bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of metastatic Vipoma by liver transplantation
Authors: Bramley P. N. , Lodge J. P. A. , Losowsky M. S. , Giles G. R. 
Published: September 2024

We report the first case of metastatic Vipoma treated by orthotopic liver transplantation. A woman with explosive secretory diarrhea causing hypokalemic acidosis was diagnosed as having a vasoactive intestinal peptide secreting tumor with widespread hepatic metastases. The symptoms were initially controlled for 9 months with increasing doses of long‐acting somatostatin analogue (Sandostatin, Sandoz Ltd, UK.). Alpha interferon was not tolerated, causing an acute paranoid psychosis. Eventually orthotopic liver transplantation was performed with the removal of the primary tumor from the distal pancreas. Postoperatively, complications were associated with the distal pancreatectomy. The patient has no evidence of tumor recurrence on imaging or serum VIP level 12 months posttransplantation.
Increased T suppressor activity in renal transplant recipients with long‐term stable graft function
Authors: Weimer R. , Pomer S. , Staehler G. , Opelz G. 
Published: September 2024

There is evidence for differences in B‐cell regulation between renal allograft recipients with long‐term stable graft function (ST patients) and patients undergoing chronic rejection (CR patients). To assess the role of T cells in B‐cell regulation, we tested T‐lymphocyte helper and suppressor functions in 26 ST patients (> 1 year posttransplant) and in 13 CR patients. 34 healthy blood donors served as controls. CD4‐positive or CD8‐positive T lymphocytes were cocultured with B lymphocytes and pokeweed mitogen for 6 days. B‐cell differentiation was assessed in a reverse hemolytic plaque assay and by ELISA determination of IgM and IgG in culture supernatants. We found a diminished T helper function and elevated T suppressor activity in ST patients (immunoglobulin‐secreting cell formation, p < 0.001; IgM secretion, p < 0.002; IgG secretion, p < 0.05) but not in CR patients. Elevated counts of CD4 cells with suppressor activity were responsible for the increased T suppression in ST patients. The percentage of CD45R‐positive CD4 cells (suppressorinducer cells) was unchanged in both ST and CR patients. Whereas all CR patients had T helper function in the normal range, 11 of 26 (42%) ST patients had defective T helper activity (p < 0.005). 62% of the ST patients demonstrated T‐cell suppression of immunoglobulin‐secreting cell formation in contrast to 23% of CR patients (p < 0.05). Our data support a role of T suppressor activity in the maintenance of allograft acceptance in long‐term transplant recipients.
Cytoimmunological monitoring of heart transplant recipients
Authors: Jutte N. H. P. M. , Hop W. C. J. , Daane R. , Essed C. E. , Weimar W. , Simoons M. L. , Bos E. 
Published: September 2024

The prognostic value of cytoimmunological monitoring of peripheral blood from heart transplant recipients was investigated with respect to the first rejection episode within the first 3 months after transplantation. The study comprised 371 CIM slides made concurrently with endomyocardial biopsies (EMB) in 70 patients. The number of lymphoblasts and activated lymphocytes counted in the slides was expressed as percentage of the total number of lymphocytes. Histological evaluation of the EMB was used as a “gold standard” for the occurrence of rejection, including myocytolysis. With regard to the absolute values of percentages of lymphoblasts and/or activated lymphocytes or their sum, no significant differences were observed between slides made when rejection was diagnosed or not. This was also the case when different immunosuppressive regimens were analyzed separately. Also, when changes in CIM parameters within individual patients were evaluated, no relation between CIM and rejection was found. In conclusion, for diagnosis of rejection of heart transplant recipients CIM was not useful for our group of patients.
Signs of nerve regeneration and repair following pancreas transplantation in an insulin‐dependent diabetic with neuropathy
Authors: Beggs John L. , Johnson Peter C. , Olafsen Astrid G. , Cleary Colleen P. , Watkins C. Jane , Targovnlk Jerome H. , Koep Lawrence J. 
Published: September 2024

AbstractNeuropathy is a common complication of diabetes mellitus (DM). Myelinated nerve fiber (MNF) abnormalities, microangiopathy of the vasa nervorum, and abnormalities of the perineurium (PN) are frequent pathological findings in the nerves of diabetics. Nerve function in most DM patients with neuropathy improves following successful pancreas transplantation (PT). In this morphometric study of sequential nerve biopsies from a DM patient who experienced a marked improvement in debilitating diabetic neuropathy after PT, we found that the progression of nerve disease was halted during the 2 yr of euglycemia after PT. We also identified signs of tissue repair and regeneration of some nerve components including: a reduction in the frequency of abnormal pericytes associated with endoneurial capillaries, a reduction of MNF abnormalities characteristic of active fiber degeneration, an increase in fiber characteristics associated with regeneration, a two‐fold increase in unmyelinated axons, and a doubling of MNF sprouts. Conclusion: Long‐term euglycemia may prevent progressive nerve disease in DM and provide a neural environment suitable for nerve regeneration and repair.
Immunologic monitoring of steroid withdrawal in renal allograft recipients on triple therapy with cyclosporine‐A, azathioprine and prednisone
Authors: von Kiparski Alexander , Frei Dieter , Fierz Walter , Uhlschmid Georg , Frei Gertrud , Largiadèr Felix , Binswanger Ulrich 
Published: September 2024

AbstractThe lymphocyte subsets in the peripheral blood were examined in 35 stable renal allograft recipients on maintenance triple therapy with cyclosporine‐A (CyA), azathioprine (Aza) and low‐dose prednisone (Pred). In 20/35 recipients, Pred was discontinued. Pred withdrawal was successful in 12 (60%) patients (group A) and unsuccessful in 8 (40%) patients (group B). Group B had a significantly higher CD4/CD8 ratio before Pred withdrawal than group A (2.4 ± 1.4 vs 1.4 ± 0.6; p < 0.05) although only 4/8 patients had a high ratio (> 2.5). After cessation of Pred, Leu3 + (helper/inducer) and Leu2 + (suppressor/cytotoxic) cells increased in group B and Leu3 + cells were significantly higher than in group A (p < 0.02). The Leu2 + /Leu15 – (cytotoxic) subset was responsible for the significant increase of the Leu2 + cells (p < 0.05). However, in 6/12 recipients of group A there was also an increase of Leu3 + and Leu2 + cells but a decrease of these subsets in the other 6 patients. After withdrawal of Pred, group A was compared to the 15 patients with triple therapy who were not withdrawn, 15 patients with conventional therapy (Aza and Pred) and 15 blood donors. B cells (Leu12 +) and Leu11 + NK cells were significantly lower in the transplanted patients compared to the blood donors. Group A and the conventionally treated patients had significantly decreased helper/inducer cells (Leu3 +) with a significantly lower CD4/CD8 ratio than the controls. In the transplant group a reversal of the Leu3 + subsets was observed resulting in higher T‐helper cell values (Leu3 + /Leu8–) and significantly lower T‐suppressor‐inducer cell counts (Leu3 + /Leu8 +) compared to the controls. A similar distribution was seen already pretransplant in 14 uremic patients. In conclusion, patients with a high CD4/CD8 ratio might represent a risk group for Pred withdrawal failure, although the outcome could not be predicted in the individual patient.
Expression of HLA‐class I molecules in human pancreas
Authors: Leprini Arnaldo , Valante Umberto , Barocci Sergio , Cantarella Sebastiana , Fontana Iris , Leprini Alessandra E. G. , Celada Franco , Nocera Arcangelo 
Published: September 2024

AbstractIn the present work we have focused our attention on the distribution of HLA‐class I molecules (A, B, C) in human pancreas. To this end, tissue sections from 12 pancreata, obtained from normal cadaver donors, were studied by means of single and double immunoenzymatic stainings with a battery of monoclonal antibodies. The analysis of 10 out of 12 organs demonstrated that: i) endocrine parenchymal cells expressed very low amounts of HLA‐class I antigens as opposed to exocrine parenchymal cells that were stained with different degrees of clear positivity: ii) within the non‐fibroblastic interstitial cell population of pancreatic tissues, dendritic cells appeared almost negative whereas macrophages stained strongly positive. Changes in the above pattern of class I antigen expression were observed in the remaining 2 pancreata. These organs did not show any histologic tissue alteration but differed from the other 10 because of an increased percentage in the exocrine portions of interstitial mononuclear cells such as monocytes, B and T lymphocytes. In these latter pancreases no differences were detectable between exocrine and endocrine parenchymal cells, both appearing sharply positive for HLA‐class I molecule expression. The inducibility of HLA‐class I antigens on pancreatic parenchymal cells was also demonstrated by in vitro experiments where human purified isolated islets were cultured in the presence of human recombinant tumor necrosis factor‐α.
Role of passenger leukocytes in islet allograft immunity
Authors: Gill Ronald G. 
Published: September 2024

AbstractThe passenger leukocyte concept proposes that a specialized antigen‐presenting cell within the graft is responsible for the induction of allograft immunity. This theory forms the basis for attempting to modify tissue immunogenicity by eliminating or inactivating these cells prior to grafting. Despite considerable work addressing this issue, the contribution of passenger leukocytes to allograft immunity remains a controversial subject. Recent studies challenge the role of passenger leukocytes as the principal inducers of alloimmunity. The goal here is to reassess the role of passenger leukocytes in alloimmunity by focusing on two central questions: (1) What is the role of MHC antigens in inducing graft rejection, and (2) What constitutes an alloantigen‐presenting cell? The evidence presented suggests that MHC alloantigens are not sufficient for the induction of allograft immunity, thus supporting a critical role for passenger leukocytes in the triggering of allograft rejection.
OKT3 and viral disease in pediatric liver transplant recipients
Authors: III James S. Bowman , Green Michael , Scantlebury Velma P. , Todo Saturo , Tzakis Andreas , Iwatsuki Shunzaburo , Douglas Laura , Starzl Thomas E. 
Published: September 2024

AbstractSeventy‐four consecutive pediatric liver transplant recipients were reviewed to assess the effect of the monoclonal anti‐T‐lymphocyte antibody OKT3 on subsequent viral infection (9 patients were excluded due to postoperative demise during the 1st week). Twenty‐two patients received OKT3 in addition to standard cyclosporine‐prednisone immunosuppression for either steroid‐resistant acute rejection (18) or to facilitate reduction of cyclosporine due to severe renal impairment (4). Invasive infections were diagnosed by histology or culture in tissue biopsies or bronchoalveolar lavage specimens. The overall incidence of viral infection was 58%, half of which was due to cytomegalovirus (CMV). Invasive viral disease was associated with increased mortality (37% vs. 3% p = 0.001). Viral‐related deaths were due to CMV (5), disseminated adenovirus (3), disseminated enterovirus (1) and respiratory syncytial viral pneumonia (1). The use of OKT3 was associated with increased viral disease (59% vs. 33% p = 0.04) and invasive primary CMV disease (58% vs. 19% p = 0.04). Trends were observed toward increased overall viral infection (73% vs. 51% p = 0.08), primary CMV infection (58% vs. 25% p = 0.08) and overall mortality (27% vs. 9% p = 0.08) following OKT3 therapy. We conclude that pediatric liver transplant recipients who require OKT3 therapy may be at increased risk for invasive viral disease and especially invasive primary CMV disease.
Sequential OKT3 and cyclosporine after heart transplantation: A randomized study with single and cyclic OKT3
Authors: Balk A. H. M. M. , Simoons M. L. , Jutte N. H. P. M. , Brouwer M. L. , Meeter KJ. , Mochtar B. , Weimar W. 
Published: September 2024

AbstractThe incidence of cardiac allograft rejection and the occurrence of renal insufficiency in the early postoperative period were compared in patients randomly allocated to receive either sequential OKT3 plus azathioprine and cyclosporine or to cyclosporine alone. Both groups were in addition on low‐dose steroids. Thirty‐three patients received OKT3 and in 10 of them a second course of OKT3 was given 3 weeks thereafter, regardless of the presence or absence of allograft rejection. Cyclosporine alone was given to 33 patients also. There was no significant difference in the number of acute rejections per patient in the OKT3‐versus cyclosporine‐treated patients (1.33 vs 1.36), nor in the freedom from rejection at 1, 3 and 6 months: 80%, 31% and 28% vs 66%, 33% and 27% respectively. No difference in freedom from rejection was found between patients who received single versus cyclic doses of OKT3. In the OKT3‐treated patients there were no nephrological problems. In the cyclosporine group median serum creatinine levels increased from 115 to 208 μmol/l in the 1st postoperative wk. There were no serious side‐effects during the first course of OKT3. In the 10 patients who received a second course of OKT3 side‐effects were badly tolerated, although not hemodynamically significant or life‐threathening. When the freedom from rejection in the OKT3 group was compared to the results in our first 32 cardiac recipients who also received cyclosporine and low‐dose steroids there appeared to be a significant (p < 0.001) delay in the occurrence of the first rejection. This delay was not significantly different in the randomized concurrent controls. This supports the need to conduct randomized trials for the comparison of immunosuppressive regimens. OKT3 facilitated patient care by preventing nephrological problems but did not reduce the incidence of cardiac allograft rejection.
Invasive Candida albicans infections in orthotopic liver graft recipients. Incidence and risk‐factors
Authors: Tollemar Jan , Ericzon Bo‐Gôran 
Published: September 2024

AbstractIn 56 consecutive liver transplantations performed in 50 patients, 13 patients had proven disseminated fungal infection (FI) by Candida albicans and 5 more patients had probable FI. The incidence of FI varied between 26% and 36%, depending on whether probable FI was included or not. During the first 10 weeks, 9 out of 13 (69%) patients with proven FI died compared to 2 of the 32 (6%) patients without FI (p < 0.001). One‐year patient survival was significantly lower for proven infected patients compared to non‐infected patients, 31% and 94%, respectively (p < 0.0001). Significant risk factors for FI in multivariate logistic regression analysis at the time of transplantation were long operation time (p < 0.01), male liver donors (p < 0.01), and poor pretransplant liver function as assessed by high bilirubin levels (p < 0.05). Ten days after the transplantation in multivariate analysis with initial and 10 d time rolled factors, long first graft transplantation time (p < 0.02) and long post‐transplant operative time (p < 0.05) were significant risk factors.
Bilateral nephrectomy for posttransplant erythrocytosis – indications and results
Authors: Garvin Paul J. , Reese Jeffrey C. , Lindsey Lisa , Aridge Della L. , Domoto Douglas T. , Ballal Sudarshan 
Published: September 2024

AbstractTo determine the incidence of posttransplant erythrocytosis (PTE) in the cyclosporine era, as well as the role of the native kidneys in its causation, a retrospective chart analysis of 292 consecutive renal allograft recipients with stable renal function for ≥ 3 months was performed. PTE was defined as two consecutive hematocrits ≥ 51 vols %, after known secondary causes were excluded. Twenty‐five patients (8.6%) developed erythrocytosis from 2.5 to 60 months (mean = 10.1 months) posttransplant. In 16 patients with a mean peak Hct of 56.7 vols %, the erythrocytosis resolved, either spontaneously (11) or due to a decrease in renal function (5), after a mean of 9.5 months. In this group, there was one thromboembolic event and 4 patients underwent phlebotomies for persistent Hcts > 55%. Of 9 patients with persistent erythrocytosis, 7 had elevated peripheral erythropoietin levels and underwent selective venous sampling which indicated excess native kidney erythropoietin secretion (mean native to IVC erythropoietin ratio = 1.8). Due to frequent phlebotomies (mean = 3.4), thromboembolic events (n = 2), and/or coexistent high renin output hypertension (1), 5 patients underwent bilatral native nephrectomy resulting in a decrease in the hematocrit (pre–nephrectomy = 59.4 vols % versus 3 months post‐nephrectomy = 39.9 vols %) and peripheral erythropoietin levels (pre–nephrectomy = 38.2 mμ/ml versus post‐nephrectomy = 13.6 mμ/ml), which persisted throughout the follow‐up period (mean = 17.0 months). This retrospective study indicates that PTE remains a problem in the cyclosporine era. Inappropriate erythropoietin production by the native kidneys is a common etiologic factor and, in these cases, bilateral nephrectomy is curative.
Ruptured splenic artery aneurysm: An unusual late complication following pancreas transplantation
Authors: Reed Alan , Sollinger Hans W. , Knechtle Stuart J. , D'Alessandro Anthony M. , Kalayoglu Munci , Pirsch John D. , Belzer Folkert O. 
Published: September 2024

AbstractThe vascular complications following pancreas transplantation have been well described and largely involve either re‐operation for hemorrhage or vascular thrombosis. We describe herein a ruptured aneurysm of the transplanted splenic artery 6 years following surgery in a nonfunctioning graft as an unusual vascular complication.
Early leukemia, seropositivity for several herpes viruses and chronic graft‐versus‐host disease are associated with decreased incidence of relapse after allogenic bone marrow transplantation
Authors: Boström Lennart , Ringdén Olle , Nilsson Bo , Jacobson Niels , Zwaan Ferry ,   Leukaemia Working Party of the European Group for Bone Marrow Transplantation
Published: September 2024

Abstract:Two‐hundred‐and‐ninety‐seven bone marrow transplantation (BMT) recipients with hematological malignancies, surviving at least 90 days after BMT, were reported from 17 European teams. The 3‐year cumulative incidence of relapse after BMT was 28%. In Cox regression multivariate analysis, statistically significant risk‐factors for relapse were: patients beyond first remission of acute leukemia or first chronic phase of chronic myeloid leukemia (intermediate or advanced leukemia) (p = 0.003), and patients seropositive to 0‐2 different herpes viruses compared to 3‐4 prior to BMT (p = 0.005). Absence of chronic graft‐versus‐host disease was borderline significant (p = 0.053). The cumulative patient survival was 58% at 3 yr after BMT. Factors associated with poor patient survival were: recipient CMV seropositivity prior to BMT (p = 0.0008), a previous grade II–IV acute GVHD (p = 0.004), patients with intermediate or advanced leukemia (p = 0.004), low bone marrow cell dose (p = 0.007) and older recipient age (p = 0.03). The 3‐yr cumulative relapse‐free survival was 55% after BMT. Poor relapse‐free survival was correlated with intermediate or advanced leukemia (p = 0.0002), older recipient age (p = 0.003), a previous grade II–IV acute GVHD (p = 0.006) and low bone marrow cell dose (p = 0.01). To conclude: Early leukemia, seropositivity to several herpes viruses and chronic graft‐versus‐host disease (borderline), were associated with a decreased risk of relapse. However, seropositivity to several different herpes viruses was associated with an increased risk of acute GVHD which reduced survival. Thus, seropositivity to several herpes viruses does not influence survival or relapse‐free survival.
Sequential immunosuppression of renal allograft rejection
Authors: Ubhi Charanjeit S. , Lam For Tai , Lodge J. Peter A. , Giles Geoffrey R. 
Published: September 2024

Abstract:Cadaveric renal allografts are currently managed by primary cyclosporine monotherapy by the oral route. Monitoring of 62 renal allografts by fine needle aspiration cytology identified 19 grafts without evidence of rejection (Group A), 24 grafts with rejection which resolved with intravenous methylprednisolone (i.v.MP) (Group B) and 19 grafts with continuing rejection after i.v. MP (Group C). All Group A grafts were functioning at 3 months with cyclosporine monotherapy. Seven grafts of Group B received further steroids for rejection and 3 were lost. Patients in Group C were randomized to receive steroids or azathioprine, but ultimately all received triple therapy of cyclosporine, azathioprine and steroids, and 3 grafts were lost. Sequential immunosuppression according to need resulted in 90.3% and 79% graft survival with 96.8% and 90.3% patient survival at 1 or 2 years, respectively.
Role of duplex imaging and fine needle aspiration cytology of renal allografts in monitoring response to anti‐rejection therapy
Authors: Rajasekar Magaral R. , Lodge J. Peter A. , Irving Henry C. , Giles Geoffrey R. 
Published: September 2024

Abstract:The role of duplex imaging and fine‐needle aspiration cytology (FNAC) in monitoring the response to anti‐rejection therapy was investigated in 14 of the 22 rejection episodes which occurred in 30 renal allografts recipients. In 9 of these 14 episodes of rejection, with good resolution, both resistive (RI) and pulsatility (PI) indices decreased by significant proportions (p < 0.05). The FNAC scores also fell significantly with anti‐rejection therapy. In 5 other episodes of rejection where the graft continued to deteriorate there was no significant fall of RI and PI (p ≥ 0.2). In a small group of patients, both FNAC and Doppler predicted rejection. In conclusion, both duplex imaging and FNAC have a role in selection and optimal modulation of drugs in the treatment of acute renal allograft ejection.
Wound abscesses following retroperitoneal pancreas transplantation
Authors: Barker Rodney J. , Mayes James T. , Schulak James A. 
Published: September 2024

Abstract:We report the management of peri‐pancreas transplant abscesses in 7 recipients of combined pancreas and kidney transplants in whom the grafts were placed in the retroperitoneum. Five of 7 abscesses were polymicrobial in nature and 3 of 7 contained Candida albicans. Patient management included surgical drainage, wound closure over suction drains, and specific antimicrobial chemotherapy. In the cases of fungal infection, both amphotericin B and ketoconozol therapy were used without untoward effects, except for transient nephrotoxicity in 1 patient due to amphotericin administration. Six of 7 patients retained long‐term endocrine pancreas and renal function and healed their wounds, including all 3 patients with fungal infections. One of the latter patients, however, developed a recurrent retropubic fungal abscess that may have been a persistent occult infection.