment course, no clear influence on the response to anti‐rejection therapy with OKT3 could be observed resulting from the development of host anti‐OKT3 antibodies, including those inhibiting the binding of OKT3 to its target. Determination of T‐cell subpopulations showed an initial decrease in circulating CD2, CD3, CD4 and CD8 positive cells. After some days of OKT3 treatment, reappearance of CD2, CD4 and CD8 positive cells was observed which, however, could not be stained with the monoclonal antibody OKT3 or a fluoresce‐inated anti‐mouse Ig antibody. In summary, our findings stress the importance of a timely intervention in acute rejection episodes, which may help to increase effectiveness of monoclonal antibody therapy and might also contribute to reduce both the risk of infection and of sensitization to the monoclonal antibody by minimizing the duration of treatment.
HLA match and other immunological parameters in relation to survival, rejection severity, and accelerated coronary artery disease after heart transplant
Authors: Pollack Marilyn S. , Ballantyne Christie M. , Payton‐Ross Charlotte , Cocanougher Beth , Rowe Steven K. , Grant Gloria J. , Farmer John A. , Noon George P. , Weilbaecher Donald G. , Flores Damien , Young James B.
Published: September 2024

The relationship of donor/recipient HLA compatibility to survival, rejection severity and development of coronary arteriopathy after heart transplant is controversial. Furthermore, immunomodulating protocols in these patients have not been based on pretransplant knowledge of HLA match or other immunological parameters. In order to clarify this issue, immunological data from 113 consecutive cardiac transplant patients who were at least 3 months post‐transplant were analyzed in relation to graft/patient survival and severity of rejection episodes. Ninety‐two of these patients either reached the 1‐year post‐transplant follow‐up point and were studied with cardiac catheterization or died with autopsy study of coronary anatomy. These patients were also analyzed for pretransplant immunological factors and post‐transplant development of new lymphocytotoxic antibodies that might predict development of coronary artery disease. Results indicate that better donor/recipient HLA matches, lower pre‐transplant T‐cell panel reactive antibodies (PRA) and negative T‐cell crossmatches are associated with improved graft/patient survival and/or less severe rejection episodes, especially in younger transplant patients. The development of new antilymphocyte antibodies after transplant was associated with the development of new coronary artery disease and with diminished survival. These data, collectively, suggest that patients, especially younger patients, with more poorly matched cardiac transplant donors or pretransplant cytotoxic antibodies should be candidates for more aggressive immunosuppression protocols because of their higher mortality and that all patients should be monitored for the development of new anti‐lymphocyte antibodies.
Decreased wound complications of combined kidney/pancreas transplants using intraabdominal pancreas graft placement
Authors: Tesi Raymond J. , Henry Mitchell L. , Elkhammas Elmahdi A. , Sommer Bruce G. , Ferguson Ronald M.
Published: September 2024

The increased success of combined kidney/pancreas transplantation due to improved immunosuppression and increasing sophistication of harvest and transplant techniques has allowed a more systematic evaluation of the outcomes of the procedure. We were impressed with the early morbidity associated with wound complications in our initial series of combined kidney/pancreas transplants. We evaluated the first 25 patients who received combined kidney/pancreas transplants at our institution. All patients received whole pancreas grafts with a duodenal segment with bladder drainage and an identical immunosuppressive protocol. Group I included 10 patients which had bilateral flank incisions with the pancreas always placed on the right side. Group II included 15 patients who had a midline incision with intraabdominal placement of the pancreas. Actuarial graft survival at 1 year was similar between the two groups at 88%. Wound complications were significantly decreased in Group II vs. Group I with 60% of patients in Group I having significant wound complications. Only 1 patient in Group II had a wound complication and this was related to a bladder leak. We conclude that intraabdominal placement of the graft through a midline incision substantially decreases morbidity associated with wound complications in a combined kidney/pancreas transplant setting.
Treatment of resistant hypertension following renal transplantation with an angiotensin‐converting‐enzyme inhibitor
Authors: Schindler J. M. , Keusch G. , Binswanger U.
Published: September 2024

The antihypertensive efficacy and the effect on renal function of angiotensin‐converting‐enzyme (ACE) inhibitor therapy in renal transplant recipients was evaluated. Posttransplant hypertension resistant to conventional antihypertensive therapy with diuretic, betablocking agent and vasodilator as observed in 21 renal transplant recipients was treated with ACE inhibitors. Prior to therapy, renal function was stable with a mean serum creatinine of 204 ± 99 μmol/l. At the end of the treatment period of 1 week to 36 months systolic blood pressure (BP) decreased from 172 ± 19 mmHg to 143 ± 21 mmHg (p < 0.001) and diastolic BP from 101 ± 9 mmHg to 88 ± 9 mmHg (p < 0.001). Renal function remained stable in 14 patients. Seven patients showed an acute increase of serum creatinine of 57 ± 29%. Renal angiography performed in all these patients disclosed 4 patients with transplant artery stenosis (TRAS) and 3 patients with biopsy‐confirmed chronic vascular rejection. After surgical correction or percutaneous transluminal angioplasty and discontinuation of ACE inhibitor therapy, renal insufficiency was reversed in all cases. In conclusion, ACE inhibitor therapy in patients with posttransplant hypertension resistant to conventional antihypertensive triple‐drug therapy shows a satisfactory and sustained antihypertensive efficacy. Acute renal failure associated with ACE inhibitor should raise suspicion of TRAS but acute deterioration of kidney function can also be due to chronic vascular rejection.
Meralgia paresthetica and renal vein thrombosis in a kidney transplant
Authors: Fligelstone L. J. , Salaman J. R.
Published: September 2024

Compression neuropathy following renal transplantation has been well described (1‐8). In these cases the deficit presents immediately post‐transplantation and has been attributed to self‐retaining retractors (1, 3, 8), direct pressure from the transplanted organ (2), hematoma (9), and ischemia (6). We report a case of delayed onset compression neuropathy following a renal transplantation in a patient found to have suffered an acute transplant renal vein thrombosis.
Ileal and colon conduits in renal transplantation
Authors: Gruessner Rainer W. G. , Tzardis Periclis J. , Matas Arthur J. , Dunn David L. , Payne William D. , Sutherland David E. R. , Najarian John S.
Published: September 2024

Twenty‐five years ago the first case of renal transplantation into an ileal conduit was performed at this institution. Since then, 16 patients (9 females, 7 males) with an average age of 24.8 yr (range 9 to 47 yr) have undergone 19 transplants into intestinal conduits. The indication was neurogenic bladder in 7 cases, major urinary tract abnormalities in 7, and vesicoureteral reflux in 2. In primary transplants, 8 kidneys were from living related donors and 8 from cadaver donors; in retransplants, 1 kidney was from a living related and 2 from cadaver donors. In all but 3 cases the intestinal loop was constructed at least 2 weeks pretransplant. An ileal loop was used in 14 cases; a colon loop in 2. Conduit‐specific complications were: calculi (n = 2), small‐bowel‐to‐ileal‐loop fistula with hyperchloremic hyperkalemic acidosis (n = 1), urinary fistula (n = 1), and recurrent UTIs (n = 12). Urosepsis caused 4 deaths. As of 9/89, 9 of these 16 patients are alive with functioning grafts (1 retransplant), 1 is alive without a functioning graft, and 6 died [urosepsis (4), ARDS (1), pneumonia (1)]. All of the 9 patients have had functioning grafts for more than 1 yr, 5 for more than 5 yr and 3 for more than 10 yr. Of the 9 functioning grafts, 6 were from living related donors and 3 from cadaver donors. Patients were divided into two groups based on time of transplantation: Group I (11/64–4/77) and Group II (5/77–9/89). In Group I, 6 of 9 patients died; 1 is alive, but without a functioning graft, and only 2 still have functioning grafts. In Group II, no patient has died and 6 of 7 primary grafts still are functioning. Improvements in immunosuppression, surgical technique, infection treatment, and selection criteria are responsible for higher graft and patient survival in Group II.
Coronary artery disease is the major late complication of successful cadaveric renal transplantation
Authors: Mahony John F. , Caterson Robyn J. , Pollock Carol A. , Jones Michael , Waugh David A. , Sheil A. G. Ross
Published: September 2024

The mortality and morbidity due to coronary artery disease (CAD) were determined in a cohort of successful renal transplant recipients. In 133 cadaveric renal allograft recipients who survived at least 10 years (range 10.0–19.4, mean 14.0) from transplantation, 32 subsequently died. The commonest cause of death was myocardial infarction (37.5%), followed by sepsis (25%) and malignancy (16%). The age‐ and sex‐adjusted increase in mortality rate from CAD was 6.76 times that of a normal population. Of the survivors, 23 (24%) have symptomatic (CAD), with half of these having had at least one proven myocardial infarction. As coronary atherosclerosis complicates all phases of renal failure and its treatment, an aggressive approach to controlling the known risk factors is warranted from the earliest stages of renal impairment.
Liposomal amphotericin‐B (AmBisome)® treatment in solid organ and bone marrow transplant recipients. Efficacy and safety evaluation
Authors: Tollemar Jan , Ringdén Olle , Tydén Gunnar
Published: September 2024

Eight patients, 4 organ and 4 bone marrow transplant recipients, were treated with a liposomal amphotericin‐B formulation (AmBisome) in a compassionate basis program. Time of treatment ranged from 9–48 days (median 15) with a cumulative AmBisome dose ranging from 450–6480 mg (median 963). Maximum dose ranged from 0.9–2.5 mg/kg (median 1.75). Six of the 8 patients with proven or probable deep fungal infection have been discharged from hospital and are well. Two bone marrow‐transplanted patients died during treatment, I was negative for disseminated fungi at autopsy after 8 days of treatment with a total dose of 906 mg AmBisome. Amphotericin B concentrations in tissue samples taken at autopsy ranged from 25 to 281 μg/g tissue in bone marrow, liver and spleen and from 0.6 to 8 in lung, heart, muscle and kidney. In the other patient, who died after 14 d of treatment with a total dose of 1020 mg AmBisome, autopsy was denied. Two patients developed high alkaline phosphatases during treatment. Otherwise, AmBisome was well‐tolerated in all patients without acute side effects.
Kidney transplantation in older patients
Authors: Howard Richard J. , Pfaff William W. , Scornik Juan C. , Salomon Daniel R. , Peterson John C. , Branson Mathew E.
Published: September 2024

Older patients are commonly believed not do as well as younger patients following renal transplantation. Between 1971 and 1988, we performed 88 kidney transplants in patients at least 55 years old. The 1‐yr graft and patient survival for recipients of first cadaver grafts for the entire series were 72.2% and 83.3%, respectively. These survival rates did not differ significantly from patients less than 55 yr old (graft and patient survival 69.0% and 88.6%, respectively, p > 0.05). For recipients of first related grafts at least 55 yr old, 1‐yr graft and patient survival were both 83.3% compared to 83.3% and 94.7% for patients less than 55 yr old (p > 0.05). For the most recent 5‐yr period, 1984‐1988, 1‐yr graft and patient survival of first cadaver grafts were 79.3% and 89.7%, respectively, for older patients compared to 77.3% and 92.3% for younger patients (p > 0.05). Older patients did not have a higher complication rate than younger patients. We believe that there should no longer be an arbitrary upper age limit to renal transplantation. The decision for or against transplantation should be based on the capacity to recover from the operation and to have one's physiologic and psychosocial status improved.
Transplantation of a polycystic kidney from a young cadaver donor
Authors: Chocair Pedro R. , Vasconez Cesar I. , Nahas William C. , Ianhez Luiz E. , Sabbaqa Emll , Arap Sami
Published: September 2024

The course of a diabetic patient receiving a polycystic kidney from a young cadaver donor with 14 cm in its greatest axis, good renal function and creatinine of 1.5 mg% is reported. After 3 years of follow‐up, no changes were observed in the cysts nor in the size of the kidney. The renal function remains steady and there is no infection, nor any other urinary complication. We believe that, in special circumstances, cadaver kidneys with major abnormalities might be used.
The delayed duct occlusion technique of human pancreatic transplantation
Authors: Largiadèr F. , Decurtins M. , Schlumpf R.
Published: September 2024

This is a report on a consecutive series of 50 primary human pancreatic transplants performed between 1980 and March 1989. All patients suffered from end‐stage diabetic nephropathy, thus all received a kidney graft simultaneously. The basic technique consisted of intraperitoneal placement of a duct‐occluded pancreas segment. The main technical and non‐immunological complications included primary non‐function (10%) because of ischemic damage or technical error, graft pancreatitis (4%), arterial thrombosis (6%) and venous thrombosis (16%). Five patients (10%) died in the later course with functioning transplant, and 10 transplants (20%) were lost due to acute or chronic rejection, 7 of them in the pre‐cyclosporin era. The technical modifications introduced during these years to overcome complications consisted of temporary percutaneous drainage of the exocrine secretion for function control, delayed occlusion of the ductal system with polyurethane, and continuous heparin perfusion of the graft in the postoperative period by means of an arterial catheter.
T‐lymphocyte subsets in the early and late phases of cytomegalovirus infection in renal transplant recipients
Authors: Mordacchini M. , Vianello A. , Calconi G. , Di Falco G. , Fabi F. , Maresca M. C. , Nieri A. , Rosa C. Dalla
Published: September 2024

Monitoring of T‐lymphocyte subsets in peripheral blood of 23 kidney‐transplanted patients who suffered a cytomegalovirus (CMV) infection after transplantation (5 primary infections and 18 secondary infections) seems to show a characteristic pattern of T‐cell subset modification. In the primary infection, we observed a sudden and persistent fall of the CD4/CD8 ratio, especially due to an abnormal CD8 subset expansion. Up to 73% of expanded CD8 cells also expressed the HLA‐DR marker in the earlier phases of the infection and they progressively switched to HNK1 antigen expression in the later phases of the disease. The CD8+HLA‐DR+ and CDS+HNK1+ subsets seem to be two functionally distinct populations and could be considered as an early and late marker, respectively, during the primary CMV infection.
Matching kidneys for size in renal transplantation
Authors: Cecka J. Michael , Terasaki Paul I.
Published: September 2024

Analyses of cadaveric renal transplants performed since 1984 show that the effective size of the donor kidney relative to the recipient is a major factor in determining graft outcome. One‐year graft survival was 78% for 13114 adult recipients of kidneys from donors aged 13 to 50 yr, but declined progressively with donor age to 54% in 276 recipients of kidneys from donors under 3 and to 61% in 230 recipients of kidneys from donors over 60. Similarly, survival of adult female but not male donor kidneys transplanted to adult recipients decreased as the recipient weight increased up to 95 kg. The optimum early graft function was excellent for 87% of recipients weighing less than 45 kg, 63% of those between 46 and 60 kg, and this proportion decreased to 25% of recipients weighing more than 95 kg. Small kidneys transplanted to large recipients may be damaged by hyperfiltration or cyclosporine toxicity in addition to the adverse effects of immunological assaults on the transplanted organ. Therefore, we recommend avoidance of radical size mismatches between donor and recipient and examination of kidneys from donors over 50 for sclerotic glomeruli to ensure that the size of the organ will be adequate for the size of the recipient.
Pancreatitis after renal transplantation: A potentially lethal condition
Authors: Browning N. G. , Botha J. R.
Published: September 2024

Pancreatitis post‐renal transplantation is a potentially lethal condition. The etiology appears to be multifactorial. Since 1966, 1088 renal transplants have been performed at this institution. We describe 3 patients who have developed pancreatitis after renal transplantation due to rather uncommon causes. Their histories and management are described. The etiological factors predisposing to this condition are discussed and our approach to the surgical management of these patients is presented.
Deleterious effect of T‐ and B‐cell panel reactive antibodies and donor‐specific B‐cell crossmatches on cadaveric renal allograft survival
Authors: Sengar Dharmendra P. S. , Couture Roger A. , Bell Robert C. , Lazarovlts Andrew I. , Jindal Shiv L.
Published: September 2024

A total of 222 cadaveric renal allografts (Tx) were analyzed to evaluate the effect of non‐current and current T‐cell as well as B‐cell panel reactive antibodies (PRA) on Tx survival. In addition, the effect of donor‐specific B‐cell crossmatches (XMs) on Tx survival in association with T‐ and B‐cell PRA was also evaluated. The majority (80%) of patients received cyclosporine (CsA). Our study revealed that the presence of non‐current or current T‐cell PRA ≥ 10% and/or B‐cell PRA ≥ 25% had a deleterious effect on Tx outcome. Similarly, patients with < 10% T‐ and ≥ 25% B‐cell PRA also had lower Tx survival than those with < 10% T‐ and < 25% B‐cell PRA. Positive B‐cell XMs were associated with lower (but not significant) Tx survival. In the patients with negative B‐cell XMs, the presence of ≥; 10% T‐cell and/or ≥ 25% B‐cell PRA was significantly associated with lower Tx survival. Overall results suggest that perhaps certain other factors (or antibodies) non‐cytotoxic to T and B cells, but detrimental to Tx, may be concomitantly present in these sensitized patients. Furthermore, patients with non‐current T‐cell PRA ≥ 25% (median 45%) after losing their T‐cell PRA prior to transplantation continued to have poor Tx survival. The present study suggests that B‐cell PRA alone or in association with T‐cell PRA and B‐cell XMs may serve as a good predictor of Tx outcome.
Stone formation as a cause of allograft pancreatitis in the recipient of a combined kidney and pancreas transplant
Authors: Wengrovitz Mark , Jarowenko Mark V. , Gifford Robert R. M. , Sechtin Alan G. , Mandall Michael J. , Yang Harold C.
Published: September 2024

Combined kidney and pancreas transplantation has become an important therapeutic option in the uremic, insulin‐dependent diabetic patient. Technical advances, particularly the duodenal segment technique of pancreatico‐duodenocystostomy, have been reported to decrease the incidence of early postoperative complications by 50% (1, 2). These complications include bladder leak, bleeding, abscess and allograft pancreatitis. Late complications have not been well‐documented. We wish to report a case of allograft pancreatitis which resulted from an obstructing calculus on a suture in the bladder at the duodenocystosomy.
Y‐shaped ureteroneocystostomy technique for double ureters
Authors: Königsrainer A. , Margreiter R.
Published: September 2024

A new technique of ureteroneocystostomy for kidneys with double ureter or pediatric kidneys transplanted en‐bloc is described: The distal ends of both ureters are sewn together, thus forming a single orifice, which is implanted into the bladder using a modified Leadbetter‐Politano technique. So far, 4 patients (2 pairs of en‐bloc pediatric kidneys, 1 horseshoe kidney, 1 kidney with double ureter) were operated on using this technique. One patient lost his graft due to irreversible vascular rejection, the remaining 3 grafts are functioning well at 29, 24 and 8 months after transplantation. Two patients have a high pressure reflux into both ureters, neither of them with signs of obstruction or urinary tract infection. This simple and safe method is therefore recommended for cases with two ureters.
Noninvasive assessment of cardiac risk in insulin‐dependent diabetic patients being evaluated for pancreatic transplantation using thallium‐201 myocardial perfusion scintigraphy
Authors: Iqbal Amjad , Gibbons Raymond J. , McGoon Michale D. , Sterioff Sylvester , Frohnert Peter P. , Velosa Jorge A.
Published: September 2024

We examined the value of thallium‐201 myocardial perfusion scintigraphy in noninvasive assessment of cardiac risk in 36 insulin‐dependent (type 1) diabetic patients being evaluated for pancreas or combined pancreas/kidney transplantation. An extensive cardiovascular evaluation including electrocardiogram was performed in all patients, and most patients were also evaluated by two‐dimensional and Doppler echocardiography. Exercise thallium studies were performed in 31 patients. Five patients were unable to exercise and underwent dipyridamole‐thallium study. The thallium images were abnormal in 12 patients, 10 of whom underwent coronary arteriography. Significant coronary artery disease was found in 7 of these patients. Nineteen patients underwent pancreatic (3 patients) or pancreato‐renal (16) transplantation without any occurrence of cardiac death or nonfatal myocardial infarction peri‐operatively or on follow‐up ranging from 7 months to 21 months. In contrast, 3 cardiac events occurred in 12 patients not approved for transplantation, each of whom had an abnormal thallium study exhibiting significant ischemia. Resting left ventricular global and regional function was not helpful in determining perioperative risk. Thus, thallium‐201 myocardial perfusion scintigraphy may be useful in identifying diabetic patients at low risk for pancreas transplantation and may obviate the need for routine coronary angiography in these patients.
Angina pectoris in a cardiac allograft recipient
Authors: Vora Kishorchandra N. , Hosenpud Jeffrey D. , Ray Judith , Pantely George A. , Norman Douglas J. , Hovaguimian Hagup , Cobanoglu Adnan M.
Published: September 2024

Following cardiac transplantation, the cardiac allograft is dener‐vated and, based on most evidence, remains so over time. The consequences of this are, among other things, lack of efferent nerves regulating heart rate responses and lack of afferent nerves which carry pain fibers. A cardiac allograft recipient is presented who, as a consequence of cardiac allograft vasculopathy, developed an acute anterior wall myocardial infarction and post‐infarction ischemia, both accompanied by typical angina pectoris. The issues of post‐transplant cardiac denervation are reviewed.
Pancreatico‐duodenal transplantation with enteric exocrine drainage: Technical aspects
Authors: Tydén G. , Tibell A. , Groth C. G.
Published: September 2024

When a pancreatic transplant program was initiated in Stockholm in 1974 we elected to use enteric drainage of the pancreatic juice; 103 segmental pancreatic transplantations were performed with this technique. However, in 1988 we began to use pancreatico‐duodenal grafts with enteric exocrine drainage and we have now performed 25 such procedures. Here we report the technical aspects of this procedure. The cumbersome pancreatico‐enteric anastomosis previously needed for enteric drainage has now been replaced by a simple bowel‐to‐bowel anastomosis. In the present series, only one graft was lost due to the enteric drainage technique, i.e. because of exocrine leakage. No grafts were lost in thrombosis. In the uremic recipients of combined renal and pancreatic grafts the 1‐year actuarial graft survival rate was 86%. Pancreatico‐duodenal transplantation with enteric exocrine drainage would, therefore, seem to be a sound surgical procedure which is also physiological and not associated with any long‐term sequelae.
Treatment options for end‐stage renal disease in children: Where have we been; where are we; and where are we going?
Authors: Welch Thomas R.
Published: September 2024

The development of effective treatments for children with end‐stage renal disease has been realized over the past three decades. Progress in dialysis and transplantation has resulted in a sophisticated management approach to this problem. Supportive care of the child with chronic renal insufficiency includes attention to nutritional status, prevention and control of bone disease, maximization of growth potential, treatment of anemic, as well as surgical correction of anatomic malformations of the urinary tract. Successful control of these aspects will result in improved rehabilitation and physical and psychological outcomes in the child with end‐stage renal disease. Medication compliance remains a serious problem in these children.
Indications for liver transplantation in pediatric patients
Authors: Whitington Peter F. , Emond Jean C. , Black Dennis D. , Whitington Susan H. , Boone Pamela , Smith Cassandra , Thistiethwaite J. Richard , Broelsch Christoph E.
Published: September 2024

Orthotopic liver transplantation has become a widely accepted therapy for children with end‐stage liver disease. Several factors need to be kept in mind when advocating this procedure in pediatric patients. These include the following: (1) Liver transplantation is a high‐risk procedure with a 10–15% mortality in the best of circumstances. (2) Recipients require long‐term drug administration and have a potential for chronic disability. (3) The procedure is extremely expensive. (4) The long‐term survival remains unknown. (5) Newer techniques and procedures need to be carefully evaluated. These factors, and the indications and contraindications for this procedure are discussed in this overview.
Overview of reduced‐size liver transplantation
Authors: Emond Jean C. , Whitington Peter F. , Broelsch Christoph E.
Published: September 2024

Organ donor availability is the major limiting factor in pediatric liver transplantation, and many children succumb from their liver disease before a suitable donor can be found. In an attempt to overcome this shortage, reduced‐size liver transplantation, split liver transplantation, and living‐donor liver transplantation have been introduced. The eventual role of these techniques will be determined by accumulated experience over the next several years.
Use of cyclosporine in pediatric transplantation: Immunology, pharmacology and therapeutic implications
Authors: Keown P. A. , Lirenman D. , Carter J. , Landsberg D. , Cameron E. , Yeung C. , Shackleton C. , Stawecki M. , Stiller C. R.
Published: September 2024

During the past decade cyclosporine has played a vital role in pediatric organ transplantation. It exerts a modulatory effect at many sites in the immune response. In young children cyclosporine clearance is significantly increased. Moreover, children are frequently on other drugs which may affect cyclosporine metabolism. These factors have to be taken into account for planning dosing regimens in children. Therapeutic monitoring has added to the efficacy and safety of cyclosporine use, particularly in those situations such as pediatric transplantation where metabolism is appreciably altered.
Prevention and treatment of selected fungal and viral infections in pediatric liver transplant recipients
Authors: Andrews W. , Siegel J. , Renard T. , Meglson S. , Foster L. , Cushion N. , Schlatter M.
Published: September 2024

Infection continues to be a significant cause of morbidity and mortality after transplantation. Three pathogens that cause significant morbidity are Candida, cytomegalovirus, and Epstein‐Barr virus. Routine culture of the Roux‐En‐Y limb at the time of biliary reconstruction, coupled with routine surveillance for Candida colonization, identified a group of children at risk for candida sepsis. With positive cultures, 7‐ to 10‐day courses of amphotericin B decreased the incidence of symptomatic and asymptomatic Candida infection by 50%. Epstein‐Barr virus (EBV) remains a difficult infection to detect. EBV hepatitis is a diagnosis of exclusion. Epstein‐Barr virus hepatitis is often initially treated as rejection (100%), can relapse (40%), and can result in graft loss (20%). Treatment with high‐dose intravenous acyclovir (45 mg/kg/day) can resolve the infection in 57% of cases. Cytomegalovirus (CMV) continues to be a major cause of morbidity after transplantation. The use of prophylactic i.v. IgG decreased the incidence of asymptomatic and symptomatic CMV infection by 50%. Symptomatic CMV disease can be successfully treated with intravenous ganciclovir with 87% survival. Ganciclovir caused minimal bone marrow suppression in this series; however, 75% of children treated exhibited at least a doubling of their creatinine during therapy, and necessitated dialysis in 1 patient. Renal function returned to normal in all patients after treatment was stopped.
Clinical correlation of cytomegalovirus cultures, serology and lymphocyte counts following renal transplantation
Authors: Herchline Thomas E. , Para Michael , Tesi Raymond
Published: September 2024

Cytomegalovirus (CMV) is known to be one of the major pathogens in the first several months after renal transplantation and may have significant associated morbidity and mortality. Ganciclovir is a drug with anti‐viral activity against CMV, but also has the potential for bone marrow toxicity. Therefore it is essential to identify patients at risk for CMV‐associated morbidity or mortality. Forty‐three patients who underwent renal transplantation and subsequently required readmission were reviewed for evidence of CMV infection and for parameters predictive of a need for ganciclovir. Patients who had positive CMV blood cultures were more likely to be symptomatic than asymptomatic, and symptomatic patients were viremic sooner than asymptomatic patients. Positive urine cultures and positive CMV IgM were not predictive of symptomatic infection. CD8 percentages increased in both primary infection and reinfection/reactivation (primary > reinfection/reactivation), but these changes were not predictive of symptomatic infection. These findings confirm previous reports regarding serology and cultures, but suggest that lymphocyte subpopulation counts may not be clinically useful for determining the need for anti‐viral therapy.
Renal transplantation into ileal conduits: Results and long‐term follow‐up
Authors: Jacoby K. , Banowsky L. H. W.
Published: September 2024

From 1977 through 1990, 708 renal transplants were performed at our institution. Eight of these allografts (1.1%) were placed into recipients who required ileal conduits. This report describes the long‐term follow‐up of these patients. Five out of 8 patients currently have functioning allografts 29 to 102 months after transplantation (with a mean allograft survival of 50 months). Construction of an ileal conduit in patients without bladders or in those who have non‐functioning bladders is a straightforward approach with minimal increased morbidity and good long‐term results.
Multiorgan procurement does not affect the immediate outcome of kidney transplants1
Authors: Morel Philippe , Troppmann Christoph , Almond P. Stephen , Schlumpf Rolf , Gillingham Kristen J. , Sutherland David E. R. , Dunn David L. , Payne William D. , Matas Arthur J. , Najarian John S.
Published: September 2024

The increasing number of organs required for transplantation has given an impetus to the development of techniques of multiorgan procurement from a single cadaver donor. We studied the effect of these techniques on the short‐term outcome of kidney transplants. Between 1.1985 and 12.1989, 168 kidneys were procured by our team during multiorgan harvests, 166 of which were transplanted in our institution or elsewhere. Follow‐up could be obtained for 161. The pancreas was retrieved simultaneously in 14 cases (9%); the pancreas and the liver in 34 (21%); the pancreas, the liver, and the heart in 73 (45%); the pancreas, the liver, the heart and the lungs in 24 (15%); the pancreas and the heart in 4 (2%); and the pancreas, the heart and the lungs in 2 (1%). We have incomplete information for 10 kidneys (7%). Immediate graft function occurred in 125 grafts (78%) (Group I); 31 kidneys (19%) had delayed graft function (DGF), 4 (2%) had technical failure (TF) (thrombosis), and 1 (1%) was a primary nonfunction (PNF) (Group II). Comparison with historical controls suggests that multiorgan retrieval had no impact on the incidence of DGF. Multivariate analysis demonstrated that the determinant factor in immediate graft function was the length of preservation – 20 ± 8 hours for Group I vs 26 ± 8 for Group II. Patients with DGF had normal creatinine values at 3 and 6 months, similar to those with immediate function. We conclude that the combined simultaneous procurement of the kidney and other organs does not affect the outcome of the kidney transplant. DGF is related to perservation time.
Factors affecting measurement of urinary amylase after bladder‐drained pancreas transplantation
Authors: Nankivell B. J. , Allen R. D. M. , Bell B. , Taylor N. , Wilson T. , Grierson J. M. , Greenberg M. , Chapman J. R.
Published: September 2024

Urinary amylase activity (UA) was evaluated in 14 diabetic patients receiving bladder‐drained whole pancreas transplants. Amylase was dependent upon pH with optimal activity at pH 7. Increasing acidity led to a substantial loss of measured UA (45% remaining at pH 4, 73% at pH 5, 86% at pH 6, p < 0.001); however, UA was stable at room temperature if the pH was kept constant. On the day after transplantation, a transient peak in UA was followed by a trough lasting a median of 3 days. Thereafter the UA rose steadily, with the rate of rise being faster if the pancreas donor was less than 30 years of age (p < 0.05). Maximal UA values were observed between 3‐6 months after transplantation. High protein and fat liquid test meals, designed to stimulate exocrine secretion, produced an 83% rise in UA (p = 0.02), which was not observed when water was given (n = 8, p = 0.007, differences at 1 hour). Fasting for 17.6 ± 2.1 h (mean ± SEM) produced a 29 ± 6% fall in 24‐h UA, without any measurable change in other parameters of renal or pancreatic function. A fall of 50% in 24‐h UA over 7 d was compared with pancreas biopsy (n = 40) for predicting rejection, and showed a sensitivity of 60% and a specificity of 93%. In 3 patients a false‐negative result occurred in the first few days after transplantation at a time when the UA failed to rise as normally expected. Understanding and eliminating some of the factors which cause variability in UA may improve the interpretation of 24‐h UA measurements in bladder‐drained pancreas allografts.
Asecretory myeloma in a renal transplant recipient
Authors: Bowen P. Allen , Caruana Ralph J. , Pantazis Cooley , Humphries Arthur L.
Published: September 2024

We report the diagnostic and therapeutic problems of a patient who developed an asecretory, widely metastatic myeloma 4 years after renal transplantation. B‐ccll lymphoproliferative disorders are well‐described in the setting of organ transplantation but the occurrence of myeloma is decidedly rare. While the nature of the association between this patient's myeloma and the immunosuppressive regimen received is unclear, the history of clinical transplantation suggests that clinicians may be faced with changing patterns of neoplasia with advances in immunosuppression.
Membranous nephropathy in renal allograft recipients: A report of 11 cases
Authors: Swan Suzanne K. , Schnell Susan , Houghton Donald C. , Barry John M. , Bennett William M.
Published: September 2024

Membranous glomerulopathy is the most common form of de novo glomerulonephritis in renal transplant recipients. Eleven patients with allograft membranous nephropathy were identified at our institution during a 78‐month period. Various parameters used to categorize these patients included recipient age, gender, immunosuppression regimen, clinical course, etiology of end‐stage renal disease, donor status, and onset of proteinuria relative to time of transplant. All patients with membranous glomerulopathy in our series presented with nephrotic‐range proteinuria and subsequently underwent percutaneous allograft biopsy. Features of chronic rejection were found in 10 of 11 patients, ranging from mild to moderate, in addition to the membranous changes. There was no correlation between the severity of rejection and the extent of membranous involvement histologically. Due to its frequency and associated complications, the pathogenesis of allograft membranous nephropathy warrants further study.
Quality of life after liver transplantation
Authors: Küchler Thomas , Kober Bernd , Broelsch Chrlstoph , Kremer Bernd , Henne‐Bruns Doris
Published: September 2024

Because of the increasing number of liver transplantations with longer periods of transplant function, there is a growing need for quality of life research in this field. (see: Consensus Conference on Quality of Life Assessment in Surgery, 1989). In addition to morbidity, mortality and rehabilitation, parameters of “Quality of Life” are evaluated: the patient's rating of his subjective physical symptoms, psychological condition (anxiety, depression and mental adjustment), social reintegration and life satisfaction. Using the methods developed by the Hamburg study group on “Quality of Life in Surgery” 38 liver transplantation patients at the University of Chicago (cross‐sectional‐study with control groups of patients with chronic liver disease as well as healthy individuals) and 29 patients at the University Clinic of Hamburg (longitudinal study with points of evaluation before and 3, 6, 12, 24 and 36 months after transplantation) have been evaluated. First results: 1. All successfully transplanted patients show a significant postoperative increase of their overall quality of life. 2. The psychological parameters of quality of life are only partly correlated with physical symptoms. 3. There is a high correlation between rejection episodes and the decrease of all quality of life parameters. 4. In both samples men have a lower quality of life than women. 5. Preoperative depression and lack of social support might be considered as being possible risk factors for long‐term survival. 6. Long‐term survivors rate their quality of life significantly higher than patients with chronic liver disease and despite persisting somatic restrictions, as high as healthy controls.
Concentrations of cyclosporine‐A and its metabolites in transplanted human kidney tissue during rejection and stable graft function
Authors: Hanas E. , Tufveson G. , Lindgren P.‐G. , Sjöberg O. , Tötterman T. H.
Published: September 2024

The concentrations of parent cyclosporine‐A (CyA) and total cyclosporine‐like material (CyA plus its major metabolites) were measured in kidney allograft tissue and whole blood of 37 patients. Kidney tissue obtained through ultrasound‐guided intermediate‐sized biopsy was extracted and drug levels were determined by three different radioimmunoassays. The (issue concentration of native CyA was found to be decreased in acute rejection (n = 16) compared with stable graft function (n = 22) using two independent assays (p = 0.038 and p = 0.019, respectively). The tissue levels of total cyclosporine‐like material were not different (p = 0.053). Blood cyclosporine determinations did not reveal any differences between the two patient groups. Parallel biopsies were taken from the kidney cortex and medulla in 12 patients. CyA levels were similar in the two tissue compartments. Finally, the ratio of total cyclosporine‐like material to parent CyA was determined in the kidney biopsies and blood of 15 patients. A significant accumulation of the parent CyA molecule was demonstrated in kidney tissue compared with blood (p < 0.003). Our results indicate that renal tissue and peripheral blood represent different drug compartments and that local mechanisms may regulate the CyA levels. Patients with low concentrations of CyA in the grafted kidney tissue are at risk for acute rejection.