bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical presentation of CMV infection in solid organ transplant recipients and its impact on graft rejection and neopterin excretion
Authors: Tilg H. , Margreiter R. , Scriba M. , Marth Ch. , Niederwieser D. , Aulitzky W. , Spielberger M. , Wachter H. , Ruber Ch.
Published: September 2024

CMV serotesting by means of ELISA was performed every alternate week in 160 patients receiving renal (n= 117), pancreas (n = 18), liver (n = 17) and heart allografts (n = 8). Prophylactic immunosuppression consisted of Cyclosporin A plus methylprednisone and was identical for the different groups of transplant patients studied. In parallel, urinary neopterin values were studied in these cases. Thirty‐eight CMV infections were observed. Of these, 74% represented secondary infections and approximately 50% were symptomatic. CMV infections preferentially occurred in hyperimmunosuppressed individuals as evidenced by (i) an almost complete lack of early acute rejection episodes in transplant recipients who subsequently experienced infection, and (ii) aggravation of severity of infection after intensification of immunosuppressive treatment. The incidence of CMV infection was also markedly increased in polytransfused organ recipients, and evidence suggests that immunosuppression by blood transfusion rather than transmission of virus is responsible. CMV infection and, in particular, CMV disease, at least in renal transplant recipients, negatively influenced graft survival: this was thought to represent a consequence of CMV‐induced enhancement of alloreactivity as well as a consequence of deliberate reduction of immunosuppression during serious CMV disease. Evaluation of the neopterin marker, although not specific, proved to be clinically useful for three reasons: (i) neopterin in response to CMV infection increases approximately 1 wk earlier than antibodies, (ii) the magnitude of CMV‐induced neopterin responses is related to the severity of the infection, and (iii) normalization of neopterin levels is related to resolution of CMV disease.
Evolution of technique and results of pancreas transplantation at the University of Iowa
Authors: Corry Robert J. , Nghiem Dal D.
Published: September 2024

Recent experience with whole organ pancreatic transplantation in our institution has been encouraging. While early problems with cardiac‐related mortality and graft thrombosis occurred, normal carbohydrate metabolism has been achieved in over half the patients over a period of 1 to 2 years. Careful patient evaluation, including coronary arteriography, is expected to reduce mortality related to inappropriate patient selection. The incidence of graft thrombosis has been reduced by an anticoagulation protocol. Wound sepsis has been lessened by using bladder drainage rather than small intestine drainage. Opening of the peritoneum has been adopted so that serous drainage will be absorbed by the peritoneum. Two major problems remain; namely, the prevention of chronic rejection, and the question of whether secondary complications of diabetes can be stabilized or reversed.
Improving results of renal transplantation with multidrug therapy in patients over 50 years of age
Authors: Fryd David S. , So Samuel K. S. , Kruse Linda , Seifeldin Raafat , Canafax Daniel M. , Sutherland David E. R. , Simmons Richard L. , Najarian John S.
Published: September 2024

The results of 182 primary renal transplants in patients over 50 yr old were analyzed by two eras: 123 patients received standard therapy (antilymphocyte globulin, azathioprine and prednisone) during Era 1 (January 1968‐July 1979); while 25 patients received standard immunosuppression, and 34 received cyclosporine (cyclosporine plus prednisone) during Era 2 (August 1979‐April 1984). Our results indicate: (1) older patients during Era 1 did significantly poorer than younger patients (p < 0.03), (2) results in older patients receiving cyclosporine improved during Era 2, (3) the greatest improvement was seen in recipients of cadaveric grafts, (4) the incidence of acute rejection episodes was slightly higher (NS) in the standard treatment groups during Era 2; however, the cyclopsorine group had easily reversed rejections while the standard therapy group developed lethal infectious complications, and (5) results in older and younger patients receiving cyclopsorine are comparable. We conclude that cyclosporine allows older patients to be transplanted safely and with excellent results.
Treatment of severe rejection of kidney transplants with Orthoclone OKT3
Authors: Ponticelli C. , Rivolta E. , Tarantino A. , De Vecchi A. , Banfi G. , Beradinelli L. , Vegeto A.
Published: September 2024

16 renal transplant recipients developed an acute rejection which, in spite of intravenous high‐dose methylprednisolone, led to an increase in plasma creatinine of at least 8 mg/dl (3 patients) or to need for dialysis (13 patients). The patients were then treated with intravenous monoclonal antibody Orthoclone OKT3. In 13 patients rejection was reversed: 8 of them developed a re‐rejection which was reversed by a further course with methylprednisolone, but I patient had a third rejection and his graft had to be removed. Another patient died from liver failure 27 months later. At present, after a mean follow‐up of 18 ± 10 months, 15 patients (94%) are still alive and 11 patients (69%) have their graft functioning. It is concluded that Orthoclone OKT3 is very effective in reversing severe rejections and can rescue a good proportion of steroid‐resistant transplanted kidneys.
Renal transplantation from HLA‐haploidentical living related donors: The Scandinavian multicenter study of the effects of cyclosporine immunosuppression
Authors: Albrechtsen D. , Flatmark A. , Lundgren G. , Brynger H. , Fredin L. , Groth C. G. , Gäbel H. , Thorsby E.
Published: September 2024

214 consecutive recipients of renal grafts from HLA‐haploidentical family members were treated with cyclosporine and prednisolone. No donor‐specific transfusions were given. The overall graft survival rate was 91.6% and 90.5% at 1 and 2 years, respectively, while the patient survival was 98.6% at 2 yr. Graft survival tended to be lower, and frequency of rejection episodes significantly higher, in recipients of HLA‐DR or MLC‐mismatched grafts, but satisfactory results were also observed in the HLA‐mismatched group. No beneficial effect on graft survival of pretransplant blood transfusions was seen. However, in the sub‐group of patients with antibodies reactive with allogenic panel T cells, significantly lower graft survival was seen, in spite of a negative cross‐match.
Early donor heart failure following transplantation from myocardial injury sustained during brain death
Authors: Novitzky D. , Cooper D. K. C. , Rose A. G. , Wicomb W.N. , Becerra E. , Reichart B.
Published: September 2024

In an experimental study in the Chacma baboon, the induction of brain death was followed by myocardial structural damage in 6 out of 10 (60%) animals. This damage, which is believed to be related to intense sympathetic nervous system activity resulting in the prolonged release of myocardial endogenous catecholamines, predominantly consists of various forms of myocardial necrosis (contraction bands, coagulative myocytolysis, coagulative necrosis), and of focal interstitial mononuclear cell infiltration and edema. We have reviewed those patients who died following heart transplantation at the Universities of Cape Town and Munich from hitherto unexplained causes either at operation or in the early post‐transplant period. Five out of 106 patients (4.7%) showed donor heart histopathological features almost identical to those seen in our experimental study. Details of these 5 patients are given. We suggest that myocardial damage sustained during the agonal period may be a major factor in those patients in whom donor heart failure occurred early during the post‐transplant period.
Primary nonfunction in human cadaver kidney transplantation: Evidence for hidden hyperacute rejection1
Authors: Iwaki Yuichi , Terasaki Paul I.
Published: September 2024

In cadaver donor kidney transplants, primary nonfunction (kidneys that never function) was found in 8% of 7788 first grafts, 14% of 1471 second grafts (p<0.0000001 vs. first), and as many as 20% of 225 third grafts (p< 0.0000001 vs. first). This difference in primary nonfunction rates between first, second, and third grafts was noted in patients grafted with kidneys having different categories of warm and cold ischemia times, in patients transplanted with kidneys from donors of various ages, in patients with different degrees of HLA mismatching, in patients treated with cyclosporine, and in patients with different levels of sensitization. Thus, regardless of these variables, the prcgrafted patients had a higher rate of primary nonfunction. Only 2% of the nonfunction rate was attributable to technical problems. This means that 6% of first grafts never function, as a result of an undetected hyperacute rejection. As many as 12% of second grafts and 18% of third grafts fail to function for the same reason. Once these nonfunctional kidneys were removed from the analysis, second and third graft recipients had 1‐yr survival rates of 63% and 64%, respectively, as compared with 68% for first grafts. Thus, the adverse effect of immunization by graft rejection can be largely neutralized by removal of the heretofore undetected hyperacute rejections.
Preoperative evaluation of the pediatric heart transplant candidate*
Authors: Bricker J. Timothy , Frazior O. Howard
Published: September 2024

Cardiac transplantation in childhood is in its early stages. The goals of preoperative evaluation include determination that cardiac transplantation is necessary, determination that cardiac transplantation is feasible, obtaining information to diminish risks and difficulties in operative and postoperative management, and preoperative evaluation for establishment of a baseline for long‐term followup. The authors present their experience to provide a framework for developing an approach to pre‐trànsplant evaluation at other pediatric cardiac centers and to stimulate dialogue regarding preoperative evaluation from other centers experienced in pediatric cardiac transplantation.
Prevention, diagnosis, and treatment of rejection in the adult hepatic transplant patient
Authors: Klintmalm Goran B. G. , Nery J. R.
Published: September 2024

Despite attempts to optimize routine maintenance immunosuppression, rejection is still one of the most frequent causes of graft dysfunction seen after liver transplantation. Using cyclosporine and prednisolone for baseline immunosuppression, 104 patients who received liver transplantation at Baylor University Medical Center were studied. Liver biopsies were performed weekly according to protocol, and on clinical indication to monitor graft dysfunction and to follow response to rejection therapy. Primary rejection therapy consisted of high‐dose steroids. OKT*3 was given as rescue therapy. Azathioprine was started when a rejection was diagnosed. After approximately 1100 liver biopsies, only 7 complications were recorded. In one patient surgery was necessary. There was no mortality. On this immunosuppressive protocol, 39% of patients never experienced acute rejection. Of the 61% who did, two‐thirds had one, and one‐third of the patients had 2 or more acute rejections. Ninety‐five percent of the first rejections occurred within the first 3 weeks of transplantation. There were 18 deaths, 4 of which resulted from complications of acute and chronic rejection. In 6 patients, the diagnosis of chronic rejection was made. We conclude that rejection is still a major cause of disability after liver transplantation but that present immunosuppressive therapy is effective in control.
Effect of immunosuppressive drugs on alpha interferon production by lymphomonocytes from transplanted patients
Authors: Lorino G. , Lun M. T. , Filadoro P. , Mancinl C. , Capobianchi M. R. , Di Marco P. , Dianzani F. , Allani D. , Cortasini R.
Published: September 2024

The interferons system is an important defense mechanism of human body; its functional integrity is essential in high‐risk patients such as transplant recipients treated with immunosuppressive therapy. Our study aimed at evaluating the capacity of PBMC from transplant patients undergoing cyclosporine A or conventional therapy to respond to several interferon inducers: killed mycoplasma pneumoniae, able to induce alpha interferon production in PBMC from healthy donors: Newcastle disease virus for alpha interferon induction; staphylococcal enterotoxin B for gamma interferon induction. The results show that PBMC from kidney transplant patients treated with conventional therapy and stimulated with mycoplasma pneumoniae fail to produce alpha interferon. Moreover, with cyclosporine therapy alpha interferon production was markedly depressed at high doses of drug, but increased to control levels with maintenance doses. The same result was observed for gamma interferon with staphylococcal enterotoxin B. On the other hand, no difference in alpha interferon production was found in PBMC from patients in immunosuppressive therapy and from healthy donors stimulated by Newcastle disease virus. Data obtained from experiments adding in vitro cyclosporine A, showed inhibition of interferon production related only with staphylococcal cntcrotoxin B induction.
Treatment of poor prognosis renal allograft rejection with anti‐lymphocyte globulin (ALG) – An analysis of late results
Authors: Foster M.C. , Wenham P.W. , Cooksey G.D. , Paterson A.D. , Cotton R.C. , Burden R.P. , Morgan A.G. , Blamey R.W.
Published: September 2024

Eighty‐four renal transplants were performed using conventional immunosuppression. Poor prognosis rejection episodes were identified using pre‐determined histological criteria in the course of 36 transplants and were treated with a 7‐day course of anti‐lymphocyte gobulin (ALG). Other rejection episodes were treated with steroids alone. Thirteen ALG‐treated grafts failed from acute rejection, and 3 patients died with functioning grafts at 2, 9 and 35 months. The remaining 20 patients have been followed for between 26 and 62 months. Eight grafts have failed from chronic rejection, 1 patient has deteriorating function and advanced chronic rejection and only 11 (31%) of those treated have stable function. Whilst our early experience with ALG in poor prognosis rejection was encouraging, the improvement in results has not been maintained with longer follow‐up.
Pre‐ and post‐transplant sensitization in cyclosporin A‐treated patients
Authors: Sumitran‐Karuppan Suchitra , Lindholm Anders , Möller Erna
Published: September 2024

A study to test donor‐reactive antibodies in a large set of current as well as non‐current sera for reactivity against donor T and B lymphoid cells was performed and their correlation to transplant survival was studied. We found that earlier sensitization in kidney grafted patients, demonstrable as the presence of cytotoxic antibodies reactive with T and B cells or with B cells only in the pretransplantation period, is associated with significantly lower graft survival and more rejection episodes compared to patients without demonstrable antibodies. In addition, patients with viral infections develop autoantibodies.
Right heart failure following orthotopic cardiac transplantation
Authors: Wahlers Th. , Beer C. , Fieguth H. G. , Cremer J. , Jurmann M. , Schäfers H. J. , Herrmann G. , Frimpong K. , Haverich A. , Borst H. G.
Published: September 2024

Restrictions concerning pulmonary vascular resistance in patients awaiting orthotopic heart transplants have been essentially unchanged throughout the last decade. In order to gain more insight into the role of this parameter, the incidence, duration, and possible influencing factors of postoperative right heart failure following orthotopic cardiac transplantation were investigated in 46 patients. Two groups of patients were identified according to the postoperative right heart performance. In group 1 (18 patients) the mean right atrial pressure was 18.5 ± 4.5 mmHg throughout the period of right heart failure compared to 10.2 ± 3.2 mmHg within the first 18 hours after the operation. The right heart impairment was observed after a mean of 46.3 ± 18.5 h for a duration of 39 ± 23 h. Throughout the same time period, group 2 (28 patients) demonstrated unchanged filling pressures (11.3 ± 2.5 mmHg), despite identical surgical and medical treatment. Analysis of differences between the groups revealed a significant negative donor/recipient weight ratio in group 1 versus group 2 (‐ 0.9 ± 7.3 kg v. + 6.1 ± 13.3 kg; p <.05), while ischemia time, age, sex, underlying diagnosis and pulmonary vascular resistance were comparable in both groups. To overcome right heart failure, the dosage of catecholamines and of diuretics was significantly higher in group 1 (p < .05). In conclusion, donor body weight of 10% less than the recipient weight represents a significant risk factor for postoperative right heart failure following orthotopic cardiac transplantation.
Renal allograft versus native kidney arterial blood flow: A comparative study
Authors: Benoit G. , Carli P. , Bensadoun H. , Ecoffey C. , Moukarzel M. , Jardin A. , Charpentier B. , Fries D.
Published: September 2024

Renal arterial blood flow (RBF) was measured comparatively, using a miniaturized implantable doppler probe, in two groups of kidneys: the first (reference group) consisted of 11 native kidneys and the second of 10 kidney allografts (6 cadaveric and 4 living). We found that in group I, RBF remained almost unchanged after renal artery manipulation. In group II, the RBF values of cadaveric transplants are much lower than those of living related donors (103 ± 69 ml/min versus 272 ± 150 ml/min) and RBF decreases with cold ischemia time. Renal transplants show a significant flow decrease at 20 min due to cortical vasospasm following reperfusion and resulting in particular aspects of flow curves. We conclude that pulsed doppler can be used to monitor RBF in renal transplantation.
Immunoregulatory (antiidiotypic ?) serum factors in pre‐ and posttransplant sera of renal transplant recipients
Authors: Daniel V. , Fatehi S. , Ritz E. , Röhl L. , Schärer K. , Opelz G.
Published: September 2024

Sera of 40 renal transplant recipients were tested for the presence of antiidiotypic antibodies against autologous donor‐reactive recipient T cells. From each patient, a series of cell cultures was established. The cultures were restimulated with specific donor cells for 2 weeks. Cells of each culture were tested in 2‐day MLC assays with the addition of autologous pre‐ or posttransplant serum or 2 control sera. For each patient the proportion of cultures was calculated that was suppressed or stimulated by autologous sera. Stimulation by pretransplant serum was correlated with the number of pretransplant blood transfusions (p<0.01), but not with graft survival. Within 2 months posttransplant, suppressive and stimulating serum factors were induced that correlated significantly with transplant outcome (p < 0.01). Patients with good graft outcome had significantly more cultures that were suppressed by posttransplant serum than patients with rejections. Conversely, stimulation was associated with graft rejection. Our data suggest a posttransplant induction of suppressive and stimulative serum factors that regulate the reactivity of donor‐reactive cell clones.
Renal transplantation in Nordic children during two decades. A retrospective study†
Authors: Weibull Henrik , Husberg B. , Gäbel H. , Fjeldborg O. , Ladefoged J. , Lindholm A. , Monn E. , Persson M. Omnell , Salmela K. , Wahlberg J.
Published: September 2024

175 children younger than 16 years received 112 living donor and 91 cadaver donor kidney transplants during a 20‐yr period. 80% of the patients were treated with an immunosuppressive protocol based on Azathioprine and 18% were based on Cyclosporin A. Overall actuarial patient survival at 10 yr was 83%. Actuarial graft survival rate was 46% at 10 yr for recipients of living donors and 23% for recipients of cadaver donor kidneys. There was no difference in graft or patient survival between groups treated with Azathioprine and Cyclosporin A, but the complication rate with regard to bacterial and viral infections and acute rejections was significantly lower in the Cyclosporin A group. Children with functioning grafts showed a catch‐up growth or followed their predicted growth curve.
Successful simultaneous heart and kidney transplantation using the same donor
Authors: Livesey S. A. , Rolles K. , Calne Roy , Wallwork J. , English T. A. H.
Published: September 2024

We report the case of a 17‐year‐old boy who presented with renal failure and was started on chronic ambulatory peritoneal dialysis. He then developed resistant heart failure due to a familial cardiomyopathy and so underwent simultaneous cardiac and renal transplantation. Factors which were taken into consideration when deciding upon this plan of management included the theoretical advantage of a common set of antigens for both allografts, the practical advantage of a single anesthetic and single hospital stay; and the possibility of monitoring rejection of both organs by cardiac biopsy. The latter proved not to be the case and the heart was more prone to rejection than the kidney.
Mismatched living related donor transplantation: Donor‐specific transfusions vs. cyclosporine
Authors: Sommer Bruce G. , Bowers Victor D. , Henry Mitchell L. , Ferguson Ronald M.
Published: September 2024

One‐hundred‐eleven mismatched living related renal transplants have been analyzed to compare the benefits and drawbacks of two seemingly complimentary immunotherapy protocols. Sixty‐one recipients received cyclosporine (CsA) and prednisone and 50 received donor‐specific transfusions (DST) combined with azathioprine, prednisone, and prophylactic antilymphoblast globulin (ALG). At 2 years, both immunosuppressive protocols have a comparable low incidence of patient and allograft loss and a comparable low incidence of rejection and infectious episodes. However, the relative cost of transplantation at 6 months was decreased by 30% (p < 0.05) in recipients who received CsA following transplantation. Furthermore, CsA allows the potential recipient immediate access to mismatched living related donor (LRD) transplantation without running the risk of possible presensitization to their donor. Recipient presensitization with DST is a problem; however, DST with conventional therapy and ALG provides for an effective alternative method of immunosuppression. Long‐term analysis of renal allograft function must be evaluated in the CsA‐treated group to ascertain if pharmacologically induced nephrotoxicity will become a significant variable in the future.
Results of steroid withdrawal in renal allograft recipients on low‐dose cyclosporine A, azathioprine and prednisolone
Authors: O'Connell Philip J. , d'Apice Anthony J. F. , Walker Rowan G. , Francis David M. A. , Clunie Gordon J. A. , Kincaid‐Smith Priscilla
Published: September 2024

One hundred and five consecutive cadaveric renal allografts have been studied to evaluate a regime of low‐dose cyclosporin A (CsA), azathioprine (AZA) and prednisolone. The objective was to eliminate maintenance prednisolone by 6 months without sacrificing graft survival or adding unacceptable levels of cyclosporin toxicity. Initially all recipients were started on AZA 2 mg/kg/day, CsA 8 mg/kg/d and prednisolone 15–25 mg/d. AZA was maintained at 2 mg/kg/d and the CsA dose was adjusted to maintain a trough whole blood concentration of 300–400 ng/ml after 1 month. The prednisolone dose was reduced by 2.5 mg every 2 wk until it was eliminated, by 4 to 6 months. The 12‐month actuarial graft survivals for primary and non‐primary grafts were 86% and 76% respectively. The 12‐month actuarial patient survival was 95%. Eleven of the 14 graft losses were due to rejection and 3 of the 4 patient deaths were due to infection. The median serum creatinine concentrations at 6 and 12 months post‐transplant were 0.12 mmol/1 and 0.13 mmol/1 respectively. Of the 60 patients who were followed for more than 6 months, 47 (78%) had ceased prednisolone. Twelve patients had restarted prednisolone 4 d to 14.5 months following its cessation; 10 of these recommenced because of rejection, 1 because of recurrent focal glomerulosclerosis and 1 because of a temporary cessation of AZA. Four of these patients again ceased prednisolone a second time. There were no graft losses and all maintained good graft function. Seven of the 10 patients who developed rejection after ceasing prednisolone had a trough whole blood CsA concentration of less than 300 ng/ml at the time of rejection and 8 were receiving AZA at less than 2 mg/kg/d. At the time of assessment, 38 (63%) had ceased maintenance prednisolone, 16 (27%) were receiving triple immunosuppression with a median prednisolone dose of 7.5 mg/d (range 1–12.5 mg/d) and 6 were receiving AZA and prednisolone. In conclusion this protocol allows most renal allograft recipients to safely cease prednisolone without compromising their graft function or survival.
Percutaneous dilation and stenting of ureteral stenoses in renal transplantation
Authors: Gregory Martin C. , Micklos Tim , Miller Franklin J. , Servilla Karen S. , Nelson Edward W.
Published: September 2024

Non‐operative management of post‐transplant ureteral stenoses has been suggested as an alternative with potentially less morbidity and graft loss than surgical reconstruction. Seven cases of ureteral stenosis, occurring 2 wk to 7 yr after engraftment, were treated with percutaneous nephrostomy followed by percutaneous dilation and prolonged internal stenting of the stenotic segment. This method has proven to be a satisfactory and practical alternative, but infectious complications are common and the long‐term durability of this technique remains to be documented.
Successful management of wound mucormycosis in a combined hepatic and renal transplant recipient: A case report and literature review
Authors: Andreone Peter A. , Ascher Nancy L , Hanto Douglas W. , Najarian John S. , Simmons Richard L
Published: September 2024

Gangrenous wound mucormycosis developed 10 days after combined liver and kidney transplant for Wilson's disease in a 22‐year‐old woman. The wound directly overlay the renal transplant. The patient was successfully treated with radical surgical excision and repeated conservative debridement with serial frozen and permanent pathologic studies for fungus eradication. Both intravenous and concentrated topical Amphotericin B applications were thought to be useful adjuncts – the former inhibiting dissemination and the latter inhibiting implantation of fungi into the freshly debrided wound. Prompt recognition and initiation of therapy is essential for survival and can only be achieved if a high clinical index of suspicion is maintained when unusual skin lesions occur in immunocompromised patients.
Renal vascular thrombosis of cadaveric renal allografts in patients receiving cyclosporin, azathioprine and prednisolone triple therapy
Authors: Jones Robert M. , Murie John A. , Ting Alan , Dunnill Michael S. , Morris Peter J.
Published: September 2024

Of 110 consecutive patients given cyclosporin, azathioprine and prednisolone triple therapy after renal transplantation, 6 had a renal vein thrombosis and 2 a renal artery thrombosis. This contrasts with 1 renal vein 1 one renal artery thrombosis in 429 patients treated with azathioprine and prednisolone (365 patients) or cyclosporin alone (64 patients). This high incidence of thrombosis may be related to the use of cyclosporin in a triple therapy protocol. The complex effects of cyclosporin on hemocoagulation are discussed.
Dietary protein manipulation or cyclosporin therapy in chronic renal allograft rejection
Authors: Kootte A. M. M. , Hart‐Eerdmans M. 't , Paul L. C.
Published: September 2024

We studied the effect of a diet low in animal proteins (0.33 g/kg/day) or of cyclosporin therapy (CsA; 5 mg/kg/d) on the rate of decline of graft function in patients with chronic renal transplant rejection; both groups and a control group were preselected and consisted of 7 patients each. The serum creatinine values (sCr) at the time of intervention were 306 ± 43 μmol/1 (mean ± SEM) in the protein‐restricted group, 285 ± 48 μmol/1 in the CsA‐treated group and 222 ± 10 μmol/1 in the controls. After an 18‐month study period, 4 patients were on dialysis; the sCr in the patients who were not on dialysis were 235 ± 19 μmol/1 in the group who had received a dietary intervention, 434 ± 40 μmol/1 in the CsA‐treated group and 346 ± 14 in the controls. In the protein‐restricted group the sCr decreased in the patients who had a sCr<310 μmol/1 at the time of intervention; in the patients who received CsA the sCr values remained generally stable after an initial increase. In the controls the sCr deteriorated at a constant rate. Since both dietary intervention and CsA may reduce the rate of deterioration of graft function in patients with chronic rejection these interventions warrant further studies in a larger group of patients.
Complications associated with the treatment of rejection in pediatric liver transplant patients
Authors: Ryckman Frederick C. , Suchy Frederick J. , Penn Israel , Alexander J. Wesley , Schroeder Timothy J. , Balistreri William F.
Published: September 2024

The management of complications following hepatic transplantation in children requires a directed approach to their early recognition and diagnosis in order to avoid misinterpretation of clinical and biochemical abnormalities and inappropriate modifications in the immunosuppressive regimen. Abnormal screening laboratory tests serve to signal the presence of allograft dysfunction, but do not allow specific definition of recurrent or persistent rejection, infection, biliary duct complications, or drug hepatotoxicity in patients undergoing primary therapy for allograft rejection. Use of a consistent radiographic screening protocol employing computed tomography of the abdomen, real‐time and doppler ultrasound, and biliary imaging allows the early recognition of technical abnormalities within the allograft. Percutaneous hepatic biopsy is essential to define complications of recurrent or persistent rejection vs infection and drug‐related hepatotoxicity. Utilizing this directed diagnostic protocol, 15 pediatric hepatic transplant patients have been successfully managed with only one retransplantation required for graft lost due to irreversible rejection, and no mortality from infection‐related or biliary tract complications.
Immune monitoring in the monoclonal era
Authors: Klein Jon B.
Published: September 2024

Monitoring of circulating immune cells has developed into a useful tool for both the treatment and investigation of transplant rejection. The most common clinical methods employed to monitor the immune system use fluorescence‐conjugated antibodies to identify specific lymphocyte subsets. Lymphocyte subset analysis carried out by flow cytometry can be used to assess adequacy of anti‐lymphocyte therapy, modulation of the immune system by anti‐lymphocyte drugs, and rebound rejection following anti‐rejection therapy. Monitoring of the circulating immune system by flow cytometry is currently being investigated as a tool to diagnose acute allograft rejection. Work from our center and others suggests that flow cytometric measurements of changes in the replicative cycle of circulating immune cells are associated with allograft rejection.
Acute rejection episodes in cyclosporine‐treated cadaver kidney recipients
Authors: Lindholm Anders , Lundgren Göran , Fehrman Ingela , Weibull Henrik , Brynger Hans , Frödln Lars , Flatmark Audun
Published: September 2024

A total of 532 acute rejection episodes were registered in 621 consecutive cadaveric renal allograft recipients treated with cyclosporine (CyA) and low dose prednisolone. Fifty‐seven percent of the patients experienced acute rejection. The occurrence of a rejection episode was an important risk factor for graft survival and acute rejection accounted for 51% of the 104 grafts lost. The 1 year graft survival rate was 59 and 82%, respectively, in patients who did or did not experience acute rejection (p < 0.001). Factors that correlated with an increased rejection frequency were the presence of panel reactive T‐cell antibodies in a current recipient serum (p < 0.01) and younger recipient age (p < 0.0l). HLA‐DR‐matching also influenced the risk of experiencing rejection (p = 0.02). If only grafts with a fully known DR‐type in both donor and recipient were taken into account, however, no difference regarding rejections was observed between the groups. HLA‐A and ‐B matching, pretransplant blood transfusions and first versus re‐transplantation had no impact on rejection frequency. In the rejecting patients, the CyA plasma and blood levels and the dose of CyA were lower during the first months posttransplant than in non‐rejection patients (p < 0.05). This finding stresses the importance of CyA monitoring and frequent dose adjustments in order to maintain adequate immunosuppression during the early posttransplant period.
Surgical correction of abdominal aortic aneurysm after renal transplantation
Authors: Hiraga Seigo , Satoh Takeshi , Kawada Shiaki
Published: September 2024

We report a case of abdominal aortic aneurysm that arose 8 years and 2 months after a living related renal transplantation. The aneurysm was located in 1 cm below the renal artery towards the abdominal bifurcation and showed marked atheromatous change. Femoral V‐A bypass with a pump oxygenator was employed for the protection of the renal graft as aneurysm repair was carried out. A review of the 17 known cases of aortic aneurysm after renal transplantion obtained from the literature is discussed.
Early detection and management of portal vein thrombosis after hepatic transplantation: A case report
Authors: Koneru Baburao , Esquivel Carlos O. , Bowen A. Delbert , Zajko Albert B. , Starzl Thomas E.
Published: September 2024

A 5‐year‐old boy developed portal vein thrombosis on the 1st day following orthotopic liver transplantation. Early and prompt diagnosis was made by ultrasonography. Angiography confirmed the diagnosis and demonstrated an enlarged coronary vein, a probable etiological factor. An immediate thrombectomy, and ligation of the coronary vein were performed. Fifteen months later the patient is asymptomatic with normal allograft function but with some stenosis of the portal vein. This is the first report of such a nature in the literature.
A multicenter experience with sequential ALG/cyclosporine therapy in renal transplantation
Authors: Ferguson Ronald M. ,   The Transplant Information Share Group (TISG)
Published: September 2024

The influence of Class I and II HLA antigen matching on renal allograft survival in the cyclosporine era is controversial. The central question is whether current immunosuppressive protocols utilizing cyclosporine can safely and effectively suppress all degrees of in vivo alloreactivity. Data from six centers was collected. All centers utilize a “sequential” immunosuppressive protocol where ALG, azathioprine and prednisone are given for days 1 through 5 post‐transplant, followed by low‐dose cyclosporine and prednisone maintenance therapy. A total of 1217 cadaveric transplants were analyzed: 993 primary and 224 multiple. Patient follow‐up ranged from 4 months to 63 months. Overall graft survival of 993 primary cadaveric transplants was 87% at 1 year and 81% at 2 yr. Analysis of HLA A, B and Dr matching in these primary transplants demonstrated no significant advantage of well‐matched vs. poorly‐matched grafts. A, B matching alone, Dr matching alone, total A. B and Dr matching, or combinations of A, B and Dr match failed to demonstrate significant differences in 1 or 2 yr graft survival. There were 123 non‐transfused and 870 transfused primary grafts. No significantly improved graft survival was noted in the transfused group. Two cyclosporine protocols were analyzed, immediate cyclosporine without sequential therapy, 166 grafts, and delayed cyclosporine with “sequential” therapy, 827 grafts. Those primary transplants receiving sequential therapy with delayed cyclosporine had a significantly better 2‐yr graft function (84%) than those who received immediate cyclosporine therapy (74%). (p < .03). Age (>50 yr) did not influence outcome of primary transplantation. Overall primary graft survival at 2 yr was most influenced by immunosuppressive protocol. HLA A, B, Dr typing, transfusion, and age had little if any influence on outcome. Patients undergoing retransplantation followed a different pattern. Dr matching lead to a significantly better graft survival at 1 and 2 yr (p < .05). Patients > 50 yr proved to have significantly poorer graft survival (p < .01). Unlike primary cadaver grafts, immunosuppressive protocol did not influence outcome for re‐transplantation.
Renal transplant pyelonephritis
Authors: Thomalla J. Vincent , Gleason Phillip , Leapman Stephen B. , Filo Ronald S.
Published: September 2024

Review of 21 episodes of renal transplant pyelonephritis in 18 patients since 1974 revealed an overall incidence of 2.25% (n = 800) with an annual incidence of less than 1%/year for the population at risk. Transplant pyelonephritis was accompanied by culture‐documented bacteremia in 71% of cases with Escherichia coli being the most common isolate (81%). Transplant pyelonephritis occurred in all age groups, from 1 month to 11 yr post‐transplantation (mean 25.1 months). Significant predisposing factors included original cause of renal failure (pyelonephritis and renal dysplasia), patient sex, and recent urinary tract manipulation/instrumentation. Transplant pyelonephritis was associated with loss of baseline renal function in 3 patients, 2 of whom have subsequently lost their graft to chronic rejection. There has been no patient mortality. Transplant pyelonephritis is infrequent but must be correctly differentiated from rejection as they share many common signs and symptoms. This differentiation often relies on a high index of suspicion coupled with microscopic examination of the urine and blood and urine culture results.
The role of fine needle aspiration cytology in late renal transplants
Authors: Walsh Noreen M. G. , Gupta Rekha , Belitsky Philip
Published: September 2024

The aim of the present study was to determine the role of fine needle aspiration cytology in late renal transplants. Twenty‐five patients with matched fine needle aspirates and needle core biopsies, taken more than 3 months post‐transplantation, were reviewed. The definitive diagnosis, for the purpose of the study, was based on histology and relevant clinical data. The findings on fine needle aspiration cytology, as originally documented, were then correlated with the final diagnosis. Identifiable causes of graft dysfunction were categorized as reversible (acute cellular rejection 5, cyclosporin nephrotoxicity 2, intragraft lymphoma 1, acute pyelonephritis 1 and ureteric stenosis 1) or irreversible (chronic rejection 13 and recurrent glomerular disease 2). Of 9 potentially reversible parenchymal lesions, 6 were independently identified by fine needle aspiration (acute cellular rejection 5 and intragraft lymphoma 1). The nonreversible lesions were not amenable to diagnosis by this method. We conclude that, in the subgroup of late transplants with remediable intrarenal causes of graft dysfunction, fine needle aspiration cytology yields valuable diagnostic information and is a sensitive indicator of acute cellular rejection in this setting.
Renal transplant parenchymal malacoplakia with preserved renal function: A case report and review of the literature
Authors: Ling Brian N. , Delaney Veronica B. , McCue Peter A. , O'Brien David P.
Published: September 2024

Malacoplakia is a rare inflammatory response primarily affecting immunocompromised patients. We describe a patient who presented with renal insufficiency secondary to graft malacoplakia 6 years post‐cadaveric renal transplantation. The diagnosis was preceded by recurrent asymptomatic E. coli urinary tract infections and was followed by many life‐threatening bacterial and fungal infections. This case is unique amongst those in the literature in that renal function is preserved by a combination of specific antimicrobial therapy, chronic prophylactic trimethoprim‐sulfamethoxazole and drastic reduction in immunosuppressives.
Interstitial nephritis secondary to OKT3 administration
Authors: Poplawski Steven , Gonwa Thomas A. , Greene Claudia , Husberg Bo S. , Klintmalm Goran
Published: September 2024

OKT3 is a murine monoclonal antibody utilized for treatment of rejection in transplant recipients. A case report is presented in which the recipient developed a previously unreported side effect, interstitial nephritis. The diagnosis was based on clinical findings and fine needle aspiration biopsy. The patient quickly responded to withdrawal of OKT3 and steroid therapy.
Psychological aspects of the approach to donor relatives
Authors: Kirste G. , Muthny F. A. , Wilms H.
Published: September 2024

This clinical report summarizes the 18 years experience of a surgical department in transplanting kidneys and seeking relatives' permission for cadaver organ donation. Decision‐influencing factors for the donation are reported and cases are evaluated and categorized with respect to emotional strains for the relatives and the dynamics of interaction, as well as aspects of ethics and efficacy of intervention. Finally, some suggestions are made as to how to approach relatives in order to achieve low refusal rates and to help them to cope with this critical situation.
Alloreactive T lymphocytes cultured from liver transplant biopsies: Associations of HLA specificity with clinicopathological findings
Authors: Markus Bernd H. , Demetris A. Jake , Saidman Susan , Fung John J. , Zeevl Adriana , Starzl Thomas E. , Duquesnoy Rene J.
Published: September 2024

Lymphocyte cultures grown from liver allograft biopsies were shown to exhibit alloreactivity towards donor cells as measured by primed lymphocyte testing (PLT). The PLT specificity was determined in assays using HLA‐typed panel cells and/or by inhibition testing with HLA‐specific monoclonal antibodies. Certain cultures exhibited PLT specificity towards class I HLA antigens of the donor, whereas others were specific for class II HLA antigens or recognized mixtures of class I and II antigens. These PLT specificity patterns were compared with clinical, histological and laboratory findings on the liver transplant patients at the time of the biopsy. Biopsies yielding class I‐specific PLT cells were taken generally during the earlier posttransplant period, whereas class II‐specific cells were grown from later biopsies. There was no significant correlation of the PLT specificity towards class I vs. II antigens with the levels of total or direct bilirubin, serum glutamate oxaloacetic transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT), although a trend towards higher values was noted for biopsies presenting with a class II‐specific infiltrate. However, the levels of gamma glutamyl transpeptidase (GGTP) and alkaline phosphatase (AP) were significantly increased when biopsies yielded class II‐specific rather than class I‐specific PLT cells. Biopsy histology showed more damage to bile duct epithelium in association with class II PLT specificity whereas intense but often reversible infiltrates were found in biopsies yielding class I‐specific cells. The elevated GGTP and AP levels are probably related to the interaction of class Il‐specific T cells with bile duct epithelium, which has been shown to express induced class II HLA antigens on their cell surface.
Prediction of DST sensitization: II. Rapid calculation of the probability of sensitization
Authors: Colombe Beth W. , Juster Richard P. , Garovoy Marvin R.
Published: September 2024

A statistical model of DST sensitization has been developed which allows calculation of the probability of sensitization of the DST recipient to the HLA‐A and ‐B locus antigens of the potential kidney donor. By linear logistic analysis, six factors were found to be associated with DST sensitization: PRA, pregnancy, previous transplants, degree of HLA‐matching, random blood transfusions and the administration of azathioprine with the DST transfusions. The logistic model incorporating the factors has been converted into a simple paper‐and‐pencil format. Values for each of the factors together with the corresponding conversion scores are arranged in look‐up tables. Simple addition of the scores gives a total score which is converted to the predicted probability. With this instrument, it is possible to rapidly calculate the probable risk of DST sensitization for selected donors, with and without azathioprine administration, and consider alternate transplant options for those patients at high risk of sensitization.
Peritoneovenous shunt: A new method of treatment for recurrent peritransplant lymphocele
Authors: Manning Peter B. , Merion Robert M. , Dafoe Donald C. , Campbell Darrell A. , Turcotte Jeremiah G.
Published: September 2024

Clinically significant lymphocele formation complicates renal transplantation in 0.6–18% of cases. Transperitoneal marsupialization has been adopted by many groups as the preferred definitive treatment because of its high success rate and low risk of infection. Occasionally, however, initial marsupialization fails to resolve the fluid collection, requiring internal or external drainage. We present a case of a recurrent peritransplant lymphocele successfully treated by placement of a peritoneovenous shunt.
Metabolic consequences of cyclosporine‐to‐azathioprine conversion in renal transplantation
Authors: Gonwa Thomas A. , Atkins Carolyn , Velez Ruben L. , Brinker Karl R. , Nesser David A. , Dickerman Richard M. , Long Dewey L. , Hull Alan R. , Vergne‐Marini Pedro J.
Published: September 2024

Cyclosporine (CY) therapy has been reported to produce nephrotoxicity along with various metabolic abnormalities. We have retrospectively analyzed both cadaveric and living related renal transplant patients before, immediately after, and an average of 1 year following CY‐to‐azathioprine (AZA) conversion for serum creatinine, glomerular filtration rate (GFR), serum uric acid, serum triglycerides and serum cholesterol. For comparison, we have also evaluated the above parameters in stable cadaveric and living related renal transplant recipients who were never treated with CY. Our results demonstrate significantly higher creatinine and uric acid levels with a concomitant lowering of GFR in CY‐treated patients compared to non‐CY‐treated patients. These values improved following conversion. By contrast, CY‐to‐AZA conversion had no significant effect on serum lipid levels. The drop in uric acid levels was not correlated with the improvement in GFR, suggesting that CY therapy raises serum uric acid levels through a mechanism other than simply lowering GFR.
Recurrence of Wegener's granulomatosis after kidney transplantation involving the kidney graft
Authors: Aunsholt N. Aa. , Ahlbom G.
Published: September 2024

A patient with Wegener's granulomatosis developed chronic renal failure and underwent chronic hemodialysis and renal transplantation. On chronic hemodialysis no manifestation of Wegener's granulomatosis occurred despite no immunosuppression. After transplantation a post‐transplant immunosuppression with cyclosporine A and prednisone could not prevent reccurrence of the disease in the graft. Cyclophosphamide but not azothioprine added to the usual immunosuppression not only reversed but also controlled the disease.