bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting erythropoietin production and correction of anemia in kidney transplant recipients
Authors: Moore Linda W. , Smith Susan O. , Winsett Rebecca P. , Acchlardo Sergio R. , Gaber A. Osama
Published: September 2024

Anemia does not correct in many kidney transplant recipients, probably due to iron deficiency or inadequate erythropoietin (Epo) production. We evaluated effects of iron (Fe) availability on correction. of anemia in renal transplant recipients and sought to characterize patterns of early Epo production by transplanted kidneys as related to peritransplant factors. In a prospective randomized trial, 51 consecutive renal transplant patients were followed for 6 months. Epo was measured on days 0, 3, 14, 48 and 168 posttransplantation. Fe status was monitored on days 14, 48 and 168. Pts were randomized at day 14 based on Fe status. Iron‐deficient (FeD) patients (n = 24) were randomized to receive daily Fe supplementation (FeDs, n=12) or no supplementation (FeDns, n = 12). Those with normal Fe status (FeN, n=27) were followed as controls. No differences were found between groups at day 0 for Hct, Cr, Epo, age, dialysis history, or type of donor. Day 3 Creatinine and Het were similar among groups, while Epo was significantly higher in FeD groups vs FeN (p<0.004), and continued higher at 6 months. Though each pt improved Hct, most FeDns and FeN were anemic and Fe deficient at 6 months while all FeDs patients had corrected their anemia (p≤0.009) and Fe status. Four FeDs patients developed polycythemia. Epo production correlated inversely to cold ischemia time in cadaver renal allografts (p<0.008). Donor age was significantly lower in the FeDs group than other groups (p≤0.009) and was negatively correlated to Epo production in the 51 patients at day 3 (p≤0.08). Fe deficiency worsens or develops during the first 6 months following transplantation in the majority of patients and Fe supplementation accelerates the correction of anemia. following renal transplantation. Younger donors and less cold ischemia time potentiate the production of Epo by transplanted kidneys and, ultimately, the correction of anemia.
Cutaneous cryptococcosis mimicking bacterial cellulitis in a liver transplant recipient: Case report and review in solid organ transplant recipients
Authors: Singh Nina , Rihs John D. , Gayowski Timothy , Yu Victor L.
Published: September 2024

Cutaneous cryptococcosis is an uncommon manifestation of disseminated cryptococcal disease. We report a liver transplant recipient presenting with onset over 3 days of progressive pain and swelling of the lower extremity and foot with erythema and heat. Cryptococcal cellulitis was documented, but in retrospect the clinical presentation was indistinguishable in presentation and appearance from acute bacterial cellulitis. The patient also proved to have concomitant cryptococcal septic arthritis; the presence of cryptococcal antigen in the synovial fluid allowed a rapid and definitive diagnosis. Subsequently, cultures of skin, synovial fluid, and blood were all positive for cryptococci. Cryptococcus should be considered in the differential diagnosis of bacterial cellulitis in a liver transplant recipient not responding to antibacterial therapy.
Needle‐localized thoracoscopic resections of small indeterminate pulmonary nodules in transplant patients
Authors: Schwarz Roderich E. , Posner Mitchell C. , Plunkett Michael B. , Selby Rick R. , Landreneau Rodney J.
Published: September 2024

Indeterminate pulmonary nodules (IPN) in transplant patients create a diagnostic and therapeutic challenge. Patients who are transplant candidates or have already undergone organ transplantation require diagnostic clarification of IPN which may represent oncologic and/or infectious disease processes. Between December 1991 and January 1993, we performed 43 needle‐localized thoracoscopic resections (NLTR) on 40 patients for IPN considered too small for less invasive diagnostic techniques. Four of these patients were candidates for orthotopic liver transplantation (OLT) and required exclusion of either extrahepatic malignancy or pulmonary infection before proceeding with transplantation. The 5th patient had undergone OLT for an unresectable hepatocellular carcinoma, and NLTR confirmed the presence of pulmonary metastatic disease. Of the 4 OLT candidates, 2 had pathologically confirmed metastases from their primary hepatic malignancy and did not undergo transplantation. The remaining 2 OLT candidates had benign pulmonary processes (hamartoma, hyaline plaque) and underwent successful OLT. In all patients, the IPN was successfully identified with NLTR. There were no complications. NLTR is a reliable and well‐tolerated method to diagnose IPN in transplant patients.
Trial of intravesical versus extravesical ureteroneocystostomy in renal transplant recipients
Authors: Jindal R. M. , Carpinito G. , Bernard D. , Schmitt G. , Idelson B. , Joshi P. , Hakaim A. , Cho S. I.
Published: September 2024

We carried out a trial to evaluate the complication rate of intravesical (LP) versus extravesical (Lich) ureteroneocystostomy in recipients of renal transplantation. Ureteric stenosis was the predominant complication in the LP technique, which was more difficult to correct. Complications by the Lich technique were urinary leaks, which were managed successfully by prolonged bladder drainage. We conclude that the Lich technique is simpler to perform and avoids the complication of ureteric stenosis, and should therefore be the procedure of choice for ureteric implantation in recipients of renal transplants.
Hepatic artery complications after liver transplantation
Authors: Sánchez‐Bueno F. , Robles R. , Ramirez P. , Acosta F. , Rodriguez J. M. , Luján J. , Pons J. A. , Aguilar J. , Parrilla P.
Published: September 2024

We present the arterial complications arising from 100 orthotopic liver transplants (OLT) carried out in 87 consecutive patients. Mean patient age was 42.5+12.8 years (7‐63). There was a predominance of male patients (67%). The most common indications were hepatic cirrhosis (53%) and severe acute hepatitis insufficiency (14%). The donor liver presented 29 arterial malformations, mainly a left hepatic artery arising from the left gastric artery, either as a single or associated anomaly. Only six arterial complications appeared in 4 of the 87 patients. Of these six, four corresponded to arterial thrombosis, and the remaining two to arterial stenosis and a ruptured mycotic aortic aneurysm. Two of the 4 patients had a double arterial complication (one had arterial thrombosis. in 2 of the 3 grafts, and the other presented arterial thrombosis and aortic rupture). No arterial complications were related to arterial anomalies in the donor liver. Three of the 4 patients died from the complication. The 1‐year actuarial survival rate in our series is 77.5%. In conclusion, arterial complications are infrequent in our series (6%) but do carry a high mortality rate (75%).
Reduced nephrotoxicity of cyclosporine A in hypercholesterolemic cadaveric renal transplant patients
Authors: Bastani Bahar , Rittenhouse Margie , Garvin Paul
Published: September 2024

In a retrospective analysis of stable cadaveric renal transplant. patients we identified 19 patients with high (>270 mg/dl) and 12 patients with low (<170 mg/dl) serum cholesterol levels. We found that patients with high cholesterol level had higher serum cyclosporine levels despite similar oral dose of cyclosporine, suggesting its increased oral bioavailability or decreased biliary excretion. Moreover, the high cholesterol patients were protected from the cyclosporine side effects such as nephrotoxicity and hypertension.
Kidney transplant outcome with and without right renal vein extension
Authors: Benedetti Enrico , Fryer Jonathan , Matas Arthur J. , Sutherland David E. R. , Payne William D. , Dunn David L. , Gores Paul F. , Gruessner Rainer W. G. , Najarian John S.
Published: September 2024

Use of the vena cava to extend the right renal vein for cadaver transplantation is controversial. Right renal vein extension permits an easier anastomosis and possibly better positioning of the kidney, but may create a low flow or turbulent state. We studied whether use of a vein extension had an impact on outcome. Between January 1986 and April 1993, 305 cadaver transplant recipients received a right kidney. Of these, 76 received a graft with vein extension. None of the 76 experienced technical vascular complications versus 5 of the 229 (2.2%) without vein extension. There was no difference in 1‐and 2‐year graft survival for those with versus without extension. We conclude that there is no increased risk with use of the vena cava extension and recommend that the donor team routinely provide the right kidney with the vena cava attached. This allows the recipient team to determine whether an extension is appropriate for the particular recipient.
Donor human leukocyte antigens in the circulation of liver allograft recipients
Authors: Chauhan Bela , Mathew James M. , Shenoy Surendra , Flye M. Wayne , Howard Todd , Mohanakumar T.
Published: September 2024

Using a solid phase enzyme immunoassay (ELISA) with three different murine monoclonal antibodies (mAb) to HLA (human leukocyte antigens) framework determinants, circulating HLA were detected and quantitated both in normal individuals as well as liver allograft recipients. In normal individuals, the level of circulating HLA remained constant for several months of this study. The quantity of antigens present in the sera was not influenced by the collection procedures. During the immediate post‐transplant period there was detectable donor HLA in the recipient's circulation; however, no correlation was noted between graft function and the large quantity of donor HLA present in the sera. Within 5 months after transplantation there was a gradual decrease in the amount of circulating HLA compared to the level seen in normal individuals. These shed donor antigens may play an active role in initiating the development of tolerance to the transplanted organ.
Antiviral prophylaxis and the Epstein Barr virus‐related post‐transplant lymphoproliferative disorder
Authors: Davis Connie L. , Harrison Karen L. , McVicar John P. , Forg Pat J. , Bronner Mary P. , Marsh Christopher L.
Published: September 2024

Epstein Barr virus (EBV) infection has been associated with the post‐transplant lymphoproliferative disorder (PTLD) in up to 8% of transplant recipients. Primary EBV infection and the use of antilymphocyte preparations appear to increase the incidence of PTLD. Experimental evidence suggests that the antiviral prophylaxis used by many transplant programs may influence the development of this post‐transplant complication. In order to investigate the influence of antiviral prophylaxis (intravenous ganciclovir followed by high‐dose oral acyclovir) on the development of PTLD in kidney‐pancreas and liver allograft recipients from the University of Washington Medical Center, records were reviewed for pretransplant EBV status, antilymphocyte preparation use and for histologic documentation of PTLD. Two of 83 kidney‐pancreas recipients (1 EBV‐seronegative, 1 EBV‐seropositive) and 1 of 123 liver recipients (EBV‐ seropositive) has developed PTLD. Six of 83 kidney‐pancreas patients were EBV‐seronegative prior to transplantation and 4 of these patients received at least two courses of an antilymphocyte preparation. Thirtyeight (49%) of the 77 EBV‐seropositive kidney‐pancreas recipients received at least two courses of an antilymphocyte globulin without the development of PTLD. Both the EBV‐seronegative kidney‐pancreas and the liver recipient who developed PTLD had received multiple courses of antilymphocyte globulins. One EBV‐seropositive kidney‐pancreas recipient had only received one course of OKT3 1 year prior to the development of PTLD. The incidence of PTLD reported here in patients receiving intravenous ganciclovir followed by high‐dose oral acyclovir antiviral prophylaxis is lower than previously recorded when consideration is given for patient's EBV status and the use of antilymphocyte preparations.
Spontaneous improvement of renal function following renal allograft rupture associated with acute rejection
Authors: Chan T. M. , Kwok T. F. , Yap F. H. Y. , Cheng I. K. P.
Published: September 2024

A renal allograft recipient developed acute cellular rejection 7 days after her second cadaveric renal transplantation. Her renal function. failed to improve after three 0.5 g pulses of intravenous Methylprednisolone therapy. Spontaneous renal allograft rupture occurred 4 days later, which was successfully salvaged surgically. There was spontaneous rapid improvement of renal function with marked diuresis immediately following the allograft rupture, without additional immunosuppressive therapy. Her clinical course illustrates that delayed improvement of renal allograft function can be a consequence of raised intra‐renal pressure during acute rejection. In addition, intensification of anti‐rejection therapy is not an absolute requirement in all cases of rejection‐associated renal allograft rupture.
Can histopathological findings in early renal allograft biopsies identify patients at risk for chronic vascular rejection?
Authors: Dimény Emöke , Wahlberg Jan , Larsson Erik , Fellström Bengt
Published: September 2024

In order to assess the prognostic value of renal transplant biopsies for identifying patients at risk for chronic vascular rejection (CVR), 99 biopsies performed at 6 months after renal transplantation were evaluated as part of a prospective study. A chronic graft damage (CGD) score was calculated from the scores of vascular intimal hyperplasia, glomerular mesangial changes, focal lymphocytic infiltration, focal and diffuse interstitial fibrosis, and tubular atrophy, features compatible with CVR. The mean score for the whole patient population was 4.7±2.9 (range 0‐11). There was a strong association between the CGD score at 6 months and the risk of graft loss up to 2 and 3 years following transplantation. Patients with a CGD‐score of ≥6 had a higher graft loss rate at 2 years than those with a score of <6 (6/35 vs 2/54; p=0.037). In patients with a functioning graft at 2 years, the CGD‐score at 6 months correlated with graft function at 2 years. In addition to higher serum creatinine (p= 0.003) and lower GFR (p=0.01), patients with a CGD‐score of ≥6 at 6 months also had a higher degree of albuminuria (p=0.008) at 2 years as compared with patients with a CGD‐score of <6. At 3 years 10/35 patients with a CGD score of ≥6 and 2/54 patients with a CGD‐score of <6 had lost their grafts (p=0.002). The relative risk for graft loss associated with a CGD‐score of ≥6 was 7.65. In patients with a functioning graft there was still a significant positive correlation between graft function at 3 years and the CGD‐score at 6 months (p=0.003). In conclusion, the histopathological picture at 6 months is a prognostic indicator of graft function and graft loss at 2 and 3 years after transplantation. Patients with a high CGD‐score, as indicated here ≥6, may benefit from pharmacological or other interventional measures directed towards the progression of CVR.
Hemophagocytic histiocytosis (HH) in renal transplant recipients under ciclosporin therapy: Report of the first two cases
Authors: Calonge Victorio Menoyo , Glotz Denis , Bouscary Didier , Duboust Alain , Bruneval Patrick , Druet Philippe , Diebold Jacques , Nochy Dominique
Published: September 2024

Hematophagocytic histiocytosis is a clinicopathologic syndrome associating fever, liver dysfunction, blood cytopenia and coagulation abnormalities with hematophagocytosis in bone marrow and lymphoïd organs. This syndrome is found in immunocompromized patients and is triggered by infection. We describe herein the first 2 cases of HH in renal transplant recipients treated with ciclosporin. In our 1st case, H.H. was not recognized early and the patient died. In the 2nd case, prompt diagnosis associated to an anti‐infectious treatment led to recovery. The clinician must thus be aware of the possibility of such a syndrome in renal transplant patients. Identification and treatment of the underlying infection is mandatory to avoid a fatal outcome.
Clinical outcome of interval cadaveric renal transplantation in cardiac allograft recipients
Authors: Kuo Paul C. , Luikart Helen , Busse‐Henry Stuart , Hunt Sharon A. , Valantine Hannah A. , Stinson Edward B. , Oyer Phil E. , Scandling John D. , Alfrey Edward J. , Dafoe Donald C.
Published: September 2024

The introduction of cyclosporine into widespread clinical use has resulted in improved patient survival following cardiac transplantation. As a result of increased numbers of cardiac transplants, the inherent nephrotoxicity of cyclosporine, and prolonged patient survival, diac transplant recipients commonly present with renal dysfunction. In the subgroup who ultimately develop end‐stage renal disease (ESRD), therapeutic options include renal transplantation. However, the clinical course associated with this treatment modality is unknown. From 1980 to 1993, 430 cardiac transplants were performed with cyclosporine‐based immunosupression at the Standard University Medical Center. Fourteen (3.3%) patients developed ESRD, requiring chronic dialysis or renal transplantation. The cause of ESRD was cyclosporine nephropathy (13/14; 93%) and glomerulonephritis (1/14; 7%). The average time interval to the development of ESRD was 82±42 months. Nine patients underwent renal transplantation. During the period of followup (38±27 months; range 6‐ 89 months) after renal transplantation, cardiac function remained stable. There were no episodes of primary nonfunction of the renal allograft. Patient and renal allograft survival was 89% at both 1 and 3 years after renal transplant. Average serum creatinine was 1.3±0.6 mg/dl at 1 year and 1.6±0.8 mg/dl at 3 years post‐transplant. The incidence of infectious complications was not statistically different when compared to that of the heart transplant controls and that of a group of cadaveric renal transplant controls (n=20). Surprisingly, the incidence of renal allograft rejection in the heart transplant patients was 10‐fold less than that of the renal transplant controls (0.006±0.02/patient‐year vs. 0.062±0.05/patientyear; p<0.01). Longitudinal comparison of cyclosporine trough levels in the two groups showed no statistical difference. These data indicate that interval renal transplantation in cardiac transplant recipients can be performed with minimal morbidity and mortality. The renal allografts function well over an extended period of time while cardiac allograft function remains stable.
Monitoring changes in cyclosporine dosage by trough level testing
Authors: Takasugi Mitsuo , Takasugi Jan K. , Barba Lily
Published: September 2024

The concept of a narrow therapeutic window has guided the management of transplant recipients on cyclosporine immunosuppression since its inception more than a decade ago. The need to maintain immunosuppression and avoid toxicity imposed the requirement of monitoring cyclosporine levels within a limited range. The use of circulating trough levels to aid in the adjustment of dosage, however, has also led to controversies. Trough levels did not immediately reflect the dose, and circulating drug levels varied even in the absence of dose changes, indicating the role of factors other than the dose. By introducing a time factor or delay between the dose and trough levels, the sequential delay analysis allows a clearer demonstration of the relationship between doses and trough levels. Using dose adjustments as markers, corresponding changes in the trough levels were observed for most markers after a short delay. The existence of a time factor imposes some restrictions on the scheduling of dose changes and trough level tests. Adjustments in dose need to be separated to avoid interference from each other and the frequency of testing after a change increased to assure its detection. Consideration of the delay should aid in the adjustment of doses and provide an initial step in the understanding of other factors in the relationship between the dose and circulating trough levels.
Long‐term outcome in kidney transplant patients with hepatitis C (HCV) infection
Authors: Orloff Susan L. , Stempel Carlos A. , Wright Teresa L. , Tomlanovich Stephen J. , Amend William J.C. , Stock Peter G. , Melzer Juliet S. , Vincenti Flavio
Published: September 2024

To assess the prevalence and long‐term impact of HCV on kidney transplant recipients, we assayed 716 pre‐transplant sera using a firstgeneration ELISA. The anti‐HCV positive sera were confirmed by a 6‐ antigen radioimmunoassay (RIA). Patients were followed up for 5 years. Graft survival, function, evidence of chemical hepatitis (AST>2×normal), patient mortality and cause of death were evaluated. The prevalence of anti‐HCV antibody was 10.3%. In the 638 patients who were followed up for 5 years, there were no differences in graft function, graft survival, overall mortality, or death from sepsis or liver disease. Peak AST levels were significantly higher in anti‐HCV positive patients compared to anti‐ HCV negative patients. At 5 years, the AST levels remained significantly higher in the anti‐HCV positive group, however, this was only 6 U/l>normal. Liver biopsies performed 3 to 7 years post‐transplant in 80% of anti‐ HCV positive patients with chemical hepatitis showed 12% CAH, 50% mild hepatitis and 38% normal histology. Six (9.7%) patients seroconverted from anti‐HCV positive to anti‐HCV negative 2 to 5 years post‐transplant. The presence of anti‐HCV does not appear to alter long‐term patient or graft survival, and histologic evidence of severe chronic liver disease was rare in anti‐HCV positive patients with chemical hepatitis. From these results, the presence of anti‐HCV antibody should not preclude kidney transplantation.
Predicting glomerular filtration rate after simultaneous pancreas and kidney transplantation
Authors: Nankivell Brian J. , Chapman Jeremy R. , Allen Richard D.M.
Published: September 2024

Impairment of glomerular filtration rate (GFR) after simultaneous pancreas and kidney (SPK) transplantation is an important marker of chronic renal rejection and recurrence of diabetic glomerulopathy. The use of unmodified serum creatinine to estimate GFR, however, is limited by variations in muscle mass. In this study, predictive factors for long‐term GFR were evaluated in consecutive SPK recipients (n=33) using a Tc99m DTPA GFR reference method between 90 days and 6 years. after transplantation (n=136 measurements). Substantial variability between serum creatinine and isotopic GFR after SPK (R2=0.30) highlighted the inaccuracy of an unmodified serum creatinine in the evaluation. of GFR. Factors which predicted GFR apart from serum creatinine included age, sex, height and body weight. A detailed formula was derived for accurate estimation of GFR (ml/min)=(71.4 (♂) or 50.4 (♀)] + 5520/ creatinine (μmol/l) + 0.27×body weight (kg) ‐0.50×age (yr) ‐0.29×height (cm). This formula was more accurate in estimation of GFR in SPK recipients than six published predictive methods which were derived from chronic renal failure patients using creatinine clearance. All of these methods overestimated GFR at lower levels of renal function. Most correlated poorly with Tc99m DTPA GFR and contained a generalized systematic overestimation of GFR which ranged from 4.7 to 8.4 ml/min (p<0.05). A simplified version for rapid calculation was also derived as GFR (ml/min)=[25 (♂) or 5 (♀)] + 5000/creatinine (μmol/l). These specific formulae, presented in this study, represent an improvement over published methods for estimation of GFR in SPK, and may be used for long‐term monitoring of renal dysfunction in SPK recipients.
Chronic rejection in renal allografts: importance of cardiovascular risk factors
Authors: Hegeman Rebecca L. , Hunsicker Lawrence G.
Published: September 2024

Using a case‐control method, we reviewed retrospectively renal transplants performed at University of Iowa Hospitals & Clinics between April 1, 1973 and May 29, 1991 to see if cardiovascular risk factors such as obesity, blood pressure, cholesterol, and tobacco use were important risk factors for development of chronic vascular rejection. Of 1161 transplants done during that time, 834 patients had renal allografts which functioned for greater than 365 days. From this subgroup we selected all surviving patients (n=97) who had a functioning graft for greater than 365 days but whose graft subsequently failed. We also selected all patients (n=26) who died with a functioning graft. Finally, we selected 52 control patients who were still living with functioning grafts, approximately matched to the study patients for date of transplant. We found no significant difference among the three groups in weight and weight changes, mean blood pressures, mean serum cholesterol values, or tobacco use. Our findings agree with previously published studies indicating a lack of correlation of cardiovascular risk factors with the development of chronic rejection of renal allografts in humans.
Hyperaluminemia associated with liver transplantation and acute renal failure
Authors: Erasmus Rajiv T. , Kusnir Jorge , Stevenson William C. , Lobo Peter , Herman Mary M. , Wills Michael R. , Savory John
Published: September 2024

Iatrogenic aluminium toxicity is reported in a patient who underwent an orthotopic liver transplant and who had concomitant renal failure requiring hemodialysis. Following transplantation the patient developed a metabolic encephalopathy with only mildly elevated blood ammonia concentrations. During the period following transplantation the patient received massive infusions of albumin and was on oral feeding (vivonexten), both of which contained aluminium, as did the dialysis fluid. Hyperaluminemia and profoundly elevated liver tissue aluminium concentrations were observed. Treatment with desferrioxamine, a trivalent ion chelator, decreased the plasma aluminium concentrations with an improvement in the patient's mental status.
Indications and donor source of hematopoietic stem cell transplants in Europe 1993: Report from the European Group for Blood and Marrow Transplantation (EBMT)
Authors: Gratwohl A. , Hermans J.
Published: September 2024

This report details the evolution of bone marrow transplantation in Europe over a 20‐year period. In 1973, 8 teams undertook a total of 16 allogeneic bone marrow transplants; in 1983, 97 teams performed 1353 transplants. In 1993, the numbers had risen to 260 teams and 7737 transplants. Donor source in 3092 cases was an allogeneic donor (2464 HLA‐identical sibling transplants, 147 non‐identical family donor transplants, 25 twin donor transplants and 456 unrelated donor transplants). For 4645 patients the transplant was autologous (2450 autologous bone marrow transplants, 1830 autologous peripheral blood stem. cell transplants and 365 combined autologous peripheral blood and bone marrow transplants). Indications for transplants in 1993 were leukemias in 3419 patients (44%; 2332 allogeneic, 1087 autologous), lymphoproliferative disorders in 2666 patients (34%; 197 allogeneic, 2469 autologous), solid tumors in 1077 patients (14%; 9 allogeneic, 1068 autologous), aplastic anemia in 251 patients (3%; 250 allogeneic, 1 autologous), inborn errors in 244 patients (3%; 242 allogeneic, 2 autologous) and miscellaneous disorders in 80 patients (1%; 62 allogeneic, 18 autologous). These data illustrate the increase of hematopoietic stem cell transplants as a therapeutic modality over the last 20 years in Europe.
Urologic complications after simultaneous pancreas‐kidney transplantation: Hand‐sewn versus stapled duodenocystostomy
Authors: Douzdjian Viken , Gugliuzza Kristene K. , Fish Jay C.
Published: September 2024

Pancreas transplantation with bladder drainage of exocrine secretions may be associated with significant urologic complications. Stapled and hand‐sewn duodenocystostomies were compared in 61 recipients of simultaneous pancreas‐kidney transplants. Both methods resulted in similar urologic complication and allograft survival rates. Duodenal segment leaks were associated with significant morbidity and decreased patient and allograft survival.
Comparison of APACHE II scoring in liver and kidney transplant recipients versus trauma and general surgical patients in a single intensive‐care unit
Authors: Sawyer Robert G. , Durbin Charles G. , Rosenlof Lynn K. , Pruett Timothy L.
Published: September 2024

Over a 26‐month period we assessed the ability of APACHE II, scored on admission to the surgical intensive care unit (SICU), to predict the in‐hospital mortality of liver and kidney transplant recipients either post‐operatively or after subsequent complications, and compared these results to non‐transplant SICU admissions. There were 866 SICU admissions, of which 128 were liver transplant recipients, 112 were renal transplant recipients, 211 were trauma admissions and 415 were non‐transplant/non‐trauma admissions. In hospital mortalities among all liver transplant admissions were 0%, 10%, 38%, and 82% for APACHE II ranges of 0‐10, 11‐20, 21‐30 and >30, respectively, with differences between the second and third, and third and fourth ranges significant (p≤0.05 by chisquare analysis). These differences were also seen when examining scores following the primary transplantation alone. Mortalities in corresponding APACHE II ranges for trauma and nontransplant/nontrauma admissions were similar. APACHE II scoring was not useful for renal transplant recipients, as it consistently overpredicted mortality. We conclude that APACHE II scoring may be useful in predicting outcome in post‐operative liver transplant recipients, but is not useful in stratifying risk in renal transplant recipients due to the inherently low mortality involved.
Successful organ donation in victims of child abuse
Authors: Duthie Susan E. , Peterson Bradley M. , Cutler James , Blackbourne Brian
Published: September 2024

Organ transplantation has become a valuable and accepted treatment for many patients with organ failure. A major limitation to transplantation is the shortage of organ donors. Due to lack of willingness by medical examiners to release child abuse cases for organ donation, child abuse victims are a greatly underutilized pool of potential donors. This paper presents a model to facilitate organ recovery in the child abuse victim. This protocol has been in consistent use in San Diego County since midyear 1991. In all cases of child abuse where the victim was brain dead and the family consented to organ donation, the medical examiner's office released the body for organ donation. Since institution of the model described in this paper, organ donation among child abuse victims has risen dramatically in San Diego County. If similar protocols are established at other pediatric centers, the disparity between supply and demand in pediatric organ donation will diminish.
Determinants of long‐term allograft function following steroid withdrawal in renal transplant recipients
Authors: Hricik Donald E. , Seliga Rose M. , Fleming‐Brooks Sandra , Bartucci Marilyn R. , Schulak James A.
Published: September 2024

We retrospectively measured changes in serum creatinine concentration as estimates of changes in renal function in 96 renal transplant recipients who were withdrawn from steroid therapy, maintained on cyclosporine and azathioprine, and followed for 1 to 5 years. Multivariate analyses were used to assess the influence of cyclosporine dose and blood levels, azathioprine dose, age, sex, race, diabetes, HLA match and mismatch, PRA, and history of rejection following steroid withdrawal on long‐term allograft function. Results indicate that acute rejection and cyclosporine dose are the major factors influencing long‐term renal function after steroid withdrawal. In this setting, there is an inverse relationship between cyclosporine dose and serum creatinine concentration for up to 5 years. Optimal renal function is achieved in patients receiving more than 5.5 mg/kg of cyclosporine per day at the time of steroid withdrawal.
Methylprednisolone and cortisol metabolism during the early post‐renal transplant period
Authors: Tornatore Kathleen M. , Reed Kristine A. , Venuto Rocco C.
Published: September 2024

Despite the widespread use of methylprednisolone and the well‐appreciated effects of this drug on HPA suppression, little data is available which describes individual patient exposure to both methylprednisolone and cortisol following renal allograft placement. The clinical utilization of methylprednisolone during the early post‐transplant period is based upon standardized dosing protocols that do not consider factors which may influence the pharmacokinetics of this drug during the post‐transplant period. Therefore, this study was designed to examine the pharmacokinetics of methylprednisolone (mean dose: 28 mg) and cortisol pharmacodynamics in 9 renal transplant recipients (4 females; 5 males) who were studied during the early post‐transplant period (5 to 12 days after surgery). All patients (mean serum creatinine: 1.4±0.3 mg/dl) had serial blood samples collected over a 12‐ to 24‐hour period (depending upon the dosing schedule) which were analyzed concurrently for methylprednisolone and cortisol. A three‐fold variation in drug clearance ranging from 174 to 638 ml/h/kg with a range in the volume of distribution of 0.83 to 2.24 l/kg and resultant half‐lives ranging from 1.20 to 3.02 hours was noted. The cortisol response was quantitated by a 12‐hour cortisol area under the curve (C‐AUC12) to examine the interpatient cortisol patterns during the early post‐transplant period. C‐AUC12 ranged from 44.0 to 636 ng h/ml. Significant correlations were noted between the cortisol plasma concentration at 12 hours and methylprednisolone clearance and area under the concentration versus time curve (AUC). Interpatient variability in the disposition of methylprednisolone and cortisol response noted during the early post‐transplant period contradict the clinical assumptions which underlie the fixed dosing protocols currently utilized for methylprednisolone.
Homing of CD4+CD56+ T lymphocytes into kidney allografts during tubular necrosis or rejection
Authors: Bachetoni Alessandra , Lionetti Paolo , Cinti Paola , Alò Piero , Molajoni Elvira Renna , Di Tondo Ugo , Barnaba Vincenzo , Alfani Dario , Cortesini Raffaello
Published: September 2024

The association between acute rejection, acute tubular necrosis, good function and relative infiltration of CD56 subsets of both CD8+ and CD4+ T cells was examined on 67 samples of graft infiltrating cells (GIC) and corresponding peripheral blood lymphocytes (PBL) obtained from renal allograft recipients. Quantification of cell subset profiles was determined by two‐color flow cytometry. While a high proportion of CD4+CD56+ GIC was detected when both renal dysfunction and graft cytopathology (acute tubular necrosis or acute rejection) were present, this cell subset was undetectable in peripheral blood. In contrast the CD8*CD56+ T‐cell subset was not discriminatory. The presence of CD4+CD56+ cells among freshly‐isolated lymphocytes from renal allografts supports the idea that the local environment is involved in the selection of this subset, thus participating in the amplification of the immuneresponse. In addition, a homing of this T‐cell subset into the transplanted organ may constitute an early sign of graft immunopathology.
Allogeneic microchimerism and donor antigen‐specific hyporeactivity in lung transplant recipients
Authors: McSherry Cynthia , Hertz Marshall I. , Jackson Annette M. , Butters Kim , Diko Michael , Matas Arthur J. , Bolman R. Morton , Reinsmoen Nancy L.
Published: September 2024

The identification of peripheral donor cells in solid organ transplant recipients has led to speculation as to the tolerogenic role of circulating donor cells. Also being debated is the possible significance of persistent donor alloantigen‐presenting cells in inducing and maintaining an alloantigen‐specific unresponsive state. Previously, we showed that donor antigen‐specific hyporeactivity is a useful marker for identifying kidney, lung, or heart recipients at low risk for immunologic complications; we found donor antigen‐specific hyporeactivity in 25% of kidney, 35% of lung, and 22% of heart recipients. All 3 hyporeactive subgroups experienced fewer late (>3 months) rejection episodes and a lower incidence of chronic rejection. The purpose of the current study was to determine whether peripheral blood microchimerism correlates with the development of donor antigen‐specific hyporeactivity and affects clinical outcome. We correlated the detection of microchimerism with in vitro proliferative response to donor antigen in 19 lung recipients who were ≥12 months posttransplant. Allogeneic peripheral blood microchimerism was studied. with a PCR‐based limiting detection assay using HLA‐DR sequence‐specific primers. We detected microchimerism in 47% (9 of 19) of the lung recipients tested. All recipients who were donor antigen‐specific hyporesponsive had microchimerism, and all recipients without detectable microchimerism were responsive to donor antigen. However, not all recipients with microchimerism developed donor antigen‐specific hyporeactivity. Further, none of the hyporesponsive recipients has been diagnosed with obliterative bronchiolitis (OB). In contrast, 2 of the 4 with microchimerism who were responsive to donor antigen have been diagnosed with OB, as have 5 of the 10 who were negative for both hyporeactivity and microchimerism.

Thus, long‐term graft outcome may correlate more closely with donor antigen‐specific hyporeactivity than with microchimerism.
Plasma magnesium during human liver transplantation
Authors: Skak Claus , Ejlersen Ellen , Mogensen Torben , Winkel Per , Secher Niels H.
Published: September 2024

Patients with severe liver disease and accompanying malnutrition may exhibit electrolyte disturbances including the magnesium balance. In 18 patients plasma magnesium (p‐Mg) was determined at the start of the liver transplantation and during the anhepatic and reperfusion phases of the operation. The blood loss was 6.9 (2.5‐8.8) 1 (median and range) and the cumulative transfusion volume was 10.2 (5.0‐17.2) 1 of which 5.9 (2.5‐14.2) 1 was with fresh frozen plasma. p‐Mg was 0.72 (0.58‐0.88) mmol and it did not change significantly during the operation. Thus, in 4 patients it was at or below the lower reference value of 0.67 mmol·l1. In 11 patients it changed less than 0.05 mmol·l1, while in 4 patients the concentration was rose, and in 3 patients we noted a fall in each of 0.08 mmol·l'. There was no correlation between p‐Mg and the blood loss or the administered volume of fresh frozen plasma. In 10 randomly chosen fresh frozen plasma units, the p‐Mg was 0.64 (0.61‐0.71) mmol‐1. These observations do not support a need for close monitoring or substitution of magnesium during human liver transplantation. On the other hand, the finding of a low value in 4 of 18 patients suggests that plasma magnesium should be monitored and eventually corrected while the patient is on the waiting list.
Antibody‐mediated hemolytic anemia following ABO‐mismatched organ transplantation: contributory role of HLA matching and polyclonal antilymphocyte globulin
Authors: Fabrega A. J. , DeChristopher J. , Sosler S. D. , Rivas P. A. , Vasquez E. M. , Pollak R.
Published: September 2024

We report three instances of antibody‐mediated hemolytic ancmia following ABO‐mismatched, but compatible, renal (n=2) and simultaneous pancreas‐kidney (n=1) transplantation. The two renal allograft recipients had received a 6‐antigen matched transplant; one received polyclonal antilymphocyte globulin to treat an early rejection episode. The simultaneous pancreas‐kidney transplant received polyclonal antilymphocyte globulin (ALG) as part of a quadruple therapy induction regimen. All three patients developed severe, but self‐limited, antibody‐mediated hemolytic anemia within two weeks of their transplants. Serologic testing demonstrated the hemolysis to be antibody mediated; furthermore, testing of the ALG lots demonstrated high titers of anti‐red blood cell antibodies. The possible contribution of ALG and HLA matching to the hemolysis seen in these patients after ABO mismatched organ transplantation is discussed.
Cytomegalovirus involving gastrointestinal tract in renal transplant recipients
Authors: Shrestha B. M. , Parton D. , Gray A. , Shepard D. , Griffith D. , Westmoreland D. , Griffin P. , Lord R. , Salaman J. R. , Moore R. H.
Published: September 2024

Infection due to cytomegalovirus (CMV) is a substantial cause of mortality and morbidity among renal transplant recipients but the prognosis of the disease has changed dramatically since the introduction of ganciclovir (GAN). During a period of 5 years we treated 54 patients who developed CMV disease. From this group of patients we identified 7 patients with primary gastrointestinal tract (GIT) CMV disease who received treatment with GAN. Tissue diagnosis was made by endoscopy of the upper GIT (6 patients) or sigmoidoscopy (one patient) and histological examination. All patients improved after treatment with GAN; three patients required additional treatment for recurrent CMV disease and recovered, and I patient relapsed without GIT involvement (P=0.014). Recurrent CMV disease was more severe (mean score of 15 in relapse compared to 7 in the first episode). We believe relapse to be more common and the disease to be more severe in the presence of GIT involvement suggesting that a longer duration of treatment with GAN may be required in this clinical manifestation of CMV disease.
Occurrence and treatment of kidney graft lithiasis in a series of 1500 patients
Authors: Benoit G. , Blanchet P. , Eschwege P. , Jardin A. , Charpentier B.
Published: September 2024

In a series of 1500 patients transplanted between 1976 and 1992, 12 patients presented urinary calculi. The symptoms presented included obstructive anuria in 3 patients and abdominal pain in 1 patient. There were 8 asymptomatic patients. The risk factors were mainly hyperparathyroidism and non‐absorbable sutures. The occurrence of renal graft calculi is now ten times less frequent than in the 1980s. In all, 5 of the patients were treated using incisional surgery, 5 with ESWL and 4 using ureteroscopy; a double J stent was inserted for the 3 cases of obstructive anuria. Nine patients are currently calculus‐free and 2 have relapsed. One asymptomatic patient was not treated. The renal function of these 12 patient was not modified and no hypertension was noted after treatment. Calculi are generally asymptomatic when they are diagnosed by ultrasonography and in our experience they can be treated using ESWL or by ureteroscopy. In our opinion all patients can be treated successfully but with a high rate of relapse if the causal factors are not treated.
Fate of renal allografts connected to vascular prostheses
Authors: van der Vliet J. Adam , Naafs Dick B.J. , van Bockel J. Hajo , Kootstra Gauke , Boll Albert P.M. , Barendregt Wouter B. , Buskens Frans G.M.
Published: September 2024

Objective

The outcome of renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is evaluated.

Patients and Methods

All 7 Dutch transplant centers were invited to review their experience. Among a total of 5791 cadaveric renal transplantations performed between 1978 and 1994, 13 cases (0.2%) in 3 different centres were identified. In 6 cases the vascular reconstruction and transplant operation were performed simultaneously, and in 7 cases separately, with a mean interval of 3.5 yr. The indications for vascular reconstruction were aneurysmal disease in 4 and obstructive disease in 9 cases.

Results

The early vascular complications of these procedures were hemorrhage in 4 and renal vein thrombosis in 1 and led to graft loss in 3 cases. The perioperative mortality was 2/13 (15%). The graft and patient survival were 68 and 83% respectively after 1 yr and 17 and 37% after 5 yr. Late mortality was mainly due to cardiovascular disease.

Conclusions

Renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is a hazardous procedure with relatively poor shortand long‐term results. These observations shoud be considered in the choice of renal replacement therapy in this special patient population.
Renal retransplants: Effect of primary allograft nephrectomy on early function, acute rejection and outcome
Authors: Douzdjian Viken , Rice James C. , Carson Richard W. , Gugliuzza Kristene K. , Fish Jay C.
Published: September 2024

Although risk factors for failure of renal retransplants have been well studied, the impact of allograft nephrectomy on subsequent renal transplantation in the cyclosporin era is not well defined. The purpose of this study is to define the effect of nephrectomy of the primary allograft on subsequent allograft survival, carly allograft function, incidence of acute rejection and patient sensitization. The records of 127 renal retransplant recipients were reviewed. Of these 127 patients who underwent retransplantation, 40 (31%) underwent nephrectomy of the primary allograft prior to retransplantation whereas 40 (31%) did not. Nephrectomy of cadaveric primary allografts was performed more commonly (48% vs 30%, p=0.003) and earlier (78% vs 54% <1 month post‐transplant, p= 0.0006) in the pre‐CSA period compared to the CSA period. Biopsy‐proven acute rejection episodes occurred more frequently in the nephrectomy group (73% vs 42%, p=0.03). Although primary allograft nephrectomy was associated with higher preformed antibody levels, it had no effect on early graft function, frequency of acute rejection or allograft outcome after retransplantation, in the CSA group. In conclusion, in the cyclosporin era, nephrectomy of the primary allograft has no significant influence on retransplantation.
Long‐term outcome after switch from cyclosporine‐based triple‐drug immunosuppression to double therapy at three months
Authors: Aichberger C. , Eberl Th. , Riedmann B. , Pernthaler H. , Öfner D. , Königsrainer A. , Margreiter R.
Published: September 2024

Cyclosporin A (CyA) together with steroids and azathioprine (Aza) has been successfully used for prophylactic immunosuppression in numerous recipients of kidney allografts. The aim of this study was to evaluate the long‐term effect of reducing this initial triple‐drug therapy to double‐drug therapy at 3 months. One hundred consecutive recipients of a cadaveric renal allograft with stable and good graft function were randomly allocated to continue with CyA and steroids (group 1) or CyA and Aza (group 2). Both groups were comparable with regard to all relevant patient characteristics. After a mean observation period of 55 (26–76) months no significant difference was observed in the incidence of acute rejection episodes after conversion (4 in group 1 and 5 in grop 2), or in the incidence of graft loss (4 in group 1 and 5 in group 2); all graft rejection episodes were easily reversed with steroid pulses and patients switched back to triple‐drug therapy. Patient survival was 94% in group 1 and 100% in group 2 at 55 months. In group 1, however, a higher number of viral infections and steroid‐related side effects was noted. From these data it is concluded that initial triple‐drug therapy can safely be reduced to a CyA‐based double‐drug combination after 3 months in renal allograft recipients with stable function. The combination with Aza is recommended because of its fewer side effects.