bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular risk factors in long‐term followup after orthotopic liver transplantation
Authors: Guckelberger Olaf , Bechstein Wolf O. , Neuhaus Ruth , Luesebrink Rainer , Lemmens Hans P. , Kratschmer Bernd , Jonas Sven , Neuhaus Peter L. 
Published: September 2024

AbstractIn a retrospective study the records of 302 adult patients (167 male, 135 female) after orthotopic liver transplantation (OLT) with a minimum follow‐up of 6 months (median follow‐up 18 months, maximum 5 yr) were reviewed with regard to cardiovascular risk factors. In 197 patients data concerning the occurrence of arterial hypertension, hyperglycemia, or hypercholesterolemia prior to OLT were available. We found a highly significant increase of cardiovascular risk factors following OLT. Obesity was found in 17.4% of male and 22.2% of female recipients after OLT. Hypercholesterolemia was evident in 66.2% of liver graft recipients. Hypertriglyceridemia occurred in 49.7% of all male patients. In females there was a significantly different prevalence of hypertriglyceridemia comparing patients with a follow‐up period up to 2 yr and more than 2 yr (50% vs. 24.6%, p=0.018). Nearly 45% of all patients met the criteria for arterial hypertension, with a slight increase in male patients beyond the second year of survival (p=0.094). Hyperglycemia had a significantly higher frequency in male than in female patients (30.5% vs. 10.4%, p<0.005). Furthermore we observed a clear trend towards reduction of occurrence of hyperglycemia more than 24 months after OLT, but not reaching statistical significance.No correlation was detected when serum levels of triglycerides, and cholesterol, body‐mass‐index, and arterial blood pressure were compared with applied dosages of immunosuppressive agents [cyclosporin A (CyA), tacrolimus, and prednisolone]. Only decreasing tacrolimus application was significantly correlated with decreasing glucosemia (p=0.041).Patients receiving tacrolimus instead of CyA as primary immunosuppressant showed a significantly lower prevalence of hypercholesterolemia. Even hypertension, hyperglycemia, hypertriglyceridemia, and obesity had a lower occurrence in patients treated with tacrolimus although not reaching statistical significance.
Clinical spectrum of invasive cryptococcosis in liver transplant recipients receiving tacrolimus
Authors: Singh Nina , Gayowski Timothy , Wagener Marilyn M. , Marino Ignazio R. 
Published: September 2024

AbstractInvasive cryptococcal infections have been reported in 0.3–1% of the patients undergoing liver transplantation in the previous reports. In contrast, invasive cryptococcosis developed in 6% of 102 consecutive liver transplants at our institution receiving tacrolimus as primary immunosuppression. Cutaneous and/or osteoarticular infections due to cryptococcus were detected in 67% of the patients with cryptococcosis, whereas meningitis was present only in 17%. One of the six patients with cryptococcosis presented with refractory shock and multiorgan system failure attributable solely to cryptococcosis. Patients with cryptococcal infections were significantly older than all other liver transplant recipients (p=0.017), suggesting reactivation as opposed to primary infection as pathogenesis of cryptococcosis. 100% of the patients with cryptococcosis resided on the Eastern coast of the United States as compared to 59% of the patients without cryptococcosis (p=0.08). There was no difference in the severity of underlying liver disease, degree of immunosuppression or CMV infection or disease between patients who did and did not develop cryptococcosis. Atypical manifestations, e.g. cutaneous diseases or sepsis syndrome, as opposed to subclinical meningitis, may be a clinical feature of cryptococcal infection in liver transplant recipients.
Colon perforation after renal transplantation: a single‐institution review
Authors: Pirenne J. , Lledo‐Garcia E. , Benedetti E. , West M. , Hakim N. S. , Sutherland D. E. R. , Gruessner R. W. G. , Najarian J. S. , Matas A. J. 
Published: September 2024

AbstractColon perforation (CP) is an uncommon but dramatic complication after renal transplantation. Of 1530 consecutive kidney transplants performed at our center, 8 recipients had an CP (incidence of 0.5%), either early (n=5, 2‐14 days) or late (n=3, 8‐48 months) post transplant. Clinical symptoms were generally vague. Biological findings were inconstant. Risk factors for CP included a cadaver graft (versus a living donor), high body weight, history of diverticulitis, and Kayexalate use. Crucial to outcome were: 1) immediate diagnosis and 2) aggressive surgical care consisting of resectional therapy, broad‐spectrum antibiotics, and reduced immunosuppression. Applying these principles, mortality in our patients (25%) was lower than in previously reported series (33–64%). All grafts were functioning at the time of diagnosis; graft function was preserved in recipients who recovered from CP. Patients with a documented history of diverticulitis should undergo prophylactic colonic resection. Constipation and colonic dilatation should be treated aggressively in the early post‐operative period.
Soluble fraction of class I human histocompatibility leukocyte antigens in the serum of liver transplant recipients
Authors: McMillan Robert W. , Gelder Frank B. , Zibari Gazi B. , Aultman Donnie F. , Adamashvili Irena , McDonald John C. 
Published: September 2024

AbstractIn previous studies we reported a solid‐phase, enzyme‐linked immunoassay (ELISA) that can be used to quantitate the soluble fraction of human histocompatibility leukocyte class I antigens (S‐HLA‐I) and study their relevance in transplantation. In this study we determined the concentration and distribution of S‐HLA‐I in patients with end‐stage liver disease (ESLD), as well as in liver transplant recipients. Sera were obtained from 51 patients with ESLD and 40 donor‐recipient pairs. We analyzed the SHLA‐I in sera obtained from liver donors, as well as from liver transplant recipients (patients with ESLD), with sera from the latter obtained before and at various intervals up to 3 yr after transplantation. The results of the analyses justify the following conclusions: 1) Patients with ESLD had mean values of S‐HLA‐I (909 ± 596 ng/ml) greater than those for the normal population (643 ng/ml) (P < 0.05); the S‐HLA‐I secretion decreased with increasing severity of liver disease. 2) Patients with tumors had mean S‐HLA‐I levels (399 ng/ml) significantly lower than those in patients with ESLD related to other causes. 3) In liver transplant recipients the S‐HLA‐I levels stabilized at approximately 1 month after transplant and remained relatively stable thereafter (mean level 950 ± 536 ng/ml). The observed levels were also greater than those for the normal population (P<0.05). 4) Preoperative and postoperative S‐HLA‐I values in liver transplant recipients demonstrated a biphasic distribution, dividing patients into highand low‐secretor groups. 5) During the post‐transplant observation period, of these selected liver transplant recipients there was no difference between highand low‐secretor groups in the incidence of rejection (high, 70%; low, 67%), graft survival (high, 95%; low, 94%), or patient survival (high, 95%; low, 94%). 6) Measurement of the total amount of S‐HLA‐I, containing yet undefined ratios of both donor and recipient S‐HLA‐I, cannot be used to predict a state of tolerance in liver transplant recipients.
Vesical calculus: an unusual complication of renal transplantation
Authors: Klein Frederick A. , Goldman Mitchell H. 
Published: September 2024

AbstractVesical calculus formation in renal transplant patients is rare. We describe seven patients who developed calcium oxylate or combination calcium oxylate‐magnesium ammonium phosphate stones on a polypropylene suture nidus at the site of a ureteroneocystostomy. The use of a nonabsorbable suture in the urinary tract should be avoided.
Intensive care unit management in liver transplant recipients: beneficial effect on survival and preservation of quality of life*
Authors: Singh Nina , Gayowski Timothy , Wagener Marilyn M. 
Published: September 2024

AbstractDeterminants of outcome of intensive care unit (ICU) stay and quality of life in survivors was prospectively assessed in 50 consecutive liver transplant recipients requiring intensive care unit (ICU) management. Variables assessed included demographic, clinical and laboratory characteristics, measures of severity of illness (Child‐Pugh, Apache II, and organ system failure scores) and quality of life measures (physical functioning, perceived quality of life, stress, depression, and adaptive coping). Overall ICU survival was 82% (41/50). Nonsurvivors had significantly higher acute physiology scores (p=0.03), Apache II score (p=0.03), Karnofsky score (p=0.01) and serum bilirubin (p=0.05) on admission than survivors. Nonalert mental status (p=0.0002), hypothermia (p=0.035) and hypotension (p=0.027) on admission were significantly associated with mortality. During the ICU stay, requirement of mechanical ventilation (p=0.02), duration of ventilation (p=0.01), requirement of dialysis (p=0.0005), development of pulmonary infiltrates (p=0.0001) and infections in the ICU (p=0.003) were significantly associated with mortality. Requirement of mechanical ventilation was an independently significant predictor of mortality (with mechanical ventilation, dialysis and infections in the logistic regression analysis model). There was no difference in post‐discharge quality of life (as assessed by the perceived quality of life, stress, depression, and coping scores) in survivors of ICU stay as compared with patients who never required ICU care. Our study suggests that the ICU management can have a positive impact on outcome for liver transplant recipients. If they survive (and 82% did in this study), their quality of life is unaffected and as good as those whose postoperative course was not complicated by a critical illness requiring ICU care.
The fate of renal transplants in patients with IgA nephropathy
Authors: Frohnert P. P. , Donadio J. V. , Velosa J. A. , Holley K. E. , Sterioff S. 
Published: September 2024

AbstractBackgroundIgA Nephropathy (IgA N) is one of the most common glomerulopathies and may lead to renal failure in 10–20% of cases. After renal transplantation, IgA N has a strong tendency to recur in the graft. Initially considered a benign condition, graft losses from recurrent IgA N have been reported over the last 20 yr, casting doubt on the initial premise. Since large single‐center studies of the fate of renal allografts in IgA N are rare and the Mayo Clinic transplant experience for IgA N is extensive (dating back to 1970), a review of these issues appeared worthwhile.MethodsA retrospective study was done of all renal transplant patients who had had biopsy‐proven IgA N as underlying disorder. We extracted data on the underlying disease, history leading to renal transplantation, factors affecting transplant outcome, and on the course after transplantation with special attention to rejection activity and recurrence of the primary disease. Standard statistical methods were employed.Results53 renal allografts were transplanted to 51 biopsy‐proven IgA N patients: 12 were cadaveric (CAD) grafts, 3 HLA‐mismatched living related donor (LRD) kidneys, 29 one haplotype‐matched LRD and 9 HLA‐identical LRD organs. Five‐year actuarial graft survival was 100% in HLA‐ identical LRD, 88% in one haplotype‐matched LRD, and 74% in CAD grafts. All three HLA‐mismatched LRD kidneys were functioning up to 1.6 yr (longest follow‐up). Only one patient died after acute rejection of the CAD graft. There were 3 early graft losses from acute rejection and 4 late losses. IgA N recurred in 26% of allografts and led to significant loss of graft function in 10 of the 14 patients (71%) over a long period of observation. Three of four late graft losses were in patients with recurrent IgA N. Recurrence was not related to the type of graft, i.e. CAD vs. LRD, nor to the extent of HLA‐matching in LRD transplantation.ConclusionRenal transplantation in patients with IgA N has excellent patient and graft survival. There is a high rate of recurrence of the primary glomerulopathy in the renal allograft, and this event is by no means inconsequential. Loss of renal function and even graft loss occur over prolonged periods of time. There is no disadvantage getting a well matched LRD in regard to incidence of recurrent IgA N. Thus, we encourage LRD transplantation in IgA N.
Exposure to Mycobacterium tuberculosis (MTB) in a renal transplant candidate: what further preoperative screening tests are available?
Authors: Felger Jason , Halff Glenn A. , Esterl Robert M. 
Published: September 2024

AbstractDespite negative preoperative screening for MTB, a renal candidate demonstrated active tuberculous lymphadenitis (TL) in a deep iliac node intraoperatively during living related renal transplantation. With intraoperative discovery of TL, both donor nephrectomy and renal transplant were aborted. The authors present this case of TL to discuss whether additional preoperative screening tests are available to document previous exposure to MTB in a renal transplant candidate. The diagnosis and treatment of MTB in patients on routine hemodialysis are reviewed. The authors review the operative case to emphasize that critical intraoperative measures must be taken to minimize operative and postoperative morbidity in the donor and recipient. Finally, the literature for current antibiotic regimens in the treatment of TL is reviewed.
Sequential biological immunosuppression. Induction therapy with rabbit antithymocyte globulin
Authors: Guttmann R. D. , Flemming C. 
Published: September 2024

AbstractThis paper describes 108 consecutively treated patients receiving 109 cadaveric (CD) and living donor (LD) renal allografts using a protocol of quadruple sequential immunosuppression with a rabbit anti‐human thymocyte IgG (Thymoglobuline®), azathioprine, tapering corticosteroids, and delayed introduction of cyclosporine A. The average length of induction was 6.1 d with an average Thymoglobuline® dose of 2.0 mg/kg/d. The mean serum creatinine pre‐transplant of the cohort was 877 ± 263 (sd) μmol/L, 146 ± 44 μmol/L by 3 months post‐transplant, and 136 ± 40 μmol/L at 1 yr. The overall 4‐yr actuarial patient survival was 96.6%, and allograft survival was 88.6% at 2 yr and 83.6% at 4 yr. The incidence of acute rejection episodes defined by intention to treat was 32%. Additionally, eight patients in this series received retreatment with Thymoglobuline® for a first acute rejection, and only one of these had a second rejection. This was in contrast to 5/11 recurrent rejections following steroid treatment only, and 5/13 recurrences following OKT3 treatment for the first rejection episode. The side‐effect profile of Thymoglobuline® was largely benign, and the biological agent was well tolerated with initial fever in 75%, chills in 27%, and leucopenia in 22% of the patients. All other drug‐related adverse events had a prevalence of less than 3%, and clinical signs of meningismus were seen in only one patient. There were five associated episodes of CMV. We conclude that Thymoglobuline as part of a quadruple sequential immunosuppressive regimen for renal transplantation is well tolerated and can be associated with a good shortand long‐term outcome of renal transplantation.
Drainage of the exocrine pancreas in clinical transplantation: comparison of bladder versus enteric drainage in a consecutive series
Authors: Pearson Thomas C. , Santamaria Pablo J. , Routenberg Kristine L. , O'Brien David P. , Whelchel John D. , Neylan John F. , Larsen Christian P. 
Published: September 2024

AbstractThe purpose of this study was to define the incidence of urologic and metabolic complications after simultaneous kidney/pancreas transplantation (SKPT) with bladder drainage (BD). Review of 55 SKPT with BD performed between 1989 and 1995 demonstrated patient, kidney, and pancreas survival rates of 95%, 89%, and 78%, respectively, with a mean follow‐up of 41 months (range 12‐78 months). Over this follow‐up period 78% of these patients experienced a urinary tract infection, 27% had hematuria, and 38% had at least one hospital admission for dehydration. Recent experience with primary enteric drainage of the exocrine secretions of the transplanted pancreas (n=11) has demonstrated the total absence of these complications (follow‐up range 2‐12 months). These results suggest the value of continuous re‐evaluation of surgical techniques as the care of transplant patients evolve.
Causes of renal allograft loss in black vs. white transplant recipients in the cyclosporine era
Authors: Valente John F. , Hariharan Sundaram , Peddi V. Ram , Schroeder Timothy J. , Ogle Cora K. , Alexander J. Wesley , First M. Roy 
Published: September 2024

AbstractBlack renal transplant recipients have a higher rate of allograft loss than white recipients. From 1 January 1984 to 1 January 1995, 463 transplants were performed at a single center and followed for a mean duration of 71 months. The causes of graft loss for white and black recipients. their age, gender, retransplantation rate, organ source, and HLA matching were compared. In the 150 black and 313 white recipients, graft loss rates in the first year were 20% in both groups, while after 1 yr there were 42 (28%) graft losses in blacks vs. 62 (20%) in whites (log‐rank test p=0.04). All diagnoses deemed causative of allograft loss were confirmed by biopsy. Chronic rejection resulting in graft loss occured in 15% (n=23) of black recipients compared to only 7% (n=22) of white recipients (p=0.002). There were no significant differences in the rate of death with a functioning kidney or other causes of graft loss between the two groups. A significant increase in HLA mismatches was noted in black recipients of cadaveric grafts compared to whites, but there was no difference between races in the rate of graft loss due to acute rejection. While the rate of graft survival remains lower in black recipients in the cyclosporine era, this is due entirely to late graft loss after 1‐yr post‐transplant due to chronic rejection.
Post‐transplant lymphoproliferative disease in kidney transplant patients in the new immunosuppressive era
Authors: Ciancio Gaetano , Siquijor Alex P. , Burke George W. , Roth David , Cirocco Robert , Esquenazi Violet , Byrne Gerald E. , Miller Joshua 
Published: September 2024

AbstractAlthough the kidney transplant program at this center has been active for the past 18 yr, five out of the seven cases of post‐transplant lymphoma in kidney transplant patients were observed over the past 2 yr. During this period, we have shifted from cyclosporine to tacrolimus (FK506 or prograf) for maintenance immunosuppression and for rescue therapy. We have also introduced mycophenolate (RS ‐ 61443) and have continued an antibody induction regimen in the immediate postoperative period. FK506 is 50‐100 times more potent than cyclosporine. We have reported a decreased incidence of rejection, improved graft survival, and a general optimalization of patient survival with these newer regimens. Nonetheless, five cases of post‐transplant lymphoma out of 233 kidney transplants (2.1%) performed during this time period (December 1993 to December 1995) occurred between 3 months to 1 yr after the transplant. Four of the five patients are still alive between 12 and 24 months after the diagnosis of lymphoma was made. All were without evidence of ongoing disease. Three of the five have grafts with excellent function for longer than 18 months after transplantation, while one is marginal and one patient expired on dialysis. The third and fourth patients had severe rejection before the diagnosis of PTLD was made. While the occurrence of five cases of post‐transplant lymphoma over a 2 yr period is alarming, this is still within the 2–4% incidence of post‐transplant lymphoma that has been reported in the literature in kidney transplant patients. Our results probably reflect the increasing potency of our immunosuppressive protocols but do not show any increase in the aggressiveness of this entity of post‐transplant lymphoma during the continued follow up.
Reversal of accelerated renal allograft rejection with FK 506
Authors: Woodle E. S. , Newell K. A. , Haas M. , Bartosh S. , Josephson M. A. , Millis J. M. , Bruce D. S. , Piper J. P. , Aronson A. J. , Thistlethwaite J. R. 
Published: September 2024

AbstractAlthough FK 506 has been shown to effectively reverse refractory renal allograft rejection, its ability to reverse accelerated renal allograft rejection as a primary agent has not been specifically addressed. Herein evidence of the ability of FK 506 to reverse accelerated renal allograft rejection is presented. A 16‐yr‐old highly sensitized (PRA 75%) male underwent a second cadaveric renal transplant procedure. Despite induction immunosuppression with ATGAM, cyclosporine, azathioprine, and corticosteroids, a marked elevation in serum creatinine (1.6‐2.1 ng/dl) and reduction in urine output (4000 ml/d–1000 ml/d) were observed on the sixth post‐transplant day. Renal allograft biopsy performed at that time revealed typical features of accelerated rejection including neutrophil margination in glomerular and interstitial capillaries, and C3, IgG, and fibrin deposition in glomerular and interstitial capillaries (by immunofluorescence). FK 506 therapy was promptly instituted and ATGAM therapy discontinued. Serum creatinine peaked within 3 d of FK 506 therapy (2.5 mg/ dl) and subsequently progressively dropped to 1.2 mg/dl. Repeat biopsy on FK 506 treatment day 12 revealed marked histologic improvement. Renal function remains excellent (1.3 mg/dl) 18 months after initiation of FK 506 therapy, and recurrent rejection has not been observed. This experience provides evidence that FK 506 therapy may effectively reverse accelerated renal allograft rejection, and that it provides a means for treating antibodymediated mechanisms of allograft rejection.
Risk of renal cell carcinoma after kidney transplantation
Authors: Kliem V. , Kolditz M. , Behrend M. , Ehlerding G. , Pichlmayr R. , Koch K. M. , Brunkhorst R. 
Published: September 2024

AbstractBetween December 1968 and July 1995, 2372 renal transplant recipients were seen regularly in our outpatient clinic. 154 patients (6.5%) of these subsequently developed a malignant tumor. One of the most frequently observed malignancies was a renal cell carcinoma in the native kidneys, found in 12 patients (7.8%; i.e. 0.5% of the total population), two of them with analgesic nephropathy and one with adult polycystic kidney disease. So‐called acquired cystic kidney disease of the native kidneys was found in 73% of the patients with renal cell carcinoma. In the patients with renal cell carcinoma the median age at transplantation was 43.9 (39–55) yr. The median time from onset of end‐stage renal failure and from transplantation to the appearance of the tumor amounted to 117.3 (43–206) and 75.8 (5–164) months, respectively. Despite nephrectomy, four patients died of the cancer (6–57 months).As a consequence we suggest a regular sonographic screening of the native kidneys twice a year in all renal transplant patients. As in dialysis patients, the main risk factors for the development of renal cell carcinoma seem to be so‐called acquired cystic disease of the native kidneys and the underlying renal disease, such as analgesic nephropathy, and obviously not the immunosuppressive regimen after transplantation.