bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multi‐organ procurement utilizing cardiopulmonary bypass and profound hypothermic circulatory arrest
Authors: Sekela Michael E. , Young James B. , Short H. David , Whisennand Hartwell H. , Noon George P. 
Published: September 2024

AbstractDespite advances in preservation solutions, hypothermia remains a critical component of organ preservation for transplantation. Many surgeons involved in multi‐organ procurement procedures have expressed concern about the possible detrimental effects of cardiopulmonary bypass and profound hypothermic circulatory arrest on non‐thoracic transplant organ function. In order to assess the validity of these concerns, a review of 20 multi‐organ harvest procedures performed utilizing cardiopulmonary bypass and profound hypothermic circulatory arrest was undertaken. In all instances this technique was combined with organ flushing utilizing cold preservation solution. Adequate data was available to assess post‐transplant organ function of all organs recovered in 16 procedures. Indication for the use of this technique was procurement of a heart‐lung bloc in 16 instances and donor instability (hypotension) refractory to volume loading and inotropic agents in 4 instances. Organs obtained, including all organs from unstable donors which would otherwise have been lost, functioned, acceptably. Additionally, blood drained into the pump was used for recipient transfusion in 8 instances. This report documents that cardiopulmonary bypass and profound hypothermic circulatory arrest may be easily combined with traditional procurement flushing techniques and it provides excellent organ preservation for subsequent transplantation. This approach can optimize organ recovery from hemodynamically unstable donors, increasing the number available for transplantation.
The ethics of unconventional living organ donation
Authors: Spital Aaron 
Published: September 2024

AbstractThe ongoing organ shortage is perhaps the major barrier facing transplantation today. Liberalizing selection criteria for living donors to include such unconventional sources as unrelated individuals and relatives at added risk could greatly increase the pool of available organs. Yet, transplant centers, appropriately concerned about the donor's motivation and the risk involved, have generally excluded these people from donation. Does this policy make sense? Assuming the donor to be competent, I will show that if traditional genetically related donors are believed to be ethically acceptable, it is inconsistent to exclude emotionally related donors. I will also argue that even the use of altruistic strangers and donors at added risk is ethically justified. These conclusions are based on the principle of respect for persons and the realization that the risk‐benefit ratio of any proposed living donor transplant is determined ultimately by value judgments. These judgments should generally be made by the one most affected by the outcome – the prospective donor.
Human herpes virus 6 infections in hospitalized renal transplant recipients
Authors: Gudnason Thorolfur , Dunn David L. , Brown Nathaniel A. , Balfour Henry H. 
Published: September 2024

Abstract:Herpesviruses are a major cause of morbidity and mortality in renal transplant recipients. Recently, a new member of the herpesvirus family, human herpesvirus 6 (HHV‐6), has been identified. We investigated the incidence and clinical manifestations of HHV‐6 infections in 25 hospitalized renal transplant recipients. HHV‐6 infections were documented serologically by comparing pre‐ and post‐transplantation antibody titers using an indirect immunofluorescence assay. Infections caused by cytomegalovirus, Epstein‐Barr virus, herpes simplex virus and varicella‐zoster virus were also studied. During the mean follow‐up period of 3½ months post‐transplant (range, 2 to 6 months), 9 recipients (36%) had serologic evidence of HHV‐6 infection. Two patients seroconverted, suggesting primary HHV‐6 infection. These patients had febrile illnesses, skin rash and malaise. Seven recipients had a non‐primary HHV‐6 infection (reactivation/reinfection) documented by a > 4‐fold rise in antibody titer that was associated with clinical illness in 5 of 7 patients. Two recipients developed primary cytomegalovirus infection and both had evidence of non‐primary HHV‐6 infection. Seven of 9 recipients (77%) who developed HHV‐6 infection had received acyclovir prophylaxis. We conclude that primary and non‐primary HHV‐6 infections occur in renal transplant recipients and can be associated with fever, skin rash and malaise. HHV‐6 infections can occur despite high‐dose oral acyclovir prophylaxis.
Value of 111indium leukocyte scanning in febrile organ transplant patients
Authors: Alsina Angel E. , Krisiunas Laine , Rosenberg Ronald J. , Sziklas John J. , Schweizer Robert T. 
Published: September 2024

Abstract:Immunosupprcssed febrile organ transplant patients present a diagnostic and therapeutic dilemma since symptomatology is often altered by immunosuppression, which also masks the location of infection. Fifty 111indium leukocyte (111In WBC) scans were performed to determine their usefulness in the organ transplant patient. The results were compared with computerized tomography (CT) and gallium 67‐citrate (Ga) scanning. Eleven patients received both 111In WBC and Ga scans; 22 received both 111In WBC and CT scans. Ten 111In WBC scans had subtraction of 99m Tc sulfur or albumin colloid for liver evaluation and four 111In WBC scans had subtraction of 99m Tc DMSA for kidney evaluation. The overall sensitivity and specificity for 111In WBC scans was 90% and 90%, respectively. Lung uptake was sensitive (89%) and specific (97%) for pulmonary infections, including bacterial, fungal and cytomegalovirus pneumonias. Renal graft uptake occurred in 15 cases (41%), all except 2 being due to rejection, pyelonephritis, urinary tract infections, or cytomegalovirus infections. Pyelonephritis and renal abscesses were diagnosed in 3 cases with 99m Tc DMSA subtraction. Perihepatic abscesses (2), and infected liver cysts (4) were diagnosed with 99m Tc sulfur or albumin colloid subtraction. There were five false‐negative CT scans and three false‐negative Ga scans. Therefore, when compared with 111In: sensitivity = 88% vs 64% (CT), specificity = 80% vs 86% (CT); and sensitivity = 111In 90% vs 67% (Ga), specificity = 100% for both 111In WBC and Ga scans. 111In WBC scans were accurate in detecting infections in organ transplant recipients, particularly liver and renal infections and, while occasionally more useful than Ga scanning, 111In scans serve a complementary role along with other diagnostic modalities.
Immunological behavior of preserved human tracheal allografts: Immunological monitoring of a human tracheal recipient
Authors: Bujia J. , Pitzke P. , Krombach F. , Hammer C. , Wilmas E. , Herberhold C. , Kastenbauer E. 
Published: September 2024

Abstract:The use of preserved tracheal allografting is a discussed method for the reconstruction of tracheal defects. To characterize the systemic and local immunological events following the transplantation of preserved human tracheal allografts, various immunological parameters were measured before and after transplantation in 1 human tracheal transplant recipient. Peripheral mononuclear cells were obtained and prepared for cytological monitoring. Biopsies of the anastomosis region were taken to characterize the histologic changes, as well as the extent and phenotype of cellular infiltrates, as determined by immunoperoxidase labelling. The results were compared with those of another patient who underwent a tracheal resection followed by an end‐to‐end anastomosis. While the biopsies showed a slight inflammatory reaction, signs of systemic immunoactivation were not found. Moreover, the absence of signs of clinical rejection suggests that merthiolate‐preserved human tracheal allografts represent a suitable replacement material for reconstruction of large tracheal defects.
Levels of tumor necrosis factor (TNF) in sera of renal allograft recipients
Authors: Segoloni Giuseppe , Vercellone Antonio , Manes Massimo , Tetta Ciro , Camussi Giovanni 
Published: September 2024

A biological assay was used for monitoring serum levels of endogenous tumor necrosis factor in 42 renal transplant recipients. The clinical events occurring in the post‐transplant period were categorized as follows: group I, acute rejection (12); group II, acute tubular necrosis (ATN, 16); group III, cyclosporine A (CyA) nephrotoxicity (13); group IV, uncomplicated transplants (22); group V, viral (6)/bacterial (4) infections. Twenty‐one health subjects served as controls (group VI). Serum TNF levels were measured every other day after transplantation for 44.2 ± 4.18 d (mean ± SEM). The means of serum TNF levels of each week for 3 wk after the beginning of each clinical event were calculated and statistical evaluation was performed between groups. In the 1st, 2nd but not in the 3rd wk of observation, acute rejection was associated with significantly increased serum TNF levels in respect to ATN, CyA nephrotoxicity, uncomplicated transplants and healthy subjects. In the 1st but not in the 2nd wk, acute rejection did not differ from viral/bacterial infections. ATN was associated with significantly increased serum TNF levels vs. uncomplicated transplants at the end of the 1st but not of the 2nd or 3rd wk. CyA nephrotoxicity showed no significant increase in serum TNF levels vs. uncomplicated transplants in all 3 wk of observation. Early monitoring of the concentrations of TNF in serum therefore may provide an additional parameter for the differential diagnosis of acute rejection in respect to CyA nephrotoxicity, provided that intercurrent infections can be excluded.
Renal transplantation associated with HIV infection: A Saudi Arabian experience and review of the literature
Authors: Barri Yoursi M. , Ellis Michael E. , Al‐Furayh Osman , Qunibi Wajeh , Taher Saadi , Al‐Sabban Essam , Bernvil Stener S. 
Published: September 2024

Of 504 kidney transplant recipients attending our center, 6 developed serological evidence of human immunodeficiency virus (HIV) infection (1.2%). All 6 patients had been transplanted abroad. Of those, 3 died (mean time from transplantation to death 37 months), 2 having developed full‐blown AIDS and the 3rd from opportunistic infections related to immunosuppressive drugs. Of the remaining 3, one developed Kaposi's sarcoma (KS) which responded to reduction in immunosuppression, but this patient was subsequently lost to follow‐up. The other 2 are asymptomatic with stable renal function. Sixty cases with HIV infection reported in the World Literature were reviewed. The incidence of Western blot positivity among renal transplant recipients ranged from 0.12% to 6.12%. Accelerated course of HIV disease was observed in this population, particularly in those who were HIV‐seropositive prior to transplantation. This study reviews various aspects of HIV infection in renal transplant recipients, including route of infection, natural history of the disease, effect of immunosuppression, allograft function, and whether opportunistic infections are related to immunosuppressive drugs or HIV infection.
Immune monitoring of heart transplant patients receiving either one or two cycles of OKT3 prophylaxis. Induced anti‐idiotypic and anti‐isotypic anti‐OKT3 antibodies do not prohibit depletion of peripheral T cells due to second OKT3 treatment
Authors: Hesse C. J. , Heyse P. , Stalk B. J. M. , Vaessen L. M. B. , Balk A. H. M. M. , Mochtar B. , Jutte N. H. P. M. , Weimar W. 
Published: September 2024

24 heart transplant recipients were treated with OKT3 together with azathioprine for 7 days as a rejection prophylaxis. The plasma OKT3 concentration ranged from 280 to 1600 ng/ml. During treatment the T cells in peripheral blood disappeared but returned modulated without TcR‐α/β‐chains and with low CD3 expression. Antimurine antibodies were induced and median IgG antimurine antibody concentrations increased from 9.6 mg/l pretransplant to 52.1 mg/l as measured by ELISA. In 13 out of 24 patients, anti‐idiotypic antibodies were present at a level that caused over 50% inhibition of OKT3 binding to T cells. The extent of inhibition was positively correlated with the increase in IgG antimurine antibody levels, both in relative (> 3 times pre‐transplant level, p < 0.05) and in absolute terms (more than 50 mg/l, p < 0.001). In 9 patients, who received two prophylactic courses of OKT3, we found a decrease in anti‐OKT3 antibody levels after the second course of OKT3 which can be caused by the additional cyclosporin A (CsA) immune suppression. The second course also resulted in a rapid depletion of circulating functional T cells despite the presence of anti‐OKT3 antibodies generated after the first course.
Comparison between the effects of cyclosporine and azathioprine on functional and morphologic renal parameters in a randomized study from 12 to 24 months after renal transplantation
Authors: Pedersen Erling B. , Hansen Hans E. , Olsen Steen , Danlelsen Henning , Eiskjær Hans , Jespersen Bente , Kornerup Hans J. , Madsen Søren , Sørensen Arne W. S. , Sørensen Seren S. 
Published: September 2024

The use of cyclosporine as an immunosuppressive agent has improved graft survival after transplantation. However, the nephrotoxicity of cyclosporine is a serious clinical problem. After treatment with cyclosporine and prednisolone during the 1st year after renal transplantation, 106 patients were consecutively randomized to either treatment with azathioprine and prednisolone (Group Az) or cyclosporine and prednisolone (Group Cy) in a prospective controlled study during the following 1 yr. 51‐Cr‐EDTA clearance (CEDTA), blood pressure (BP), plasma concentrations of atrial natriuretic peptide (ANP), angiotensin II (Ang II), and aldosterone (Aldo), and urinary excretion rate of prostaglandin E2 (PGE2) were determined at the start of the study and every 6 months. Systematic, blind and semiquantitative histopathologic analyses were performed on biopsies from the renal grafts at the start of the study and after 12 months. Comparison within groups showed that GFR increased in Group Az (44 to 48 ml/min, p < 0.05) and decreased in Group Cy (43 to 39 ml/min, p < 0.05) after 6 months, and that GFR was unchanged after 12 months in Group Az (42 ml/min) and reduced in Group Cy (39 ml/min, p < 0.05) compared to baseline level. Comparison between groups showed a significantly higher GFR in Group Az than in Group Cy after 6 months, but no significant difference in GFR at the start of the study or after 12 months. The extent of arteriolar hyalinosis increased significantly in Group Cy (0.82 to 1.72 score, p < 0.001) after 12 months but was unchanged in Group Az (0.97 to 0.94 score), whereas interstitial fibrosis increased to the same level in both groups. After 12 months, BP was decreased and ANP, PGE2, Ang II and Aldo were unchanged in Group Az. Contrariwise, in Group Cy BP remained unchanged, ANP and PGE2 were increased, and Ang II and Aldo suppressed. The increased arteriolar hyalinosis during cyclosporine treatment most probably results in a higher BP than during azathioprine treatment. The higher ANP and PGE2 during cyclosporine treatment may be compensatory phenomena in order to preserve graft function and reduce BP. Conversion to azathioprine treatment may be superior to continued cyclosporine treatment at least from 12 to 24 months after renal transplantation.
Noncompliance in renal transplant recipients: Experience in Taiwan
Authors: Lal Ming‐Kuen , Huang Chiu‐Ching , Chu Sheng‐Hsien , Chuang Cheng‐Keng , Huang Jeng‐Yi , Chen Hsiao‐Wen 
Published: September 2024

Abstract:Patient compliance is one of the key factors of successful treatment following renal transplantation. Eleven out of 228 renal transplant recipients (4.8%) in our series displayed evidence of medical noncompliance which happened after the recipients had enjoyed good graft function for an average of 53.1 ± 16.9 months after transplantation. In comparison with the control group, these recipients were usually younger (26.3 ±5.49 vs 32.6 ±8.92 years old, p<0.05), had fewer rejection episodes (0% vs 21.4%, p<0.05) and had lower educational level (p<0.01). Nine of these noncompliant patients (81.8%) lost their kidney grafts eventually. Three of them died from complications after kidney graft failure. Noncompliance was responsible for 21.4% of total graft loss, the third leading cause of graft loss after rejection (50.0%) and infection (26.2%). Since there is a severe shortage of donor kidneys in the Taiwan area, great effort much be spent to prevent kidney graft loss from patient noncompliance. Patient education and alertness to the risk factors of noncompliance should be emphasized.
Pseudomonas pulmonary artery graft endocarditis in heterotopic heart transplant: Case presentation and literature review
Authors: Grinstead W. Carter , Noon George P. , Sekela Michael E. , Samo Tobias , Verani Mario S. , Hays John , Young James B. 
Published: September 2024

Abstract:A heterotopic heart transplant patient developed Pseudomonas aeruginosa infection 3 days after transplantation. Pseudomonas infections recurred 4 and 8 months later. During the second recurrence a new systolic murmur was noted. An indium‐111 white blood cell scan showed abundant uptake in the location of the prosthetic pulmonary artery graft and angiography revealed a mobile filling defect near the anastomosis of the graft and the native pulmonary artery. The grossly infected graft was surgically replaced without the need for cardiopulmonary bypass. Cultures from the graft's partially dissected pscudointima grew Pseudomonas aeruginosa. The patient remained free of recurrent Pseudomonas infection 12 months after graft replacement. Timely recognition of this previously unreported complication of heterotopic heart transplantation allowed surgical cure of this potentially devastating infection.
Temporary wound closure with expanded polytetrafluoroethylene in pediatric liver transplantation
Authors: Shun A. , Thompson J. F. , Dorney S. F. A. , Sheil A. G. R. 
Published: September 2024

Abstract:A shortage of donor organs of appropriate size causes lengthy delays for many children awaiting liver transplantation, and results in the death of some children on the active waiting list. A major contribution to overcoming this problem has been the use of reduced livers from adult donors. However, reduced adult livers are frequently too large to be used for small pediatric recipients (<8 kg) because of the serious problems which occur when too light an abdominal closure is attempted. We report a technique which we have used successfully in 2 children, involving the insertion of a temporary patch graft of expanded polytetrafluoroethylene. This allowed comfortable abdominal wound closure, which would not otherwise have been possible. Delayed primary closure of the abdomen 4‐5 days later was achieved without difficulty in each case, the liver grafts having decreased markedly in size by this time. The technique allows greater flexibility in the use of donor livers for pediatric recipients, and thus has the potential to reduce waiting times and deaths on the waiting list for small children requiring liver transplantation.
“Growth” of adult kidneys transplanted into small children
Authors: Bunchman Timothy E. , Lynch Robert E. , Garvin Paul J. , Fleming Susan S. , Wood Ellen G. 
Published: September 2024

We reviewed the renal allograft length as determined by serial ultrasound examinations in 12 children who underwent renal transplantation at less than 4 years of age (18.1 ± 4.1 months, 9.48 ± 0.78 kg, mean ± SEM) receiving an adult donor kidney. Follow‐up serum creatinines and allograft length, (determined by ultrasounds) were reviewed for a mean of 59.7 ± 7.4 months after transplantation. Nine of 12 children have stable allograft function whereas 3/12 children have functional deterioration with histological evidence of chronic rejection. Compared to baseline, in those children with stable function there was a mean decrease in allograft length (–0.7 ± 0.1 cm) at 1 yr post‐transplantation with return to baseline allograft length at 4 yr (+0.2 ± 0.2 cm). Beyond 4 yr, there is a persistent increase in allograft length of +0.6 ± 0.3, +1.3 ± 0.6 and + 1.9 ± 0.5 cm as compared to baseline at 5, 6 and 7 yr respectively (p < 0.01). This is in contrast to a persistent diminution in allograft length with failure to return to baseline length in those children with chronic rejection. In this small number of young children there appears to be growth potential over time of the donor adult allograft with stable function, which appears to be lacking in those allografts with chronic rejection. The stimulus for the allograft growth may be due to unique growth factors that are yet to be determined.
Cadaveric renal transplantation using kidneys from donors greater than 60 years old
Authors: Vivas Carlos A. , O'Donovan Richard M. , Jordan Mark L. , Hickey David P. , Hrebinko Ronald , Shapiro Ron , Starzl Thomas E. , Hakala Thomas R. 
Published: September 2024

Transplantation of kidneys from donors over the age of 60 yr is controversial. However, as the demand for cadaveric kidneys far exceeds the supply, exploration of the usefulness of kidneys outside the currently accepted donor pool is necessary. Between January 1987 and July 1989, 31 (5.5%) of the 558 cadaveric renal transplants performed at the University of Pittsburgh utilized organs from donors older than 60 yr. Median recipient age was 41 yr (range 24‐71 yr); 4 recipients were diabetic and 6 had panel‐reactive antibody levels greater than 20% at the time of transplant. All recipients were treated with cyclosporine, prednisone and azathioprine. The 1‐yr allograft survival was 65% which was less than but not statistically different from the graft survival of 80% in a retrospective selected control group who received grafts from younger donors aged 11 to 50 yr. However, the 1‐yr graft survival of older donor kidneys with cold ischemia time greater than 48 hours was 38%, which was significantly poorer than the 78% 1‐yr graft survival seen with cold ischemia times less than 48 h (p = 0.04 Breslow). The mean serum creatinine was significantly higher in the older donor kidneys at 1, 3, and 12 months posttransplant than in the control kidneys even when kidneys with greater than 48 h of cold ischemia time were excluded. In summary, transplantation of cadaver kidneys from donors older than 60 yr results in acceptable graft survival rates. These kidneys are more susceptible to cold ischemic injury and function with a higher serum creatinine than kidneys from younger donors. Expansion of the donor pool by the use of older donor kidneys in selected recipients could have an impact on alleviating the chronic national cadaver kidney shortage.