bluuebunny/crossref_metadata_2025 huggingface dataset:
Cadaver renal transplantation in children: Long‐term impact of new immunosuppressive strategies
Authors: Ettenger Robert B. , Rosenthal J. Thomas , Marik Jennifer , Malekzadeh Mohammed , Grimm Paul C. , Salusky Isidro B. , Kamil Elaine S. , Fine Richard N.
Published: September 2024

We examined the effects of sequential immunosuppression on pediatric cadaveric renal transplantation. In both primary transplantation and retransplantation, graft outcome was significantly improved in patients receiving sequential immunosuppression. Allograft function, as determined by serum creatinine levels, was good in long‐term cyclosporine (CsA)‐treated patients, but tended to erode slightly over time; this erosion did not differ from that seen in allograft recipients not treated with CsA. CsA dosing and levels were higher in children 1‐12 years than in older recipients. Prednisone dosages were significantly lower in young CsA‐treated children when compared with recipients not on CsA during the 1 yr after transplantation. Hypercholesterolemia and medication non‐compliance continued to be long‐term problems under CsA immunosuppression, despite lower corticosteroid requirements. Non‐compliance was particularly common in adolescents. We conclude that dramatically improved cadaver graft outcome is achievable in children using sequential immunosuppression, but formidable obstacles remain to full medical rehabilitation.
Growth after renal transplantation – A potential role for growth hormone therapy
Authors: Kamil Elaine S. , Yadin Ora , Ettenger Robert B. , Boechat M. Ines , Pyke‐Grimm Kimberly , Nelson Pauline A. , Lippe Barbara M. , Fine Richard N.
Published: September 2024

We treated 9 stable, growth‐retarded renal transplant recipients with either thrice weekly or daily subcutaneous rhGH for 12 to 36 months. The annualized growth velocity during the 1st year of rhGH therapy was significantly improved over that obtained in the preceding year (2.5 ± 2.1 versus 5.7 ± 2.7 cm/yr, p < 0.0001). Bone age increased no more rapidly than did chronological age. There was no significant increase in the mean fasting glucose and insulin levels, and renal function was well preserved during the treatment period. The incidence of rejection episodes in these patients was similar during the treatment period to the equivalent period prior to rhGH treatment. We examined the medical records of 74 cyclosporin (CsA)‐treated recipients of cadaveric renal allografts at UCLA from August 1984 to August 1989 and determined their height and weight standard deviation scores (SDS) over the first 2 yr post‐transplant. The children less than 12 yr of age exhibited improvement in height SDS scores in this time period from –2.16 ± 1.26 to –1.75 ± 1.04. The older recipients fared less well. While the recently transplanted, younger children appear to have improved growth over that previously reported, long‐term follow‐up will be needed. Treatment with rhGH in these few renal transplant recipients appeared to be safe and efficacious. Larger, controlled clinical trials in selected, growth‐retarded renal transplant recipients should be performed before the use of rhGH can be recommended.
OKT3 and viral disease in pediatric liver transplant recipients
Authors: III James S. Bowman , Green Michael , Scantlebury Velma P. , Todo Saturo , Tzakis Andreas , Iwatsuki Shunzaburo , Douglas Laura , Starzl Thomas E.
Published: September 2024

Seventy‐four consecutive pediatric liver transplant recipients were reviewed to assess the effect of the monoclonal anti‐T‐lymphocyte antibody OKT3 on subsequent viral infection (9 patients were excluded due to postoperative demise during the 1st week). Twenty‐two patients received OKT3 in addition to standard cyclosporine‐prednisone immunosuppression for either steroid‐resistant acute rejection (18) or to facilitate reduction of cyclosporine due to severe renal impairment (4). Invasive infections were diagnosed by histology or culture in tissue biopsies or bronchoalveolar lavage specimens. The overall incidence of viral infection was 58%, half of which was due to cytomegalovirus (CMV). Invasive viral disease was associated with increased mortality (37% vs. 3% p = 0.001). Viral‐related deaths were due to CMV (5), disseminated adenovirus (3), disseminated enterovirus (1) and respiratory syncytial viral pneumonia (1). The use of OKT3 was associated with increased viral disease (59% vs. 33% p = 0.04) and invasive primary CMV disease (58% vs. 19% p = 0.04). Trends were observed toward increased overall viral infection (73% vs. 51% p = 0.08), primary CMV infection (58% vs. 25% p = 0.08) and overall mortality (27% vs. 9% p = 0.08) following OKT3 therapy. We conclude that pediatric liver transplant recipients who require OKT3 therapy may be at increased risk for invasive viral disease and especially invasive primary CMV disease.
Sequential OKT3 and cyclosporine after heart transplantation: A randomized study with single and cyclic OKT3
Authors: Balk A. H. M. M. , Simoons M. L. , Jutte N. H. P. M. , Brouwer M. L. , Meeter KJ. , Mochtar B. , Weimar W.
Published: September 2024

The incidence of cardiac allograft rejection and the occurrence of renal insufficiency in the early postoperative period were compared in patients randomly allocated to receive either sequential OKT3 plus azathioprine and cyclosporine or to cyclosporine alone. Both groups were in addition on low‐dose steroids. Thirty‐three patients received OKT3 and in 10 of them a second course of OKT3 was given 3 weeks thereafter, regardless of the presence or absence of allograft rejection. Cyclosporine alone was given to 33 patients also. There was no significant difference in the number of acute rejections per patient in the OKT3‐versus cyclosporine‐treated patients (1.33 vs 1.36), nor in the freedom from rejection at 1, 3 and 6 months: 80%, 31% and 28% vs 66%, 33% and 27% respectively. No difference in freedom from rejection was found between patients who received single versus cyclic doses of OKT3. In the OKT3‐treated patients there were no nephrological problems. In the cyclosporine group median serum creatinine levels increased from 115 to 208 μmol/l in the 1st postoperative wk. There were no serious side‐effects during the first course of OKT3. In the 10 patients who received a second course of OKT3 side‐effects were badly tolerated, although not hemodynamically significant or life‐threathening. When the freedom from rejection in the OKT3 group was compared to the results in our first 32 cardiac recipients who also received cyclosporine and low‐dose steroids there appeared to be a significant (p < 0.001) delay in the occurrence of the first rejection. This delay was not significantly different in the randomized concurrent controls. This supports the need to conduct randomized trials for the comparison of immunosuppressive regimens. OKT3 facilitated patient care by preventing nephrological problems but did not reduce the incidence of cardiac allograft rejection.
Invasive Candida albicans infections in orthotopic liver graft recipients. Incidence and risk‐factors
Authors: Tollemar Jan , Ericzon Bo‐Gôran
Published: September 2024

In 56 consecutive liver transplantations performed in 50 patients, 13 patients had proven disseminated fungal infection (FI) by Candida albicans and 5 more patients had probable FI. The incidence of FI varied between 26% and 36%, depending on whether probable FI was included or not. During the first 10 weeks, 9 out of 13 (69%) patients with proven FI died compared to 2 of the 32 (6%) patients without FI (p < 0.001). One‐year patient survival was significantly lower for proven infected patients compared to non‐infected patients, 31% and 94%, respectively (p < 0.0001). Significant risk factors for FI in multivariate logistic regression analysis at the time of transplantation were long operation time (p < 0.01), male liver donors (p < 0.01), and poor pretransplant liver function as assessed by high bilirubin levels (p < 0.05). Ten days after the transplantation in multivariate analysis with initial and 10 d time rolled factors, long first graft transplantation time (p < 0.02) and long post‐transplant operative time (p < 0.05) were significant risk factors.
Bilateral nephrectomy for posttransplant erythrocytosis – indications and results
Authors: Garvin Paul J. , Reese Jeffrey C. , Lindsey Lisa , Aridge Della L. , Domoto Douglas T. , Ballal Sudarshan
Published: September 2024

To determine the incidence of posttransplant erythrocytosis (PTE) in the cyclosporine era, as well as the role of the native kidneys in its causation, a retrospective chart analysis of 292 consecutive renal allograft recipients with stable renal function for ≥ 3 months was performed. PTE was defined as two consecutive hematocrits ≥ 51 vols %, after known secondary causes were excluded. Twenty‐five patients (8.6%) developed erythrocytosis from 2.5 to 60 months (mean = 10.1 months) posttransplant. In 16 patients with a mean peak Hct of 56.7 vols %, the erythrocytosis resolved, either spontaneously (11) or due to a decrease in renal function (5), after a mean of 9.5 months. In this group, there was one thromboembolic event and 4 patients underwent phlebotomies for persistent Hcts > 55%. Of 9 patients with persistent erythrocytosis, 7 had elevated peripheral erythropoietin levels and underwent selective venous sampling which indicated excess native kidney erythropoietin secretion (mean native to IVC erythropoietin ratio = 1.8). Due to frequent phlebotomies (mean = 3.4), thromboembolic events (n = 2), and/or coexistent high renin output hypertension (1), 5 patients underwent bilatral native nephrectomy resulting in a decrease in the hematocrit (pre–nephrectomy = 59.4 vols % versus 3 months post‐nephrectomy = 39.9 vols %) and peripheral erythropoietin levels (pre–nephrectomy = 38.2 mμ/ml versus post‐nephrectomy = 13.6 mμ/ml), which persisted throughout the follow‐up period (mean = 17.0 months). This retrospective study indicates that PTE remains a problem in the cyclosporine era. Inappropriate erythropoietin production by the native kidneys is a common etiologic factor and, in these cases, bilateral nephrectomy is curative.
Ruptured splenic artery aneurysm: An unusual late complication following pancreas transplantation
Authors: Reed Alan , Sollinger Hans W. , Knechtle Stuart J. , D'Alessandro Anthony M. , Kalayoglu Munci , Pirsch John D. , Belzer Folkert O.
Published: September 2024

The vascular complications following pancreas transplantation have been well described and largely involve either re‐operation for hemorrhage or vascular thrombosis. We describe herein a ruptured aneurysm of the transplanted splenic artery 6 years following surgery in a nonfunctioning graft as an unusual vascular complication.
Early leukemia, seropositivity for several herpes viruses and chronic graft‐versus‐host disease are associated with decreased incidence of relapse after allogenic bone marrow transplantation
Authors: Boström Lennart , Ringdén Olle , Nilsson Bo , Jacobson Niels , Zwaan Ferry ,   Leukaemia Working Party of the European Group for Bone Marrow Transplantation
Published: September 2024

Two‐hundred‐and‐ninety‐seven bone marrow transplantation (BMT) recipients with hematological malignancies, surviving at least 90 days after BMT, were reported from 17 European teams. The 3‐year cumulative incidence of relapse after BMT was 28%. In Cox regression multivariate analysis, statistically significant risk‐factors for relapse were: patients beyond first remission of acute leukemia or first chronic phase of chronic myeloid leukemia (intermediate or advanced leukemia) (p = 0.003), and patients seropositive to 0‐2 different herpes viruses compared to 3‐4 prior to BMT (p = 0.005). Absence of chronic graft‐versus‐host disease was borderline significant (p = 0.053). The cumulative patient survival was 58% at 3 yr after BMT. Factors associated with poor patient survival were: recipient CMV seropositivity prior to BMT (p = 0.0008), a previous grade II–IV acute GVHD (p = 0.004), patients with intermediate or advanced leukemia (p = 0.004), low bone marrow cell dose (p = 0.007) and older recipient age (p = 0.03). The 3‐yr cumulative relapse‐free survival was 55% after BMT. Poor relapse‐free survival was correlated with intermediate or advanced leukemia (p = 0.0002), older recipient age (p = 0.003), a previous grade II–IV acute GVHD (p = 0.006) and low bone marrow cell dose (p = 0.01). To conclude: Early leukemia, seropositivity to several herpes viruses and chronic graft‐versus‐host disease (borderline), were associated with a decreased risk of relapse. However, seropositivity to several different herpes viruses was associated with an increased risk of acute GVHD which reduced survival. Thus, seropositivity to several herpes viruses does not influence survival or relapse‐free survival.
Sequential immunosuppression of renal allograft rejection
Authors: Ubhi Charanjeit S. , Lam For Tai , Lodge J. Peter A. , Giles Geoffrey R.
Published: September 2024

Cadaveric renal allografts are currently managed by primary cyclosporine monotherapy by the oral route. Monitoring of 62 renal allografts by fine needle aspiration cytology identified 19 grafts without evidence of rejection (Group A), 24 grafts with rejection which resolved with intravenous methylprednisolone (i.v.MP) (Group B) and 19 grafts with continuing rejection after i.v. MP (Group C). All Group A grafts were functioning at 3 months with cyclosporine monotherapy. Seven grafts of Group B received further steroids for rejection and 3 were lost. Patients in Group C were randomized to receive steroids or azathioprine, but ultimately all received triple therapy of cyclosporine, azathioprine and steroids, and 3 grafts were lost. Sequential immunosuppression according to need resulted in 90.3% and 79% graft survival with 96.8% and 90.3% patient survival at 1 or 2 years, respectively.
Role of duplex imaging and fine needle aspiration cytology of renal allografts in monitoring response to anti‐rejection therapy
Authors: Rajasekar Magaral R. , Lodge J. Peter A. , Irving Henry C. , Giles Geoffrey R.
Published: September 2024

The role of duplex imaging and fine‐needle aspiration cytology (FNAC) in monitoring the response to anti‐rejection therapy was investigated in 14 of the 22 rejection episodes which occurred in 30 renal allografts recipients. In 9 of these 14 episodes of rejection, with good resolution, both resistive (RI) and pulsatility (PI) indices decreased by significant proportions (p < 0.05). The FNAC scores also fell significantly with anti‐rejection therapy. In 5 other episodes of rejection where the graft continued to deteriorate there was no significant fall of RI and PI (p ≥ 0.2). In a small group of patients, both FNAC and Doppler predicted rejection. In conclusion, both duplex imaging and FNAC have a role in selection and optimal modulation of drugs in the treatment of acute renal allograft ejection.
Wound abscesses following retroperitoneal pancreas transplantation
Authors: Barker Rodney J. , Mayes James T. , Schulak James A.
Published: September 2024

We report the management of peri‐pancreas transplant abscesses in 7 recipients of combined pancreas and kidney transplants in whom the grafts were placed in the retroperitoneum. Five of 7 abscesses were polymicrobial in nature and 3 of 7 contained Candida albicans. Patient management included surgical drainage, wound closure over suction drains, and specific antimicrobial chemotherapy. In the cases of fungal infection, both amphotericin B and ketoconozol therapy were used without untoward effects, except for transient nephrotoxicity in 1 patient due to amphotericin administration. Six of 7 patients retained long‐term endocrine pancreas and renal function and healed their wounds, including all 3 patients with fungal infections. One of the latter patients, however, developed a recurrent retropubic fungal abscess that may have been a persistent occult infection.
Pancreatic pseudocyst formation following renal transplantation: A lethal development
Authors: Chapman William C. , Nylander William A. , Williams Lester F. , Richie Robert E.
Published: September 2024

In this retrospective study, extending from 1 January 1972 to 30 June 1988, we identified 10 patients who had pancreatitis and who developed pancreatic pseudocysts out of 1177 patients receiving renal transplants. Two patients had complete spontaneous resolution of their pseudocysts over 25 and 30 days of observation, while the remainder required operative intervention. Standard internal drainage was possible in only 1 of the 8 operated patients. This patient was followed with serial CT scans for more than 100 d prior to exploration. The remaining 7 patients had either thin cyst walls (N = 3) or infected cysts (N = 4) at operation (mean period of preoperative observation 36.5 d for thin‐walled cysts, 39 d for infected cysts) and therefore received external drainage. There were seven major complications in these 10 patients: 2 patients developed massive intraabdominal bleeding from splenic artery erosions, 1 had spontaneous rupture of a pancreatic pseudocyst, 1 patient developed a colocutaneous fistula, and 3 lost graft function. Overall mortality was 50%. Severe pancreatitis, sepsis, and multiple organ failure was the cause of death in 4 out of 5 deaths. Transplant recipients who develop pancreatitis and pancreatic pseudocysts should be managed with reduction of immunosuppressive therapy to maintenance levels, close observation for signs of sepsis and immediate aggressive management once this is present. In the stable patient, elective internal cyst drainage may not be possible until later than in the non‐immunosuppressed patient. This study represents the largest reported series of patients with pancreatic pseudocysts following renal transplantation and confirms the ominous nature of this complication in renal transplant recipients.
Concomitant reduction in urinary amylase and acute first‐phase insulin release predict pancreatic allograft transplant rejection in type I diabetic recipients
Authors: Henry Mitchell L. , Osei Kwame , O'Dorisio Thomas M. , Tesi Raymond J. , Ferguson Ronald M.
Published: September 2024

Decreased urinary amylase (UA) concentration has been advocated as an early marker for pancreatic allograft rejection in type I diabetic recipients. Since there is a dissociation between exocrine and endocrine pancreatic functions, we speculated that a specific beta cell marker is necessary to confirm the specificity and sensitivity of decreased UA as a marker for endocrine function. Because blunted acute first‐phase insulin release is regarded as an important predictor for future beta cell destruction, we evaluated the phases of insulin secretion to intravenous (i.v.) glucose (25 g) and glucagon (1 mg) in 9 type I diabetic pancreatic allograft recipients who had diagnosis of presumed pancreatic graft rejection based on UA alone. All the patients were normoglycemic and insulin‐independent at the time of the study. Despite remarkable depression (≥ 50–90%) in UA values in the subjects and normoglycemia, 5 patients had qualitatively and quantitatively normal acute first‐phase insulin release (Group 1) while the remaining 3 had blunted first‐phase insulin release (Group 2). While all the Group 1 patients have maintained normoglycemia and insulin‐independence for 6–44 months (average 18 months), Group 2 patients suffered pancreatic graft failure (2 rejection, 1 thrombosis). Our preliminary data demonstrated that progressive decline in UA alone does not necessarily reflect pancreatic endocrine failure. In contrast, blunted acute first‐phase insulin release in the face of decreased UA appears to be a harbinger of pancreatic graft failure.
A new scan pattern suggesting early donor‐specific rejection in recipients of donor‐specific transfusions
Authors: Mehta Rahul C. , Wilson Michael A. , Perlman Scott B. , Sollinger Hans W. , Pirsch John D. , Belzer Folkert O.
Published: September 2024

We describe a new scan pattern of acute rejection identified only in living‐related (LR) renal transplantation, specifically in the patients receiving donor‐specific transfusions (DST). The pattern is characterized by a normal post‐operative day‐1 scan, and later a scan which shows good perfusion and good extraction of the renal tubular agent I‐131‐OrthoIodo‐Hippurate (OIH) but decreased excretion of the OIH and with obvious renal stasis of the tracer. Correlation of clinical indicators of rejection, serum creatinine changes, and the success of anti‐rejection therapy support this new scan pattern as being the result of rejection. This pattern differs from that of acute tubular necrosis (ATN) in its temporal relationship to the transplant procedure, its clinical presentation and response to therapy, and the fact that seldom do living‐related recipients suffer ATN because of the coordination of donor and recipient operative procedures.
Pancreas transplantation: long‐term results
Authors: Caldara Rossana , Sanseverino Roberto , Lefrancois Nicole , Martin Xavier , Martinenghi Sabina , Dubernard Jean Michel
Published: September 2024

The rationale behind pancreatic transplantation is to provide a self‐regulated, endogenous source of insulin and other islet hormones, thus restoring normal metabolism with the ultimate goals of prevention, stabilization or reversal of secondary degenerative complications. We report clinical and metabolic data of 8 patients submitted to simultaneous kidney and pancreas transplantation in our institute, who had a pancreatic graft function for 4 (1 case) and 5 (7 cases) years. To assess the impact of transplanted pancreatic mass on long‐term function, we also included 10 patients from a comparative study between segmental pancreas transplantation (group A, 5 pts) and whole pancreas with enteric diversion transplantation (group B, 5 pts), who had pancreatic function for 2 and 3 yr. All patients are alive. Seven of these patients are off insulin, while one patient lost pancreatic function during an operation performed to correct an arterial stenosis of the graft. HbA1c levels were normal during the entire follow‐up period (5.2 ± 0.14% at 4 yr; 5.1 ± 0.6% at 5 yr). In 24‐hour metabolic profiles we observed near normal blood glucose levels, with good insulin release at 4 yr and a mild hyperglycemia at 5 yr (BG at 9 p.m.: 8.8 ± 1.3 mmol/l). OGTT performed in 5 patients, 4 yr after pancreas transplantation, showed an impaired glucose tolerance, while the same test performed at 5 yr, showed higher values (BG 120 minutes: 14.7 ± 0.2 mmol/l). Group A and group B patients are all alive, with good renal and pancreatic function. The same values of fasting blood glucose and HbA1c were observed at 2 and 3 yr, but an impaired glucose tolerance was observed in group A recipients during OGTT performed at the same time‐interval. Nerve conduction velocity improved in the post‐transplant period, but whether the improvement is due to treatment of uremia or to the normalization of glucose metabolism is difficult to determine. In the long term, we observed a stabilization of advanced retinopathy, present at the time of transplantation in most of our patients.
Cyclosporin A does not cause hyperlipidemia in kidney graft recipients
Authors: Traindl O. , Reading S. , Franz M. , Pohanka E. , Pidlich J. , Kovarik J.
Published: September 2024

The aim of this study was to compare total cholesterol and triglyceride levels in 281 kidney graft recipients with stable graft function and different immunosuppressive regimens. All patients had low‐dose prednisolone (mean daily dose 7.7 mg ± 4.8). In 57 patients immunosuppression consisted of prednisolone and azathioprine (Group A), 141 had prednisolone and cyclosporin A (Group B) and 83 were treated with prednisolone, azathioprine and cyclosporin A (Group C). There was no significant difference in daily prednisolone dose, sex, age, mean graft survival and proteinuria between the three groups. Cholesterol values for Groups A, B and C were 257 mg/dl, ± 69.6, 261 mg/dl, ± 70.2 and 247 mg/dl, ± 65.9, respectively. The triglyceride values for the groups A, B and C were 201 mg/dl, ± 199, 211 mg/dl, ± 139, and 220 mg/dl, ± 154. All values are the group means with their standard deviations. Comparison of the cholesterol and triglyceride values between the three treatment groups showed no significant differences. Importantly, no difference could be observed between patients receiving cyclosporin A and conventional therapy. We conclude that immunosuppression with cyclosporin A need not cause hyperlipidemia in the face of low‐dose prednisolone administration.
Renal allograft immunosuppression V: Glucose intolerance occurring in different immunosuppressive treatments
Authors: Isoniemi Helena
Published: September 2024

The incidence of posttransplant diabetes mellitus and abnormal glucose tolerance test has been investigated 2 years after cadaveric renal transplantation. The study group consisted of 98 out of 128 patients entering a prospective randomized trial who did not have type I or II diabetes at the time of transplantation. All patients were initially on triple therapy, i.e. on cyclosporin (CyA), azathioprine (Aza) and methylprednisolone (MP). After 10 weeks they were randomized into four different immunosuppressive treatment groups: one group continued with triple therapy and three other groups with different combinations of two drugs, i.e. with Aza and CyA, with Aza and MP and with CyA and MP. At 2 yr the graft survival was 80% and patient survival 87% for all patients, and for the non‐diabetic patients 83% and 90%, respectively. 7 of 98 (7%) patients without type I or type II diabetes mellitus at the time of transplantation developed posttransplant‐diabetes mellitus requiring drug therapy. 10 further patients had abnormal oral glucose tolerance test at 2 yr. All patients with posttransplant‐diabetes received methylprednisolone as part of their immunosuppressive treatment at the time when posttransplant‐diabetes manifested. Methylprednisolone was also included in the treatment regimen of every patient who had an impaired glucose tolerance test at 2 yr. None of the patients using Aza and CyA, without corticosteroids, had abnormalities in glucose metabolism. We conclude that if immunosuppressive treatment has a causative effect of posttransplant diabetes mellitus, it is accompanied rather by the use of steroids than with the use of low‐dose cyclosporin.
Combined kidney and auxiliary partial orthotopic liver transplantation in type I primary hyperoxaluria
Authors: Potaux L. , Saric J. , Janvier G. , Brunier G. , Morel D. , Larue J.R. , Aparicio M.
Published: September 2024

Combined kidney and hepatic transplantation which may treat the renal insufficiency, and correct the alanine glyoxalate aminotransferase deficiency responsible for the disease, seems to be the treatment of choice in type I primary hyperoxaluria. We report an original case of combined kidney and auxiliary partial orthotopic liver transplantation in this indication.
Racial differences in primary renal cadaveric allograft survival
Authors: Butkus Donald E. , Kirchner Kent A. , Krueger Ronald , Cruse Julius , Raju Seshadri
Published: September 2024

Blacks reportedly have poorer cadaveric renal allograft survival than whites. To evaluate racial differences in allograft survival and factors potentially contributing to those differences, we studied 100 consecutive primary renal cadaveric allograft recipients (61 black and 39 white), 48 of whom received conventional immunosuppression (CI), with prednisone and azathioprine and 52 of whom received a triple‐drug regimen with prednisone, azathioprine and cyclosporin (CSA). There were no significant differences in patient survival at 1 year. Overall 1‐yr allograft survival was significantly less in blacks than whites (64% vs 90%, p = < 0.01) and was most pronounced with CI, (50% vs 86%, p = < 0.05). In blacks receiving CI, allograft survival was correlated with number of HLA antigens matched and was significantly worse in black males receiving zero Ag‐matched kidneys from white donors (23%; p = < 0.025). CSA improved allograft survival only in blacks (from 50% to 82%, p = < 0.025) as opposed to 92% in whites (NS) and the effects of poor HLA match and male sex on graft survival in blacks were eliminated. Neither etiology of ESRD, number of pre‐transplant transfusions, recipient age, pre‐transplant PRA, donor race, delayed onset of allograft function or Lewis antigen match or status, affected outcome. In summary, primary renal cadaveric allograft survival in blacks with conventional immunosuppression is inferior to that in whites, but is greatly improved, although still not equivalent, with cyclosporin.
Successful pancreas and renal transplantations from a donor who died of cyanide poisoning
Authors: Hantson P. , Squifflet J. P. , Vekemans M. C. , Evrard P. , Hassoun A. , Sepulchre M. A. , De Ceuninck P. , Mahieu P.
Published: September 2024

We report successful pancreas and renal transplantations from a brain‐dead victim of cyanide poisoning. A 41‐year‐old diabetic man with pre‐end‐stage renal failure received the pancreas and the right kidney. The left kidney was implanted in a 27‐yr‐old woman with chronic renal failure. Postoperative evolution was not complicated. At 6 months, grafts function remains excellent. The management of cyanide poisoning, especially in the setting of organ donation, is discussed.
The effect of aprotinin on blood product requirements during orthotopic liver transplantation
Authors: Bechstein Wolf O. , Riess Hanno , Neuhaus Peter , Himmelreich Gabriele , Steffen Rudolf , Slama Klaus‐Juergen , Rossaint Rolf , Blumhardt Gerhard
Published: September 2024

The effect of aprotinin, a protease inhibiting agent, on blood product requirements in liver transplantation was investigated in a prospective, open, non‐randomized study. From September 1988 until January 1990, 60 consecutive liver transplantations were performed in 56 adult recipients. The first 10 patients (group I) were treated without aprotinin; for the next 50 transplantations (group II) aprotinin was applied in a total dose of 1.5‐2.0 mio units i.v. intraoperatively. During primary transplants a mean of 9.7 ± 5.5 units packed red blood cells (RBC) were substituted in group I vs. 7.5 ± 4.6 units RBC in group II (n.s.). Fresh frozen plasma was substituted with 10.4 ± 6.2 (group I) vs. 9.1 ± 6.7 (group II) units (n.s.). Adverse effects of aprotinin were not observed. The trend towards decreased transfusion requirements and the observation of reduced fibrinolysis prompted us to continue routine use of aprotinin in liver transplantation.
Successful repair of a transplant renal artery mycotic pseudoaneurysm
Authors: Sánchez Luis A. , Schechner Richard , Greenstein Stuart M. , Tellis Vivian A.
Published: September 2024

Mycotic arterial aneurysms and pseudoaneurysms are uncommon vascular complications of renal transplantation. These vascular infections usually present with severe hemorrhage, and are often associated with high morbidity and mortality. The traditional treatment for these aneurysms has been debridement and ligation of the affected artery, with resulting loss of the renal allograft in most cases. We present a case of a pseudoaneurysm in a transplant renal artery following a Candida albicans infection. The pseudoaneurysm was diagnosed prior to rupture and was successfully treated by repairing the arterial defect using a greater saphenous vein patch, with preservation of the renal allograft. A review of the literature is included.
Myocardial preservation in brain‐dead patients maintained with vasopressin and catecholamine
Authors: Okamoto Ken , Kinoshita Yoshihro , Yoshioka Toshlharu , Kawaguchi Naomasa , Onishi Shunzo , Sugimoto Tsuyoshi
Published: September 2024

In order to examine hemodynamic and ultrastructural changes of the myocardium, 37 brain‐dead patients were divided into three groups by circulatory support: (1) epinephrine alone (group A, n= 12), (2) arginine vasopressin (ADH) and epinephrine (group B, n= 12), (3) ADH and dopamine (group C, n= 13). In group A, a large dose of epinephrine failed to improve initial circulatory instability and to prevent hemodynamic deterioration and eventual cardiac arrest occurring within 3 days. In contrast, the systemic circulation in groups B and C was rapidly improved, and a small dose of epinephrine or dopamine could steadily maintain normal hemodynamics until the ventilator was disconnected in 21 of 25 patients. The mean duration of initial circulatory instability in group B was significantly shorter than that in group C. Myocardial ultrastructure of biopsy specimen was semiquantitativcly analyzed in all the groups. In group A, swollen mitochondria and nuclei, intracellular edema and dilated sarcoplasmic reticulum were marked soon after brain death. Irreversible changes such as disrupted mitochondria, pyknosis of nucleus and contraction bands of myofibrils were noted by the 3rd day. In groups B and C, the myocardial changes were mild and irreversible changes in organelles were rare throughout this study. Especially, the myocardial ultrastructure in group B was almost normal for 2 weeks. The degree of ultrastructural changes was related to the duration of circulatory instability, which suggested that the major impairment of the heart might result from instability of systemic circulation after brain death. Evidence from this study suggested that our method with the combined administration of ADH and epinephrine might be beneficial for procurement of suitable heart donors.
A case control study of renal transplantation in patients with type I diabetes
Authors: Munson* Jennifer L. , Bennett William M. , Barry John M. , Norman Douglas J.
Published: September 2024

A case control study was undertaken comparing the outcome of 208 renal allografts transplanted into diabetic recipients with those transplanted into an appropriately matched group of non‐diabetic recipients. In each group there were 151 cadaver, 21 two‐haplotype identical, 35 one‐haplotype identical, and one zero‐haplotype identical living‐related grafts. For the entire group of diabetics, 1‐ and 5‐year graft survivals were 71.3% and 46%. Graft survivals for the non‐diabetic recipients at 1 and 5 yr were 81.8% and 57.8% (p<0.05). In all patient subgroups divided according to the donor source, the graft and patient survival rates for the non‐diabetic recipients exceeded those of the diabetic recipients. One‐ and 5‐yr diabetic patient survivals were 90% and 70%, and for the non‐diabetics they were 97% and 95%, respectively (p< 0.001). There were 40 deaths among the diabetics and 15 among the non‐diabetics. Cardiovascular disease was the major cause of death in the diabetics, accounting for 40% of the deaths. In addition, allograft loss due to patient death was a significant cause of graft loss in the diabetic group, 24 grafts (28%). Seven grafts (10%) were lost due to patient death in the non‐diabetic group (p<0.05). Post‐transplant, diabetic recipients had a greater incidence of stroke, angina, myocardial infarction, peripheral vascular disease, urinary tract infections (p<0.01 for each), and wound infections (p<0.05). Despite improvements in results with renal transplantation in diabetics, our study indicates that the results do not approach those of an appropriately matched group of non‐diabetics. With their higher incidence of complications, the management of diabetics will continue to be a challenge.
Early aggressive management for the prevention of renal allograft loss and patient mortality following major urologic complications
Authors: Waltzer W. C. , Frischer Z. , Shabtai M. , Jao S. , Rapaport F. T.
Published: September 2024

In 219 renal allograft transplants performed at the University Hospital, State University of New York at Stony Brook, 24 urological complications were encountered (10.8%). There were 12 episodes of ureteral obstruction and 8 of ureteral fistulas with extravasation. Four patients had bladder fistulas. In all patients, early surgical corrective procedures were employed. No graft or patient losses occurred as a result of these complications or of their treatment (0% mortality; 0% graft loss). Based on this as well as others' experience (1–24), it appears that early aggressive diagnosis and surgical treatment, combined with urological expertise, are a central requirement for the avoidance of graft loss or mortality following urological complications.
Renal artery aneurysm in a living‐related kidney donor: A report of two cases
Authors: Shapiro Ron , Scantlebury Velma P. , Zajko Albert B. , Simmons Richard L.
Published: September 2024

Saccular aneurysms of two living‐related donor renal arteries were excised and the kidneys used for successful transplantation.
Acute focal bacterial nephritis in a kidney transplant
Authors: Levy David A. , Seftel Allen , Schulak James A.
Published: September 2024

Acute urinary tract infections and graft pyelonephritis are common complications in kidney transplantation. We report a case of a complex renal allograft infection that developed into acute focal bacterial nephritis (lobar nephroma). The diagnosis was made by both ultrasound and computed tomographic imaging and final bacterial isolation required needle aspiration and biopsy. The patient, who developed severe renal dysfunction as a result of this infection, recovered after appropriate antibiotic therapy. Follow‐up sonographic examination revealed a residual area of scarring and her renal function has stabilized but has not returned to her pre‐infection baseline. This case illustrates the importance of radiologic imaging and tissue biopsy in order to make the diagnosis and to render appropriate therapy for acute focal bacterial nephritis in a kidney transplant.
Management of the multiple organ donor
Authors: Fisher Robert A. , Alexander J. Wesley
Published: September 2024

The identification and management of the brain‐dead multiple organ donor should be treated as a critical care subspeciality of medicine because of the life‐saving value of organ donation to transplant recipients. The growing mortality rate amongst persons awaiting a transplant will negate future advances in allograft survival if donor organ availability does not improve. In this review we outline the problems and present solutions in the areas of donor recognition; medical, legal and legislative issues of brain death; and the request and referral for donation. The scientific and practical strategies of the transition from brain injury‐oriented care to donor organ maintenance are reviewed in depth.
Posterior subcapsular cataract after kidney transplantation
Authors: Virga G. , Maresca M. C. , Calconi G. , Gatti P. L. , Rosa C. Dalla , Falco G. Di , Chlara G. , Valtorta F. , Boschi G. , Vianello A.
Published: September 2024

79 kidney transplanted patients whose grafts functioned for at least 1 year (mean follow‐up 44.4, range 14‐153 months) were examined for posterior subcapsular cataract (PSC) after kidney transplantation in a search for factors able to predict the development of this disease. PSC developed in 36 patients, was symptomatic in about half of them and required lens removal in 4 cases. There were no differences in the prevalence of the disease with regard to the immunosuppressive treatments (steroids + azathioprine; steroids + CsA; steroids + CsA + azathioprine) or pre‐transplant steroid therapy. We found that total amounts of steroids, azathioprine and CsA in the 1st yr after transplantation, number of steroid boli in the 1st yr after transplantation, age, dialytic age, and renal function at the end of the 1st yr after transplantation were not explanatory factors for PSC. An individual susceptibility linked to some HLA‐A, B antigens was not identified. A protective role against steroid‐induced PSC for low doses of aspirin was not demonstrated. PSC after kidney transplantation remains a puzzling problem.
An evaluation of the cyclosporine parent‐compound‐specific whole blood TDx assay
Authors: Pescovitz Mark D. , Book Benita K. , Pollard Stephen G. , Milgrom Martin L. , Leapman Stephen B. , Filo Ronald S.
Published: September 2024

The new Abbott TDx cyclosporine parent‐compound‐specific fluorescence polarization immunoassay (TDxP) was evaluated and compared to the cyclosporine‐and‐metabolites‐specific TDx (TDxT) and a cyclosporine parent‐compound‐specific radioimmunoassay (RIA) (Sandimmun‐Kit, INCSTAR). The TDxP assay was linear within the range of 31 to 1600 ng/ml (r = 0.985) with a lower limit of detection of < 31 ng/ml. The TDxP had excellent intra‐ and interassay reproducibility (CV = 1.2 to 4.5) that was significantly better than that of the radioimmunoassay. 230 whole blood samples obtained from 65 kidney, 19 liver, and 8 pancreas transplant recipients were analyzed with each of the three assay methods. TDxP had a much stronger correlation with the RIA than did TDxT (r = 0.95 versus 0.83). The difference between the correlations was greatest for the liver and pancreas recipients. The mean ratio of the cyclosporine level determined by TDxP to RIA was 1.0 versus 2.4 for TDxT to RIA. The new TDxP assay provides results equal to a parent‐compound‐specific RIA but with the added advantages of decreased sample turn‐around time and improved intra‐ and interassay coefficients of variation.
Mycobacterial infection after liver transplantation: A report of three cases and review of the literature
Authors: Sterneck Martina , Ferrell Linda , Ascher Nancy , Roberts John , Lake John
Published: September 2024

We report 3 cases of tuberculosis occurring after liver transplantation. Two patients presented with fever, 2 and 8 months after transplantation, while the 3rd patient was asymptomatic. In the 1st case, disseminated disease developed rapidly; the other 2 patients presented with pulmonary disease only. In all patients the mycobacterial infection was treated with INH, rifampin and pyrazinamide, as well as ethambutol in the 1st case. Anti‐tuberculous treatment was complicated in the 1st case by development of severe INH hepatitis after 9 months, necessitating drug withdrawal. The prophylaxis, diagnosis and treatment of mycobacterial infections in liver transplant recipients are discussed.
Predictive value of doppler ultrasonography in renal transplantation
Authors: Germain Michael J. , Lipkowitz George S. , Patel Jehangir , Hampf Frederick
Published: September 2024

During a 17‐month period, 268 doppler sonography studies were performed on 46 consecutive renal transplant patients. There were 35 episodes of acute rejection in 10 patients, 8 episodes of delayed function and 47 episodes of high cyclosporine levels (greater than 800 ng/dl by TDX method) in 21 patients. Defining an abnormal resistive index (RI) as greater than 0.8 or a 20% increase above baseline, the test has a specificity of 99% and a sensitivity of 94% in the 1st month post‐transplant and had an overall predictive value of 99%. Episodes of high cyclosporine levels ranging from 800 to 1650 ng/dl did not correlate with a high RI except in one circumstance with concurrent acute rejection. Within the 1st month post‐transplant, only 1 false‐negative study occurred. An additional 8 false‐negative studies occurred beyond 1 month post‐transplant. Patients with delayed function are separated into three groups based on the doppler ultrasounds: Group I, patients with an accelerated acute rejection with high RI (N = 2); Group II, patients with true ischemic acute tubular necrosis with normal RI (N = 2); and Group III, patients with possible immunologically‐mediated delayed function with intermediate RI between 0.6 and 0.8 (N = 4). Doppler ultrasound is a useful ancillary test to confirm the clinical suspicion of acute rejection. Since high cyclosporine levels do not cause an increase in RI, doppler ultrasound may help to avoid confusion between acute rejection and cyclosporine toxicity. Additionally, this test may offer insight into the cause of early post‐transplant renal dysfunction.
CD3+ and CD19+ lymphocyte depletion following a course of anti‐lymphocyte globulin in renal allograft recipients
Authors: Mordacchini M. , Calconi G. , Falco G. Di , Innocenti P. , Maresca M. C. , Mastrosimone S. , Mercatante M. R. , Nieri A.
Published: September 2024

The T‐cell and B‐cell monitoring in peripheral blood of 13 renal allograft recipients, who received a prophylactic course of anti‐lymphocyte globulin (ALG) in the early post‐transplant period, showed a selective effect of ALG on CD3+ cells. The adjustment of ALG dosages, in order to maintain the CD3+ cell number below 10 cells/mm3 (analogously to OKT3 treatment) has provided a rejection‐free course of 3 months in all but one the patients of the study, without increasing the risk of ALG immunosuppression.
Optimizing the immediate posttransplant prednisone dose – A prospective randomized trial
Authors: Matas A. J. , Payne W. D. , Gillingham K. J. , Dunn D. L. , Sutherland D. E. R. , Najarian J. S.
Published: September 2024

Adult recipients of HLA non‐identical living‐related donor (LRD) kidneys were stratified into low‐risk and high‐risk groups and randomized to receive high‐dose (starting at 1 mg/kg) vs. low‐dose (starting at 30 mg/day) prednisone. Patient and graft survival and 1‐year creatinine levels for the two groups were identical. The low‐dose group had more rejections; only 38% of low‐dose patients were rejection‐free vs. 65% of high‐dose patients (p < 0.05). In part, because of the increased incidence of rejection, the low‐dose group had significantly more readmissions (p = 0.04). We conclude that, in LRD transplant recipients, low‐dose and high‐dose prednisone protocols are associated with equivalent graft and patient survival. However, there is an increased incidence of rejection and readmissions with low‐dose prednisone.
Effect of storage temperature on early graft function following liver transplantation
Authors: Morino Mario , Adam René , Diamond Tom , Castaing Denis , Reynes Michel , Bismuth Henri
Published: September 2024

The effect of storage temperature on early graft function following liver transplantation was investigated by analyzing the results following transplantation during three periods in which different techniques for graft storage were used. The techniques involved ice‐packing (period 1), storage in a standard operating room refrigerator without ice‐packing (period 2) and storage in an accurately controlled refrigerator without ice‐packing (period 3). In period 2 there was a significantly higher incidence of histological lesions, primary non‐function and retransplantation compared to periods 1 and 3. It was concluded that this was due to inaccurate control of the standard refrigerator in period 2, thus allowing the temperature of the graft to increase, while in periods 1 and 3 the graft temperature was kept close to 4°C by ice‐packing and accurate refrigerator control, respectively. These results demonstrate that accurate control of storage temperature is important in terms of subsequent graft function. This may become more important as storage times are progressively increased with the use of UW solution.