bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foot problems in the diabetic transplant recipient
Authors: Kalker Alan J. , Pirsch John D. , Heisey Dennis , Sollinger Hans W. , Belzer Folkert O. , Knechtle Stuart J. , D'Alessandro Anthony M. 
Published: September 2024

AbstractDiabetic transplant recipients are at a high risk for foot pathology leading to amputation. This retrospective study from 1/85 to 2/92 examines the risk of foot complications in a population (n=340) of diabetic renal and combined renal/pancreas transplant recipients. All groups suffered high lower extremity amputation and foot fracture rates. Patients with better circulation and protective sensation intact fared better. Smoking had a profoundly negative effect on the amputation rate as did an amputation prior to the transplant. Patients with pretransplant dialysis were at a higher risk for post‐transplant amputation. Concomitant pancreas transplant did not in general significantly affect the risk of amputation or fracture. Females had almost twice the fracture rate of males.
Long‐term function of vascular access for hemodialysis
Authors: Enzler Markus A. , Rajmon Tomas , Lachat Mario , Largiadèr Felix 
Published: September 2024

AbstractObjectivesTo compare the outcome of autogenous arteriovenous fistulas (AVF) with interposition graft fistulas for hemodialysis access.DesignRetrospective clinical study.SettingDepartment of Surgery, Zurich University Hospital.MethodsPrimary and secondary patency rates were calculated by life tables. Factors potentially affecting patency were studied by comparison of life tables using the log rank test.Main resultsFrom 1980 to 1992, 414 patients were operated on for long‐term vascular access. 720 fistulas were created including 429 AVF and 291 interposition grafts (150 bovine xenografts, 69 PTFE grafts, 59 sheep collagen grafts, 10 autologous and 1 homologous vein grafts). Secondary patency rates after 1 and 3 yr were 74/64% in AVF, 56/24% in bovine xenografts, 58/40% in PTFE grafts and 71/45% in sheep collagen grafts. The latter performed not significantly worse than AVF. Primary and secondary patency rates were significantly lower in women.ConclusionsAVF remains the procedure of choice. Female sex adversely affects patency rates.
Intragraft IL‐4 mRNA expression is associated with down‐regulation of liver graft rejection
Authors: Baan C. C. , Metselaar H. J. , Mol W. M. , Tilanus H. W. , IJzermans J. M. N. , Zondervan P. E. , Schalm S. W. , Niesters H. G. M. , Weimar W. 
Published: September 2024

AbstractThe mechanism underlying spontaneously resolving allograft rejection following clinical liver transplantation is unidentified. In this process, immunoregulatory T helper (Th)‐2 cytokines like IL‐4, often identified with down‐regulation of the Th1‐dependent (IL‐2) cell‐mediated response, might play a significant but unknown role. For this reason, we analyzed mRNA expression by reverse transcriptase‐polymerase chain reaction (RT‐PCR) in 57 biopsies derived from 19 recipients. Specimens included biopsies without evidence of rejection (n=36), biopsies with histological evidence of rejection (n=10) not followed by clinical signs of graft rejection, and biopsies with histological rejection that were accompanied with clinical rejection (n=11), defined by rising serum bilirubin and aspartate amino transaminase (ASAT) levels. Intragraft IL‐4 mRNA expression significantly correlated with spontaneously resolving rejections. In 70% (7/10) of these biopsies, IL‐4 mRNA was detectable, while only 19% (7/36) of the biopsies without signs of rejection (p<0.01; Fisher's exact test) and 18% (2/11) of the rejection biopsies concurrent with graft dysfunction expressed the IL‐4 gene (p=0.03). In contrast, IL‐2 mRNA expression was not detectable in biopsies derived from the spontaneously resolving rejections. None (0/10) of these samples expressed the IL‐2 gene, which was not significantly different from the proportion of biopsies transcribing the IL‐2 gene in the absence of rejection (11%, 4/36). IL‐2 mRNA expression was found more often in biopsies associated with graft dysfunction (36%, 4/11). These results show that IL‐4, in contrast to IL‐2 mRNA expression, is associated with spontaneously resolving liver rejection. This suggests that Th2 cells down‐regulate the Th1‐dependent cell‐mediated immune response after clinical liver transplantation.
The feasibility of HLA matching for lung transplantation
Authors: McGee C. , Fox M. D. , Loyd J. E. 
Published: September 2024

AbstractThe benefits of HLA matching have been clearly demonstrated in renal and cardiac transplantation. Recent studies suggest that HLA matching may be associated with improved survival rates for lung transplantation as well. However, the effect of HLA matching for lung transplantation has not been clearly demonstrated. Despite the possible benefits of HLA compatibility, matching for lung transplantation is based solely on ABO compatibility and lung size. Several factors limit the feasibility of utilizing HLA matching for lung transplantation. Among these factors is the time required to perform HLA typing, to identify appropriate recipients, and to allocate lungs; an additional constraint is the urgent need for transplantation in patients experiencing rapid clinical decline. The obstacles to using prospective HLA matching for lung allocation are significant, and matching lung donors and recipients according to histocompatibility status would require considerable effort. However, with supra‐regional cooperation among transplant centers and procurement agencies, it appears feasible to consider HLA matching for lung transplantation. Given the potential for improved survival, a project should be undertaken to determine the impact of HLA matching on the outcome of lung transplantation.
Type II diabetes after combined kidney and pancreas transplantation for type I diabetes mellitus and end‐stage renal disease
Authors: Jones Jon W. , Mizrahi Solly S. , Bentley Frederick R. 
Published: September 2024

AbstractWe report a case of a patient who developed type II diabetes after receiving a successful combined kidney and pancreas transplant for type I diabetes and end‐stage renal disease. This patient underwent a combined kidney and pancreas transplant and had no evidence of rejection with good function following the transplant for nine months. The patient developed significant post‐transplant obesity with her transplant weight of 80 kg rising to 109 kg. At this level of obesity, the patient developed fasting hyperglycemia of 180 mg/dl with no change in her renal function or her pancreas exocrine function. She developed hyperinsulinemia to this fasting hyperglycemia. The clinical course of this patient demonstrates that rapid weight gain following transplantation can result in type II diabetes.
SEOPF high‐grade match algorithm: the effect of HLA matching with ROP trays in transplanting highly sensitized patients
Authors: Tardif Gilman N. , McCalmon Robert T. 
Published: September 2024

AbstractThe SEOPF high‐grade match (HGM) algorithm for sharing kidneys was designed to increase utilization of kidneys for excellent HLA matches, decrease sharing for poor HLA matches, and improve the chances for highly sensitized patients to receive a kidney transplant through the use of ROP crossmatch trays. All retrieved kidneys from participating centers were offered to the system to be shared for high‐grade HLA matches after six‐antigen match obligations were satisfied with UNOS. Kidneys were shared according to HLA matches in the following priority: 1) 0‐ABDR mismatch six ‐ Antigen Matches. 2) 0‐AB mismatch PRA>40%, ROP tray negative crossmatch. 3) 0‐BDR mismatch PRA>40%, ROP tray negative crossmatch. 4) 0‐BDR mismatch PRA<40%. All patients with PRA's>40% must be repesented on the ROP tray to be considered for a shared kidney. Preliminary ROP tray crossmatch results must have been known for these patients in order to access the system. Here we report results of 126 shared kidneys using the HGM algorithm from January 1994 to September 1995. HLA typing concordance between the initial typing of cadaver donors by the donor center and repeat typing by recipient center was 94.7%. There were six (5.3%) typing discrepancies: HLA‐A, no typing discrepancies; HLA‐B, 2 (1.8%) typing discrepancies; and HLA‐DR, 4 (3.5%) discrepancies. A total of 34 of 126 (27%) kidneys were shared for patients with high grade HLA matches, PRA's >40% and a negative ROP tray. Twenty‐eight of 34 (82.4%) shared kidneys were final crossmatch negative and transplanted into the intended recipient. Six of 34 (17.6%) shared kidneys were transplanted into backup recipients. All six of the intended recipients had positive final crossmatches using enhanced crossmatch procedures, such as antiglobulin and flow cytometry. In conclusion, the HLA concordance rate for shared kidneys within SEOPF was 94.7%. Kidney sharing using the HGM algorithm was very effective in transplanting highly sensitized patients when good HLA matching was combined with a negative ROP tray result.
Utility of DRB1 subtyping: a case report
Authors: Lower F. E. , Jennings C. D. , Phillips G. L. , Thompson J. S. 
Published: September 2024

AbstractThe purpose of presenting this case is to illustrate the importance of high‐resolution DNA Class 2 typing when assignment of MHC antigens is of extreme importance (i.e. bone marrow transplantation); suggest this test as a substitute for the mixed lymphocyte culture (MLC), and provide evidence that DRB1 subtype mismatches may be clinically significant. Initial serological and monoclonal HLA Class 1 and low‐resolution DNA‐SSP Class 2 typing of a potential bone marrow transplant patient and two sisters revealed all to be HLA identical with apparent homozygosity for DRB1*04. High‐resolution DNA‐SSP Class 2 typing was then performed and revealed electrophoretic banding patterns which were not specific for any DRB1*04 subtype. One sister and the patient had identical patterns, while the other sister had a different pattern. Complete HLA Class 1 and high‐resolution DNA‐SSP Class 2 typing of the parents was performed. The mother was found to be heterozygous for Class 1 and Class 2 antigens and possess the DRB1*0404, 0405 subtypes. In contrast, the father was found to be homozygous for Class 1 antigens, heterozygous for Class 2 antigens and possess the DRB1*0404, 0407 subtypes. This led to the initial false assumption of HLA identity for the patient and her two sisters. However, assignment of haplotypes revealed one sister to be HLA identical with the patient and the other sister to be a one‐haplotype five‐antigen match with the patient, mismatching for one DRB1 allele. Bone‐marrow transplantation was performed utilizing the latter sister, which resulted in intractable acute graft vs. host. disease that resulted in the patient's demise.
T10B9 (MEDI‐500) mediated immunosuppression: studies on the mechanism of action
Authors: Brown Stephen A. , Lucas Bruce A. , Waid Thomas H. , McKeown J. Wade , Barve Shirish , Jackson Lisa R. , Thompson John S. 
Published: September 2024

AbstractThe murine IgM anti‐human CD3/TCR mAb T10B9 is an effective agent for the reversal of acute cellular renal allograft rejection which offers several advantages over conventional OKT3 therapy. These include reduced morbidity and a more rapid decrease in serum creatinine levels. In the studies presented here comparing T10B9 and OKT3, soluble T10B9 is shown to be a nonactivating anti‐T cell mAb. Evidence for its lack of activating potential includes in vitro failure to stimulate PBMC proliferation either alone or in the presence of nonmitogenic doses of phorbol ester, failure to induce the expression of early and late activation antigens and failure to induce IFN‐γ, TNF‐α, IL‐6 or IL‐2 release. Analysis of acute renal allograft rejection patient plasma cytokine levels 2 h after the first dose support the hypothesis that T10B9 has reduced immunoactivation activity in vivo. Both TNFa and IFNy patient plasma levels are significantly reduced in T10B9 as compared to OKT3 therapy. However, T10B9 is capable of cellular signaling as demonstrated by its ability to induce apoptosis and IL‐2 release in the human T cell line Sup‐T13. Thus T10B9 retains the potent immunosuppressive activity of OKT3 with reduced immunoactivation.
Effects of azathioprine withdrawal in kidney recipients with stable function two years after transplant
Authors: Goldman Mitchell H. , Davis Brooks , Cruz Edgar , Miller Patricia , Stevens Scott L. , Freeman Michael B. , Tyler John D. 
Published: September 2024

AbstractTo assess the effects of azathioprine withdrawal, renal recipients with grafts >2 yr function (103 study patients) were tapered off azathioprine over a 1‐yr period and compared to 69 patients 2 yr after transplant who were not tapered (controls). Of the 103 study patients, 16 (15%) were living‐donor transplants and 87 were cadaveric. Of the 69 control patients, 9 (13%) were living related transplants and 60 were cadaveric. The mean HLA match for those tapered was 3.3 Ag and 3.1 Ag for those remaining on azathioprine. Two study patients restarted azathioprine on their own. Age, sex, and cause of renal failure in both groups was similar. Of the 101 study patients remaining, 9 (8.8%) returned to dialysis due to biopsy proven chronic rejection. There were no acute rejection episodes. Six of the 69 control patients (8.7%) also returned to dialysis for the same reason. Of the 92 patients who have completed the taper, 85 have been off azathioprine for six or more months. There was not a significant difference between the mean 12‐ and 24‐month creatinine levels of the study patients (1.6 mg%, 1.7 mg%) and those of the controls (1.5 mg%, 1.8 mg%). The mean 12‐ and 24‐month hematocrits of patients tapered (41.3%, 40.8%) were comparable with patients not tapered (42.3%, 42.8%). Of interest. the mean hematocrits of both study and control patients rose from 28.9% and 33.5%, respectively, to 41.3% and 42.3% 1 yr following entry into the study. The mean 12‐ and 24‐month white blood counts of those tapered (8.9, 8.7) did not differ significantly from those continued on azathioprine (8.8, 8.8). In stable renal transplant patients on triple drug immunosuppression for at least 2 yr, azathioprine can be discontinued, in a tapered protocol, without an increased risk of graft loss or compromise of renal function.
Immunogenetic factors that may contribute to ethnic differences in renal allograft survival
Authors: Ward Frances E. , MacQueen J. Marilyn 
Published: September 2024

AbstractIn the United States, allocation of cadaveric kidneys is federally regulated and based on the concept of equal access to all patients, regardless of race, sex, age, or socioeconomic status. Nevertheless, it has been widely reported that African American patients with renal disease wait longer for kidney transplantation and, once transplanted, have poorer graft survival. We have assessed immunogenetic factors that may contribute to ethnic differences in allograft survival by examining the distributions of ABO blood groups, HLA antigens and haplotypes, percent reactive antibody (PRA), age, and gender in our local patient population. Approximately 62% of patients at our transplant center waiting for renal transplantation are African American; 39% are female. Age distribution is comparable to that reported nationally. ABO blood groups of patients on the waiting list are distributed similarly to those reported nationally for other renal patients. Sensitization to HLA antigens, through either blood transfusion, prior transplant, or pregnancy, has been strongly associated with poorer graft survival. Although, as expected, distribution of PRA was significantly different for males versus females at one time point, it did not differ between ethnic groups in our patient population. HLA polymorphism was assessed by comparisons of HLA allele and haplotype frequencies determined by analyses of African American and Caucasian families typed in our program since 1991. Haplotypes observed in each ethnic population were subjected to a variety of statistical analyses. Coefficient of contingency and Cramer's V statistic (measures of degree of association) were consistently higher for Caucasian haplotypes than for those of African Americans. Significantly more unique HLA haplotypes were observed among African American families than among Caucasian families. Thus, our data provide evidence for greater HLA linkage disequilibrium in Caucasians than in African Americans. HLA antigen and haplotype polymorphisms are likely, therefore, to be major immunogenetic factors contributing to ethnic differences in renal allograft survival.
Disproportionate HLA matching may contribute to racial disparity in patient survival following cardiac transplantation
Authors: Park M. H. , Tolman D. E. , Kimball P. M. 
Published: September 2024

AbstractThe purpose of this study is to investigate the impact of recipient race as well as HLA matching upon long‐term survival following heart transplantation (HTx). The study also determines whether the degree of HLA matching between Caucasians and African Americans differs. This study was a retrospective analysis of 336 males (77% Caucasians and 23% African Americans) transplanted between 1983 and 1994, all having received cyclosporine‐based immunosuppression. The results showed African Americans were transplanted at a significantly younger age than Caucasians (39.1±11.2 vs. 48.2±10 yr). The composition of end stage cardiac disease was startlingly different. Caucasians demonstrated 62% CAD, 31% IDCM and 7% other, whereas African Americans exhibited 24% CAD, 69% IDCM and 7% other. The ten‐year survival rate for African American male recipients was inferior to Caucasian males. Survival at 1, 3, 5, 7 and 9 yr was 83%, 73%, 63%, 51%, 46% for Caucasians and 70%, 58%, 51%, 38% and 32% for African Americans. Furthermore, African Americans received more poorly matched organs compared to Caucasians. Among Caucasians for Class I, 46%, 53% and 1% received poor, moderate and well matched hearts, respectively. In contrast, African Americans were allocated 65%, 33% and 0% of poor, moderate, or well matched hearts. An analysis of Class II data revealed the same pattern (63%, 35%, 2% of Caucasians and 78%, 18%, and 4% of African‐ Americans received poor, moderate or well matched hearts). Survival for Caucasians improved when moderately versus poorly matched for Class I. Class II matching did not have an effect. African Americans showed a similar trend, although statistical significance was not reached. When comparing equivalent degrees of matching, African Americans had inferior survival rate when poorly matched for Class I relative to Caucasians. No statistical difference was observed for moderate matched Class I or for Class II analysis.
Routine early biopsy of allografts with delayed function: correlation of histopathology and transplant outcome
Authors: Gaber Lillian W. , Gaber A. Osama , Hathaway Donna K. , Vera Santiago R. , Shokouh‐Amiri M. H. 
Published: September 2024

AbstractApproximately 25–30% of our cadaveric renal transplant recipients have required post‐transplant dialysis. In an attempt to discern the etiology, routine biopsies were performed 7‐10 d post‐transplant and repeated weekly. All patients received a triple‐therapy cyclosporine‐based regimen with (N=61) or without (N=10) antilymphocyte induction. Rejection was classified as ‘early’ when it appeared on the first biopsy (8.9±0.3 d), ‘delayed’ when it appeared only on the second biopsy (17.9±1.0 d) and persistent when present on both biopsies. Adequate biopsy material was obtained from 71 patients who provided a total of 117 biopsies. Acute tubular necrosis was the most common finding (50%) in the first biopsy, while rejection occured in 30% of biopsies. Rejection on the first biopsy was strongly associated with primary nonfunction (PNF) (8 of 21 vs. 1 of 40, p≤0.0001). In contrast, eight patients without rejection on Biopsy I developed delayed rejection on Biopsy 2; only one was associated with PNF DGF persisted beyond the second week in 38 patients; 17 (38%) of which had rejection. Nine patients had persistent rejection 55% of whom experienced PNF compared to 6% without persistent rejection (p≤0.001). The occurrence of early rejection was associated with pretransplant peak PRA levels >50% (p=0.01). Graft survival for all patients was 79% and 65% at 1 and 2 yr. Rejection influenced 1‐yr graft survival for patients with persistent rejection who had 55% incidence of primary nonfunction and 1‐ and 2‐ yr graft survival rates of 42% and 37%. These data indicate that early biopsies are useful in unmasking rejection during DGF and at predicting primary nonfunction. Based on these data we recommend the routine utilization of biopsies for all patients with DGF.
Renal allograft rupture: a clinical review
Authors: Azar G. J. , Zarifian A. A. , Frentz G. D. , Tesi R. J. , Etheredge E. E. 
Published: September 2024

AbstractRupture of a renal allograft (RAR) is an uncommon but serious complication of renal transplantation. A recent RAR prompted a review of our experience, with the purpose of (1) identifying conditions that may predispose this complication and (2) defining strategies for prevention. A 5‐yr, consecutive living‐related (LRD) and cadaver donor (CD) cohort of 331 patients was studied retrospectively. Twelve patients (3.6%) had RAR. Donor characteristics, procurement and preservation conditions, and recipient characteristics were major study categories. Data analysis was computer‐based and included multivariate analysis. The nine White and two Black cadaver donors were “ideal”, mean age 29 yr, with mean high creatinine (CR) of 1.3 and terminal CR of 1.1 mg/dl, and mean terminal urine output of 423 ml/min. Nine of 11 CD had low‐dose dopamine use (terminal, mean 8, range 5‐13 μg/kg/min). Eleven of 11 donors had procurement en‐bloc, 9 of which were multiple organ procurement. All had 4+/4+ flush and cold storage with UW solution. Mean cold ischemia time (CIT) was 22 h, 28 min (range 15 h, 16 min to 40 h). For patients with RAR mean age was 39 yr; there were 12 Black patients and 7 males, 5 females. HLA match was 1 antigen (AG) for 3, 2 AG for 8, and 4 AG for 1 (mean 1.9). Nine patients had delayed or declining renal function requiring dialysis. The panel reactive antibody was at peak, mean 47% (range 0–100%) and current, mean 18% (range 0–84%). Six of 12 had OKT3 therapy at time of RAR and six had biopsies. Day of RAR was mean 10, median 9 (range 4–21). Pain and drop in hematocrit were observed in most. There was one fatality (8%), and all kidneys were removed. All kidneys showed at least minimal rejection but six had severe acute tubular necrosis (ATN) with edema and minimal rejection. Statistically significant associations with RAR were older recipient age (p= 0.04), donor‐recipient race mismatch (White donor to Black recipient) (p= 0.007), and dialysis requirement (p<0.0001). Other variables were not statistically correlated: gender, race, CIT, transplant number, LRD vs. CD, peak or current PRA, and total HLA and BDR mismatch. The data suggest that ATN and rejection act synergistically to cause RAR and that early delayed function requires intensive and perhaps novel immunosuppression, especially in Black recipients.