bluuebunny/crossref_metadata_2025 huggingface dataset:
Venous complications after orthotopic liver transplantation
Authors: Settmacher U , Nüssler Nc , Glanemann M , Haase R , Heise M , Bechstein Wo , Neuhaus P
Published: March 2003

Complications involving the portal vein or the vena cava, are rare after orthotopic liver transplantation. We report on the incidence and treatment of venous complications following 1000 orthotopic liver transplantations in 911 patients. Twenty‐six of the adult patients (2.7%) suffered from portal complications after transplantation, whereas complications of the vena cava were observed in only 17 patients (1.8%). Technical problems or recurrence of the underlying disease (e.g. Budd–Chiari syndrome) accounted for the majority of complications of the vena cava, whereas alteration of the vessel wall or splenectomy during transplantation could be identified as important risk factors for portal vein complications. In patients undergoing modification of the standard end‐to‐end veno‐venous anastomosis of the portal vein due to pathological changes of the vessel wall, complications occurred in 8.3%, whereas only 2.4% of patients who received a standard anastomosis of the portal vein experienced complications of the portal vein. Furthermore, splenectomy during transplantation was also associated with an increased incidence of portal vein complications (10.5 vs. 2.2% in patients without splenectomy). Treatment was dependent on the signs and symptoms of the patients, and varied considerably between patients with portal vein complications and patients suffering from complications of the vena cava. Complications of the vena cava led to retransplantation in about one‐third of the patients, whereas in patients with occlusion of the portal vein, retransplantation was necessary in only 15%, and more than half of the patients suffering from portal vein complications did not require any treatment at all. Usually, treatment of patients with portal vein complications only became necessary when additional complications such as arterial occlusion or bile duct injuries occurred.
Students' acceptance of clinical xenotransplantation
Authors: Hagelin Joakim , Carlsson Hans‐Erik , Hau Jann
Published: March 2003

The aim of this study was to elucidate undergraduate university students’ views on clinical xenotransplantation. A total of 1875 students from eight faculties at Uppsala University and the Swedish University of Agricultural Sciences answered a questionnaire. Three out of four respondents would be prepared to receive a transplant from an animal on medical grounds if necessary. Forty percent had signed an organ donation card. There was no difference in attitude between those who had signed an allotransplantion card and those who had not. According to gender, age, length of university program, and faculty, results showed that a higher proportion of those who approved were male, young, and studying on programs longer than three years; also, they were more likely to study programs in the Faculties of Agriculture and Pharmacy. At the Medical Faculty, nursing students seemed to be less approving, compared to future biomedical analysts, biomedical scientists, and physicians. The acceptance of xenotransplantation also tended to be positively associated with morally accepting and understanding the use of animals in biomedical research, the approval of euthanasia, the approval of early abortion, and the use of human fetuses in research, as well as clinical testing of humans.
Characteristics of infectious complications associated with mortality after solid organ transplantation
Authors: Pelletier Shawn J , Crabtree Traves D , Gleason Thomas G , Raymond Daniel P , Oh Chang‐Kwon , Pruett Timothy L , Sawyer Robert G
Published: March 2003

Infection remains a common source of morbidity and mortality after solid organ transplantation. The purpose of this study was to characterize the continuously changing patterns of post‐transplantation infections, analyze early post‐transplantation infections, and evaluate characteristics associated with mortality. A secondary analysis was performed on prospectively collected data for all episodes of infection occurring between 10 December 1996 and 28 October 1998 on the surgery services at a university medical center. Post‐transplantation infections were compared with those in non‐transplantation patients randomly matched by severity of illness. Further analysis was performed on post‐transplantation infections occurring during the admission of transplantation compared with those in subsequent admissions. To evaluate factors associated with mortality, episodes occurring in survivors and non‐survivors were compared. The results demonstrated that infections in transplantation recipients (n=303) were associated with a younger age and had significantly lower white blood cell counts (WBC) compared with non‐transplantation patients. There was no difference in mortality (15.5 vs. 16.5%, p=0.74). Post‐transplantation infectious complications during the initial hospitalization (n=105) occurred at 38±6 compared with 695±66 d (p<0.0001) after transplantation and were associated with a longer length of stay (LOS) and increased mortality (30.5 vs. 7.6%, p<0.0001) compared with those occurring in subsequent admissions (n=198). Although multiple characteristics of post‐transplantation infections were associated with mortality, only the Acute Physiology and Chronic Health Evaluation (APACHE) II score was an independent predictor of mortality. Post‐transplantation infections remain a significant source of morbidity and mortality. The leukocyte response to infection was suppressed in the transplantation population. Post‐transplantation infections which occur during the admission for transplantation have a markedly increased mortality.
Influence of religious and spiritual values on the willingness of Chinese–Americans to donate organs for transplantation
Authors: Lam Wilbur Aaron , McCullough Laurence B
Published: March 2003

The rate of organ donation among minority groups in the United States, including Chinese–Americans, is very low. There is currently very little data in the biomedical literature that builds on qualitative research to quantify the attitudes of Chinese–Americans toward organ donation. The present study quantitatively assesses the religious and cultural reasons that Chinese–Americans appear to be less willing to donate their organs than other populations. It also seeks to determine whether Confucian, Buddhist, or Daoist ideals are a significant factor in their overall reluctance to donate organs among respondents in this sample. A questionnaire distributed to Chinese–American adults asked about general feelings toward organ donation and Buddhist, Confucian, Christian, Daoist, and other spiritual objections. The results suggest that Chinese–Americans are indeed influenced by Confucian values, and to a lesser extent, Buddhist, Daoist, and other spiritual beliefs, that associate an intact body with respect for ancestors or nature. Another significant finding is that the subjects were most willing to donate their organs after their deaths, to close relatives, and then in descending order, distant relatives, people from their home country, and strangers. This ‘negotiable’ willingness has enormous implications for clinicians, who may be able to increase organ donation rates among Chinese–Americans by, first, recognizing their diverse spiritual beliefs, and, second, offering a variety of possibilities for the organ procurement and allocation.
Combined pancreas and kidney transplantation improves survival in patients with end‐stage diabetic nephropathy
Authors: Tydén G , Tollemar J , Bolinder J
Published: March 2003

The purpose of this study was to find out whether prolonged normoglycemia, as achieved by a successful pancreas transplantation, can improve survival in patients with insulin‐dependent diabetes mellitus.  A retrospective analysis of actual 10‐yr patient survival rates was done for all renal graft recipients who were given transplants more than 10 yr ago but within the cyclosporin era (i.e. 1981–1988).  The actual 10‐yr patient survival rate in non‐diabetic renal graft recipients was 72%. In recipients of pancreas and kidney grafts and with prolonged function of the pancreas graft, the survival rate was 60%, whereas in patients subjected to simultaneous pancreas and kidney transplantation, but where the pancreatic grafts failed within 2 yr, the survival rate was 33%. In diabetic recipients of kidney transplants alone, the survival rate was 37%.  The patient survival rate was substantially higher in non‐diabetic patients and patients with functioning pancreas grafts compared with diabetic patients with kidney transplants alone or with failed pancreas grafts. We speculate that the decrease in mortality was due to the beneficial effect of long‐term normoglycemia on diabetic late complications.
Cyclosporine withdrawal in stable renal transplant recipients after azathioprine‐mycophenolate mofetil conversion
Authors: Thervet Eric , Morelon Emmanuel , Ducloux Didier , Bererhi Linda , Noël Laure Hélène , Janin Anne , Bedrossian Janine , Puget Sophie , Chalopin Jean Marc , Mihatsch Michael , Legendre Christophe , Kreis Henri
Published: March 2003

Background: Cyclosporine A (CsA) nephrotoxicity is a non‐immunologic factor of chronic allograft dysfunction (CAD) in kidney transplant recipients. Mycophenolate mofetil (MMF) may allow CsA dosage reduction or even complete withdrawal in selected populations with CsA nephrotoxicity or CAD. The aim of the present study was to evaluate the efficacy and safety of CsA withdrawal after azathioprine (AZA)‐MMF conversion in a population of stable renal transplant recipients.  Methods: Twenty‐eight first cadaver kidney recipients were included. AZA was then discontinued, MMF was introduced and after 4 months CsA was completely withdrawn. All patients underwent inuline clearance measurement and renal biopsy at inclusion and at the end of the follow‐up (40 wk).  Results: CsA was completely discontinued in 20 patients. No patient lost his graft during the study period, but 1 patient experienced a reversible acute rejection episode. Inuline clearance improved significantly in the whole series. At the end of follow‐up, histological worsening was observed in 50% of patients without any specific risk factor. In these patients, inuline clearance did not improve. Systolic blood pressure, the need for anti‐hypertensive drugs and HDL cholesterol improved.  Conclusion: In stable kidney transplant recipients, CsA withdrawal after AZA replacement by MMF switch was safe with regard to acute rejection. It improved blood pressure and the lipid profile, but, in 50% of patients was associated with histologic deterioration.
Immunosuppressant side effect profile does not differ between organ transplant types
Authors: Winsett R. P. , Stratta R. J. , Alloway R. , Wicks M. N. , Hathaway D. K.
Published: March 2003

Transplantation has enhanced the quality of life of all transplant recipients, but concern remains regarding the side effects of immunosuppressant drugs. In order to respond to these concerns, a survey to ascertain the side effect profile of transplant recipients was undertaken to identify the impact of chronic immunosuppression on quality of life. A nationwide survey of solid organ transplant recipients was carried out using a newly developed immunosuppressant side effect survey. Kidney, kidney–pancreas, liver and heart recipients responded to the survey (n=505) and reflect the national distribution based on the UNOS data for organ type, recipient race and gender. The survey had four subscales: emotional burden, life/role responsibilities, mobility and GI distress. A fifth subscale included miscellaneous side effects that are more prevalent during the first 2 years post‐transplant. Frequency and severity of each side effect were coded on a scale of 0–4 from ‘no problem’ to ‘always’ a problem. The entire range of possible scores (0–160) was reported, reflecting adequate variability in the responses. The sample consisted of 51% males, 77% Caucasians, 15% African Americans, with the remaining 8% other races. There were 225 (44.5%) kidney, 147 (29.1%) liver, 101 (20%) heart and 32 (6.4%) pancreas included. Age ranged from 18–71 years with time since transplant 1–21 years. Overall frequency (12.1±6.08), severity (10.5±6.96) and weighted scores (25.4±19.9) were low suggesting that, as a whole, immunosuppressant side effects, while present, were not severe or troublesome for most patients. Side effect profiles appeared similar among organ types. Differences were detected in the GI distress subscale with the heart recipients reporting significantly less GI distress than liver recipients (13.8 vs. 19.2;P<0.05). Side effect impact on mobility tended to increase between time eras; however, no statistical significance was detected. Side effects are a concern among health‐care professionals; however, based on the results of this study, immunosuppressant‐related side effects are not detrimental to quality of life and show no differences between types of organ transplanted.
Does infiltration of neutrophils in peritubular capillaries indicate humoral rejection? A case displaying a characteristic lesion of a significantly high amount of neutrophils in peritubular capillaries at 1‐h graft biopsy during transplant operation
Authors: Inagaki Hiroko , Takeda Asami , Sato Tethuhiko , Watanabe Izuru , Katayama Akio , Haba Toshihito , Tominaga Yoshihiro , Uchida Kazuharu , Oikawa Tadashi , Morozumi Kunio
Published: March 2003

Inagaki H, Takeda A, Sato T, Watanabe I, Katayama A, Haba T, Tominaga Y, Uchida K, Oikawa T, Morozumi K. Does infiltration of neutrophils in peritubular capillaries indicate humoral rejection? A case displaying a characteristic lesion of a significantly high amount of neutrophils in peritubular capillaries at 1‐h graft biopsy during transplant operation. Clin Transplantation 2001: 15 (Supplement 5): 35–40. ©Munksgaard, 2001

We present a case report of a 50‐yr‐old Japanese woman with a significant accumulation of neutrophils in the peritubular capillaries (PTC) and severe acute tubular necrosis (ATN) at 1‐h allograft biopsy during transplant operation from cadaver donor after a cardiac death. Significant accumulation of neutrophils in the PTC is usually valuable diagnostically for acute humoral rejection. However, the patient showed no clinical signs of acute rejection. A second graft biopsy performed on the fifth postoperative day (POD) revealed that both infiltration of neutrophils in PTC and ATN lesions were more aggravated. Neither clinical course nor other morphological findings were compatible with humoral rejection. After the third biopsy of POD 27 revealing acute vascular rejection of moderate degree, acute rejection therapy using methylprednisolone pulse therapy and OKT‐3 therapy was performed. Consequently, after a period of delayed graft function requiring haemodialysis for approximately 4 wk, graft function was restored and serum creatinine decreased to 2 mg/dL. Later, we were able obtain information from a paired graft from the same donor. Significant accumulation of neutrophils in the PTC similar to our recipient was also noted in a 1‐h biopsy specimen of the paired kidney. This confirmed that the accumulation of neutrophils in the PTC noted in two recipients was transmitted from the donor kidney. The pathogenesis and clinical significance of neutrophils in the PTC has been shrouded in mystery.
Kidney retransplants after initial graft loss to vascular thrombosis
Authors: Humar Abhinav , Key Nigel , Ramcharan Thiagarajan , Payne William D , Sutherland David Er , Matas Arthur J
Published: March 2003

Background: Vascular thrombosis early after a kidney transplant is an infrequent but devastating complication. Often, no cause is found. These recipients are generally felt to be good candidates for a retransplant. However, their ideal care at the time of the retransplant and their outcomes have not been well documented. We studied outcomes in 16 retransplant recipients who had lost their first graft early posttransplant (<1 month) to vascular thrombosis.  Methods: Of 2 003 kidney transplants between 1 January 1984 and 30 September 1998, we identified 32 recipients who had lost their first graft early posttransplant to vascular thrombosis. Of these 32 recipients, 16 were subsequently retransplanted and detailed chart reviews were done.  Results: Of the 16 retransplant recipients, 12 lost their first graft to renal vein thrombosis and 4 to renal artery thrombosis. Thrombosis generally occurred early (mean, 3.6 d). Five recipients underwent a complete hematologic workup to rule out a thrombophilic disorder before their retransplant: 4 had a positive result (presence of antiphospholipid antibodies, n=3; increased homocysteine levels, n=1). These 4 recipients, along with 1 other recipient who had a strong family history of thrombosis, underwent thrombosis prophylaxis at the time of their retransplant. Prophylaxis consisted of low‐dose heparin for the first 3–5 d posttransplant, followed by acetylsalicylic acid or Coumadin.  Of the 16 retransplant recipients, none developed thrombosis. Of the 5 who underwent thrombosis prophylaxis, none had significant bleeding complications. At a mean follow‐up of 5.4 yr, 10 (63%) recipients have functioning grafts. Causes of graft loss in the remaining 6 recipients were death with function (n=5, 31%) and acute rejection (n=1, 6%). Graft and patient survival rates after these 16 retransplants were equivalent to results after primary transplants. The incidence of acute and chronic rejection was also no different (p=ns).  Conclusion: Vascular thrombosis in the absence of obvious technical factors should prompt a workup for a thrombophilic disorder before a retransplant. Recipients with an identified disorder should undergo prophylaxis at the time of the retransplant. Results in these retransplant recipients are equivalent to those seen in primary transplant recipients.
The process of organ donation and its effect on consent
Authors: Siminoff Laura A , Arnold Robert M , Hewlett Joan
Published: March 2003

Objective: To identify those factors that enhance or inhibit organ donation in order to provide data to help policy makers, hospital administrators and transplantation professionals make informed choices about how to modify the donor system and to structure ‘best practice’ interventions.  Summary of background data: Legislative efforts to increase donation rates have not been successful. An emphasis on process is needed to help explain this.  Methods: The study was conducted using a stratified random sample of 23 hospitals in the Pittsburgh and Minneapolis/St Paul standard statistical metropolitan areas. Each week, the medical charts of all in‐patient and emergency room patient deaths at each hospital were reviewed using a standardized review protocol to determine eligibility for organ, tissue, and cornea donation. A total of 10 681 patient charts were reviewed over a 4‐yr period. Eight hundred and twenty‐eight cases out of 1 723 eligible cases were selected for inclusion in the study. Data were collected on 827 of these cases. All health care providers (HCPs) who spoke with the family after the patient's death or discussed donation with the family were interviewed.  Results: Of the 10 681 patient charts reviewed, 16.5% were eligible to donate either organs, tissues, or corneas, and 87.0% of donor‐eligible patients’ families were approached and asked to donate. Consent rates were 23.5% for corneas, 34.5% for tissues, and 46.5% for organ donation. Multiple logistic regression demonstrated that the best and strongest predictor of donation decisions was the family's initial response to the donation request, as reported by the HCP. Three initial response groups are examined and compared. Those families who expressed an initially favorable reaction were most likely to agree to donation. Furthermore, discussion patterns differed by initial reaction group, with families who expressed initial indecision about donation sharing more characteristics with families who were not favorable than those who were favorable. More detailed information was provided to the favorable families, as compared to the other two groups, concerning the effect of donation on funeral arrangements and costs. Families who were favorable were also more likely to meet with an organ procurement organization representative than were other families. The strongest predictor of a family's unfavorable response to a donation request was the belief that the patient would have been against donation. A number of other variables, including HCP attitudes, also had an impact on the family's decision to donate.  Conclusions: A number of discussion and HCP characteristics are associated with a family's willingness to consent to organ donation. Further study is needed to determine if interventions based on the characteristics identified in this study will increase consent to donation.
Comparisons of cutaneous blood flow reactivity to norepinephrine and sodium nitroprusside between patients with heart transplantation and healthy subjects
Authors: Wu Ying‐Tai , Chen Shiau‐Yee , Chou Nai‐Kuang , Wang Shoei‐Shen
Published: March 2003

Heart transplant patients are reported to have impaired regulation of the microvasculature. The purpose of this study was to investigate the cutaneous blood flow and its reactivity to sodium nitroprusside (vasodilator, Nipride 0.1%) and norepinephrine (vasoconstrictor, Levophed 0.1%) in patients after heart transplantation in comparison to normal healthy individuals. Eighteen patients after heart transplantation and 16 healthy, nonsmoking individuals served as subjects of the study. Sodium nitroprusside and norepinephrine were introduced by iontophoresis to the skin of the right and left forearms, respectively. After measuring cutaneous blood flow reactivity in the pre‐exercise state by laser Doppler flowmetry, subjects were then asked to close and open their fists for 2 min. The same measurements were repeated after exercise. Comparisons between the groups were carried out by the Wilcoxan signed rank test. The Mann–WhitneyU‐test was used for comparison between pre‐exercise and post‐exercise states. The results demonstrated that sodium nitroprusside significantly increased forearm cutaneous perfusion at rest but produced only a mild increase after exercise. This reactivity was significantly lower after exercise with no significant differences between groups. Norepinephrine decreased cutaneous blood flow at rest. The transplant patients were significantly less sensitive to norepinephrine before but not after exercise. The changes in norepinephrine reactivity with exercise were significantly different between groups (p<0.05).
Intragraft cytokine expression in heart transplants with mild or no histological rejection
Authors: Álvarez Cristiam M , Fernández Darío , Builes Miguel , Zabaleta Jovanny , Restrepo Luz M , Villegas Alberto , García Luis F
Published: March 2003

The study of pro‐inflammatory cytokines producedin situin heart allografts may help to understand the mechanisms of rejection and open new possibilities to control graft rejection.  Methods: A total of 23 endomyocardial biopsies obtained from 16 transplanted patients treated with triple‐drug therapy (azathioprine, prednisone, and cyclosporine) were studied. mRNA expression for tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6, IL‐10, IL‐12, IL‐15, transforming growth factor (TGF)‐β, and β‐actin was determined by reverse transcription polymerase chain reaction (RT‐PCR) and Southern blotting. Semiquantitative analysis was done by establishing the ratio between densitometric integrated value of each cytokine with the β‐actin and correlated with the histopathologic findings.  Results: Three groups of biopsies were determined according to the International Society for Heart and Lung Transplantation criteria: grade 0 (control group, n=12), grade 1A (sub‐clinical rejection, n=6) and ‘quilty effect’ (n=5). An increased expression of mRNA for TNF‐α and IL‐6 (p=0.0091 and 0.0075, respectively) was found associated with rejection grade 1A episodes, mRNA for IL‐1β was nonspecifically expressed in all the study groups, while IL‐10 mRNA was not detected in any of the biopsies studied. mRNA for IL‐12 and IL‐15 was not associated with rejection. Interestingly, TGF‐β was not detected in any of the biopsies with the ‘quilty pattern’.  Conclusion: The association of TNF‐α and IL‐6 mRNAin situexpression with mild histologically probed rejection episodes may be used in the monitoring of heart transplants.
A case of traumatic renal graft rupture with salvage of renal function
Authors: Akabane Shin‐ichi , Ushiyama Tomomi , Hirano Yasuhiro , Ishikawa Akira , Suzuki Kazuo , Fujita Kimio
Published: March 2003

An 18‐yr‐old man received a kidney graft from a 60‐yr‐old female cadaver donor on February 8, 1996. Postoperative course was uneventful and his serum creatinine level was stable at about 1.8 mg/dL. On April 30, 1999, he collided with a truck while riding a motor cycle. Macroscopic hematuria was observed and CT showed an extensive retroperitoneal hematoma. Because his anemia and hypotension were becoming worse after transfusion of 9 units of blood, he was operated on as an emergency case. A large rupture reaching the pelvis and calyces was observed in the upper pole of the grafted kidney. There were also numerous shallow lacerations, but the major arteries and veins were not injured. The rupture was closed by suturing the renal parenchyma with the peritoneum, and the other shallow lacerations were closed by suturing the renal capsule. The kidney could be salvaged without requiring hemodialysis. The serum creatinine was maintained at 2.1 mg/dL during follow‐up.  A review of the literature showed that 6 cases of traumatic renal graft rupture with salvage of the kidney have been reported. Our present case was the seventh, and was the most severe graft rupture reported so far.
Pharmacokinetics help optimizing mycophenolate mofetil dosing in kidney transplant patients
Authors: Cattaneo Dario , Gaspari Flavio , Ferrari Silvia , Stucchi Nadia , Del Priore Laura , Perico Norberto , Gotti Eliana , Remuzzi Giuseppe
Published: March 2003

Background: Mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), is now routinely used as immunosuppressant in solid organ transplantation in a fixed daily dose regimen (2 g/d) in association with cyclosporine (CsA) and steroids. However, no correlation has been shown between fixed MMF dose and clinical outcome.  Methods: Here we examined the possibility of optimizing MMF dosing by drug pharmacokinetic monitoring in 46 stable kidney transplant recipients. MPA plasma concentration profiles were measured by a reverse‐phase high‐performance liquid chromatography method 6–9 months after transplantation and related with routine laboratory analysis tests. Since MPA is extensively bound to serum albumin and only the free fraction is pharmacologically active, in a subgroup of 23 patients free plasma MPA was also determined.  Results: Despite a comparable MMF dose, a large interindividual variability in both MPA area under the curve (AUC) from 0 to 12 h (range 10.1–99.8 μg/mL · h) and in trough levels (range 0.24–7.04 μg/mL) was found. Patients with AUC >40 μg/mL · h showed a better (p<0.05) renal function than patients with lower AUC (creatinine clearance 85.7±23.2 versus 64.5±17.5 mL/min), despite no difference in CsA dose, CsA AUC and blood CsA trough level. The percentage of free plasma MPA but not total MPA correlated with the red blood cell and leukocyte count.  Conclusions: Therapeutic MMF drug monitoring might contribute to a better management of kidney transplant recipient with the goal of optimizing drug dosing and limiting the risk of MMF‐related toxicity.
Quality of life in kidney recipients: comparison of tacrolimus and cyclosporine‐microemulsion
Authors: Reimer Jens , Franke Gabriele H , Philipp Thomas , Heemann Uwe
Published: March 2003

Treatment of end‐stage renal disease (ESRD) is evaluated by survival, quality of life (QOL) and cost‐effectiveness. Little is known about the influence of immunosuppressive agents on global and disease‐specific QOL in kidney recipients.

In winter 1997/98 (t0) as well as in winter 1998/99 (t1), all kidney recipients of our University were asked to participate in a QOL study. The psychodiagnostic approach combined a global QOL‐measure (SF‐36 Health Survey) and a disease‐specific questionnaire (ESRD‐SCLTM, Nephron 1999). Inclusion criteria for the final analysis were (a) participation in both surveys and (b) eligibility after the matching procedure: patients with tacrolimus‐based immunosuppressive regimen were matched to patients with cyclosporin‐microemulsion (CsA‐ME)‐based immunosuppressive‐regimen as to age, gender and duration of graft function. Group data were compared by performing a two‐variate (`immunosuppression', `time') analysis of variance. Both groups consisted of 63 patients. Analysis of QOL revealed statistically significant advantages for the tacrolimus treated patients concerning global (SF‐36 `Physical Component Summary') as well as disease‐specific QOL (ESRD‐SCLTM`Global Severity Index'; both p < 0.05). In detail, these results were due to statistically significant better QOL in tacrolimus treated patients as to the SF‐36 subscales `Physical Functioning' and `General Health' (p < 0.05) and the ESRD‐SCLTMsubscales `Limited Physical Capacity' (p < 0.05), `Cardial and Renal Dysfunction' (p < 0.01) and `Increased Growth of Gum and Hair' (p < 0.001). The factor `time' did not contribute statistically significant to explanation of variance.

In terms of QOL in kidney recipients, tacrolimus is superior to CsA‐ME. Tacrolimus improves disease‐specific QOL and also shows slight advantages concerning global QOL compared with CsA‐ME. To record differentiated aspects of QOL in kidney recipients, the diagnostic approach should include a global QOL measure completed by a sensitive disease‐specific instrument.
Compressed spectral arrays of patients with fulminant hepatic failure in hepatic coma undergoing liver transplantation
Authors: Takeichi Takayuki , Asonuma Katsuhiro , Kim Ildeok , Inomata Yukihiro , Kasahara Mureo , Ohwada Susumu , Morishita Yasuo , Tanaka Koichi
Published: March 2003

Assessing the coma status of patients with fulminant hepatic failure (FHF) is important for determining the reversibility of brain damage and for properly timing liver transplantation. The compressed spectral array (CSA) method is a frequency analysis technique that processes electroencephalogram signals by computer to facilitate on‐line interpretation. This method has been used to monitor the consciousness levels of neurointensive care unit patients. In this study, we determined whether CSA could be used to assess the coma status of patients with FHF, and whether CSA provided information that was useful in deciding when to proceed with liver transplantation. CSA recording was carried out in 17 FHF patients with encephalopathy (coma grade III–IV) who underwent living‐related liver transplantation between August 1997 and May 1999. Recording was performed with a Neuromonitor OEE‐72044 (NIHON KOHDEN, Osaka, Japan) every 24 h before and after transplantation, until the patients regained consciousness. The CSAs of healthy controls were distributed almost equally between 0 and 16 Hz. The CSAs of FHF patients in hepatic coma were classified into three patterns. Eight of the 17 patients showed very prominent slow waves of about 2 Hz (group A), and seven patients showed strongly suppressed rapid waves between 8 and 16 Hz (group B). The remaining two patients showed CSA patterns that were similar to those of healthy controls, even though these patients were comatose (group C). Abnormal CSA patterns were observed in 15 of the 17 patients (88%). Group B patients seemed to have higher coma grades than did group A patients. Sixteen patients underwent liver transplantation, completely recovered from hepatic encephalopathy, and subsequently showed CSA patterns similar to those of healthy controls. One patient died without regaining consciousness. These results suggest that CSA is useful in assessing the coma status of FHF patients and in evaluating electrophysiological recovery from hepatic coma after liver transplantation.
Living‐related liver transplantation for Crigler–Najjar syndrome in Saudi Arabia
Authors: Shurafa Haider Al , Wali Sami , Chehab May S , Shahed Mona Al , Jawdat Muaffak , Djurberg Hans , Bassas Atef
Published: March 2003

Objective: To analyse the outcome of six children with Crigler–Najjar syndrome type I (CNS‐I) and report the first three living‐related liver transplants for this syndrome in Saudi Arabia and the Middle East.

Settings: To review the medical records of six children suffering from CNS‐I, three of whom underwent living‐related liver transplantation (LRLT) between 22 November 1998 and January 2001.

Main results: Living‐related liver transplantation was performed in three children with a pre‐transplant unconjugated bilirubin level of 362, 381 and 502 μmol/L, respectively, despite daily phototherapy of ≥ 12 h. Two of the transplanted children developed acute hepatocellular rejection, which was successfully treated with methylprednisolone pulse therapy. One tested cytomegalovirus positive (using the PP65 method), but showed no signs of clinical infection and was treated with ganciclovir. One patient had a biliary leak at the cut surface of the graft which was surgically repaired. Post‐operative bilirubin levels returned to normal in all three transplanted children and no further phototherapy was required. One patient, who was not transplanted but received phototherapy, developed severe neurological damage prior to the start of our living‐related liver transplant programme with a bilirubin level of 450 μmol/L, her sister is still awaiting transplantation. A 14‐yr‐old child with a bilirubin level of 420 μmol/L is presently undergoing phototherapy whilst awaiting orthotopic liver transplantation because of the lack of a suitable living‐related donor. Six siblings of the six children in our series were reported dead by the families.

Conclusion: Crigler–Najjar syndrome type I is a relatively common disease in Saudi Arabia for which LRLT is a curative treatment when performed at an early age before the development of kernicterus and neurological deficiency. In countries where there is a severe shortage of cadaveric organs, as is the case in Saudi Arabia, LRLT is the optimum treatment modality for this syndrome.
Comparison of two drug regimens upon clinical outcome among renal transplant recipients with positive flow cytometric crossmatches
Authors: Kimball Pam , Wagner Beth , King Anne , Fisher Robert A , Dawson Sherfield , Cotterell Adrian , Posner Marc
Published: March 2003

Renal transplant recipients with positive flow cytometric crossmatches (FCXM) face greater risk of early rejection and graft failure. It is clear that the pharmacologic needs of this high risk group have not been identified. We retrospectively compared the impact of two drug regimens upon early rejection and 5 yr actuarial survival among 324 primary cadaveric transplant recipients with positive and negative FCXM. Patients received either Regimen I (OKT3 induction, cyclosporine and steroids) or Regimen II (mycophenolate mofetil with cyclosporine or Prograf). Recipient gender, age, disease etiology, ethnic distribution and cytotoxic panel reactive antibody (PRA) were equivalent between regimens (p=ns). With Regimen I, the incidence of rejection was greater for FCXM positive vs. FCXM negative patients (51 vs. 21%, p=0.001). In contrast, with Regimen II the incidence of rejection for FCXM positive and FCXM negative patients was equivalent (18 vs. 12%, p=ns) and lower than patients treated with Regimen I (p < 0.01). Ethnic variation was only observed with Regimen I in which African Americans with positive FCXM had more rejections than Caucasians (60 vs. 45%, p < 0.05). Five‐year actuarial survival was lower for FCXM positive vs. FCXM negative patients treated with Regimen I (40 vs. 75%, p=0.0006) or Regimen 2 (60 vs. 90%, p=0.001). Allograft survival was equivalent (p=ns) among FCXM positive individuals receiving Regimen I or II. However, allograft survival among FCXM negative individuals improved with Regimen II (p < 0.05). Ethnic variation in survival was not observed with either regimen (p=ns).
The outcome of post‐transplant transitional cell carcinoma in 10 renal transplant recipients
Authors: Wang Hwa‐Ben , Hsieh Hwei‐Ho , Chen Yen‐Ta , Chiang Chao‐Yang , Cheng Yuan‐Tso
Published: March 2003

Abstract:At our clinic we followed 320 renal transplant recipients, 16 of whom developed malignancies within 15 yr. Ten of the 16 malignancies were transitional cell carcinoma (TCC) of the urinary tract. The modalities of treatment included standard nephroureterectomy with bladder cuff removal for upper tract tumor, transurethral resection for superficial bladder tumor and partial cystectomy for one case of invasive bladder tumor, as requested by the patient. Post‐operative intravesical chemotherapy with epirubicin, or immunotherapy with bacillus Calmette–Guerin (BCG) were carried out for superficial bladder tumor. Cyclosporine (CsA) used as post‐transplant immunosuppressant was switched to low dose azathioprine (Aza) at the initial diagnosis of TCC. Four patients experienced tumor recurrence despite conversion of immunosuppressant from CsA to Aza. Among these 10 patients, five maintained normal renal function, three returned to hemodialysis without tumor recurrence, and two patients died of cancer.
Psychosocial outcome of living donors after living donor liver transplantation: a pilot study
Authors: Walter Marc , Bronner Ekkehard , Pascher Andreas , Steinmüller Thomas , Neuhaus Peter , Klapp Burghard F , Danzer Gerhard
Published: March 2003

Walter M, Bronner E, Pascher A, Steinmüller T, Neuhaus P, Klapp BF, Danzer G: Psychosocial outcome of living donors after living donor liver transplantation: a pilot study. Clin Transplant 2002: 16: 339–344. © Blackwell Munksgaard, 2002

In view of the scarcity of organ resources available for transplantation, living donor liver transplantation (LDLT) is gaining growing importance in the treatment of chronically terminal liver diseases. In the period between December 1999 and October 2000, 47 potential living liver donors were evaluated and 24 right hepatic lobes and two left lateral segments were transplanted at the Virchow‐Klinikum of the Charité Hospital in Berlin. The present study looks into biomedical and psychosocial parameters of 23 donors before and 6 months after LDLT. Our aims were to investigate the development of psychosocial parameters after donation and the relationship between psychosocial findings and post‐operative complications. Most donors showed an improved quality of life (QoL) after LDLT when compared with pre‐operative results. Twenty‐six percent of donors show high values for `tiredness', `fatigue' and `limb pain' following donation. The post‐operative complications had no influence on the psychosocial outcome. In this pilot study the resection of the right hepatic lobe amounts to a safe operation for donors and holds promise of a good psychosocial outcome for most donors, irrespective of donation‐related complications. The pronounced complaints appears to indicate psychological tension and distress in some donors following donation.
Administration diluents differentiate Neoral from a generic cyclosporine oral solution
Authors: Kovarik John M , Barilla Denise , McMahon Louis , Wang Yibin , Kisicki James , Schmouder Robert
Published: March 2003

A non‐microemulsion cyclosporine oral solution was recently recalled from the market because of the lack of bioequivalence when administered with apple juice compared with water as the diluent. This open‐label, randomized, two‐period, crossover study assessed the effect of apple juice on Neoral, a microemulsion cyclosporine oral solution. The study enrolled 34 subjects who received 180 mg Neoral oral solution diluted in 200 mL tap water or apple juice. Cyclosporine was measured in whole blood by a liquid chromatography method. Pharmacokinetic parameters were compared by standard bioequivalence tests. With water vs. apple juice, cyclosporineCmaxwas 1263 ± 203 vs. 1191 ± 225 ng/mL and AUC was 4714 ± 1117 vs. 4788 ± 1320 ng h/mL, respectively. Bioequivalence was demonstrated for both parameters. These data were comparable with those from a previous study in which subjects received 180 mg Neoral oral solution with orange juice. Cyclosporine bioavailability is unaltered when Neoral is administered diluted in apple juice or orange juice compared with tap water which conforms to the cyclosporine product label.
Acute pancreatitis following kidney transplantation – role of viral infections
Authors: Sinha Sanjay , Jha Ratan , Lakhtakia Sundeep , Narayan Girish
Published: March 2003

Abstract: Acute pancreatitis following renal transplantation is an unusual complication that carries a high mortality. Over the last 10 yr, five of 185 patients at our center developed acute pancreatitis. All had live related donors and were on conventional triple drug immunosuppression. Pancreatitis was classified according to the computed tomography scan based on Atlanta Classification. All five patients who developed acute pancreatitis had evidence of symptomatic or serologically active viral infection (chicken pox in two, cytomegalovirus infection in two, hepatitis E virus in one) and no patient without viral infection developed pancreatitis. Overall, 45 patients developed symptomatic or serologically active viral infection. There was a significant association between viral infection and pancreatitis (chi‐square test, p < 0.001). Three patients with severe acute pancreatitis died while both patients with mild pancreatitis survived. An active search for viral infections should be made in all patients with acute pancreatitis. Specific antiviral measures may help reduce the mortality of acute pancreatitis in these patients. Consideration must be given to varicella immunization in patients with renal failure.
Stroke in renal transplant recipients: epidemiology, predictive risk factors and outcome
Authors: Oliveras Anna , Roquer Jaume , Puig Josep M , Rodríguez Ana , Mir Marisa , Orfila M Antonia , Masramon Jordi , Lloveras Josep
Published: March 2003

Abstract: Background:  Cerebrovascular and cardiovascular diseases are the most important causes of increased morbidity and mortality in patients with end‐stage renal disease. Stroke has been widely reported in chronic dialysis patients, but there is scarce information about stroke in renal transplant recipients (RTR), although cerebrovascular events are the most common and potentially life‐threatening neurological complications in them. Our aim is to analyze the prevalence, risk factors, etiopathogenia, clinical aspects and outcome of stroke in RTR.

Methods:  We analyzed 403 patients who received one or more renal grafts between 1979 and 2000: group A = patients who had stroke (n = 19); group B = those who did not (n = 384). Medical records and pertinent data were compiled. The risk of stroke was studied using univariate and multivariate Cox regression models.

Results:  prevalence of stroke in RTR was 7.97% at 10 yr. Time elapsed between renal transplantation (RT) and stroke: 49.3 months. Possible risk factors based on the univariate analyses were: diabetic nephropathy (DN) (p < 0.001) and autosomal‐dominant‐polycystic‐kidney‐disease (p = 0.049) as original nephropathies, peripheral vascular disease (PVD) (p < 0.001), diabetes mellitus prior to RT (p = 0.005), age older than 40 yr (p = 0.037) and hypertension (p = 0.049). Other analysed risk factors such as gender, renal function, cytomegalovirus infection, hyperlipidemia, hyperuricemia, erythrocytosis or hypertensive donor failed to show any significant predictive value for stroke in these patients. When multivariate analyses were carried out, we found that DN (OR = 4.8; p = 0.010), PVD (OR = 8.2; p < 0.001) and age > 40 yr (OR = 3.3; p = 0.019) were predictive risk factors for stroke. For group A, hypertension was present in all patients, 68.4% had hyperlipidemia and 42.1% reported previous stroke. Cerebral hemorrhage occurred in seven of 19 (36.84%) of the stroke patients, but no subarachnoid hemorrhage occurred in them. Seven of 12 ischemic strokes were atherotrombotic. Considering all strokes, basal ganglia was the predominant localization. The outcome was poor, as nearly half of the patients died in the 3 months following stroke.

Conclusions:  Prevalence of stroke in our RTR population was 7.97%. Cerebral hemorrhage appears to be more prevalent in RTR than in general population. More than that, the cerebral hemorrhage rate we found is higher than that reported elsewhere in RTR. The main predictors of stroke were DN, PVD and age. No patient with interstitial nephropathy suffered stroke. Mortality is high in RTR with stroke.
Failure of cyclosporin A to induce transforming growth factor beta (TGF‐β) synthesis in activated peripheral blood lymphocytes
Authors: Goppelt‐Struebe Margarete , Esslinger Birgit , Kunzendorf Ulrich
Published: March 2003

Abstract:  Induction of transforming growth factor beta (TGF‐β) by the immunosuppressive drug cyclosporin A (CsA) in activated lymphocytes has been claimed to add to the renal pro‐fibrotic effects of CsA. The aim of this study was to evaluate CsA‐mediated TGF‐β induction in a larger number of lymphocyte preparations from different donors. Peripheral blood lymphocytes (PBL) were obtained from healthy blood donors. The cells were stimulated with phytohemagglutinin E (PHA) and phorbol ester (tetradecanoyl phorbol acetate, TPA) in the presence or absence of CsA. TGF‐β, interleukin‐2 (IL‐2) and cyclooxygenase‐2 (Cox‐2) mRNA were detected by Northern blot analysis or by real time reverse transcriptase‐polymerase chain reaction (RT‐PCR). TGF‐β and IL‐2 protein were determined in the cellular supernatants by enzyme‐linked immunosorbent assay. TGF‐β mRNA and protein were up‐regulated when the cells were stimulated with PHA/TPA. Cyclosporin A at high concentrations (500 ng/mL) caused a transient increase in TGF‐β mRNA which was significant after 2 h. CsA did not induce sustained TGF‐β protein expression (24–72 h) in any of the preparations (n = 14), whereas the up‐regulation of IL‐2 mRNA and protein was prevented by CsA in the same preparations. Furthermore, up‐regulation of Cox‐2 mRNA was inhibited by CsA. Taken together, there was no evidence for TGF‐β as a clinically relevant mediator being induced by CsA in activated peripheral blood T‐lymphocytes.