bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparate changes in plasma and tissue pentosidine levels after kidney and kidney‐pancreas transplantation
Authors: Hricik Donald E. , Wu Yu Ching , Schulak James A. , Friedlander Miriam A. 
Published: September 2024

AbstractThe advanced glycation end‐product, pentosidine, was measured in plasma proteins and skin collagen before and after kidney and kidney‐pancreas transplantation in order to determine the relationship between plasma and tissue levels and to characterize the pattern of change in pentosidine levels after correction of hyperglycemia and/or renal failure. The content of pentosidine in skin collagen was higher than that in plasma proteins both before and after transplantation. However, there was no correlation between plasma and skin pentosidine levels. Prior to transplantation, the content of pentosidine in skin collagen was related to the duration of dialytic therapy, presence of diabetes mellitus, age, and female gender. Following transplantation, plasma pentosidine levels were inversely correlated with glomerular filtration rate (r=‐0.64; p<0.01). While plasma pentosidine levels consistently decreased after transplantation, levels in skin collagen increased in 10 of 13 patients, including 5 of 6 recipients of kidney‐pancreas transplants. Our results indicate that tissue levels of pentosidine persist for long periods of time after kidney or kidney‐pancreas transplantation, despite consistent decreases in levels measured in plasma proteins. The observed increase in tissue pentosidine levels in a majority of patients suggests that formation of advanced glycation end‐products may continue after otherwise successful kidney or kidney‐pancreas transplantation.
CREG matching for first cadaveric kidney transplants (TNX) performed by SEOPF centers between October 1987 and September 1995
Authors: Thompson John S. , Thacker Leroy R. 
Published: September 2024

AbstractThe Southeastern Organ Procurement Foundation (SEOPF) data base from October 1987 to September 1995 includes 12 536 first cadaveric kidney transplants, of which 39.5% were placed into non‐white recipients (N‐WR). Consequently, the SEOPF data offered an excellent sample in which to examine the effect of a number of conventional HLAA, B versus public (crossreactive group, CREG) matching schemes on access and graft survival (GS). The standard applied was that 3‐yr GS had to be greater than that of the mean GS of the racial group. Because of the excellent 1‐ and 3‐yr GS of 0 A,B,DR mismatched kidneys in both white recipients (WR)=87.9% and 82.8% and N‐WR‐86.9% and 80.9%, these transplants were excluded from further analysis. Thereafter, the mean 1‐ and 3‐yr GS of the remaining 7011 WR and 4862 N‐WR transplants used for all subsequent comparisons were 82.5% and 72.4% for WR versus 80.9% and 63.0% for N‐WR. Four different matching schemes were compared: 1) Class I A, B versus CREG hierarchical effect disregarding DR; 2) 0, 1, 2B, DR versus 0‐2 CREG, DR mismatching; 3) DR mismatching disregarding Class I A, B or CREG mismatching and 4) Class I A, B versus CREG mismatching stratified for DR. Two and possibly three CREG, DR mismatched groups were identified in which improved access and GS occurred in comparison with the 0, 1, and 2B, DR mismatched transplants currently receiving 7, 3 and 1 point in the UNOS sharing algorithm. The 1‐ and 3‐yr GS in WR and N‐WR of these groups were as follows: 0 CREG, 0 DR mismatches: 85.7% and 78.3% in WR (n=385); 83.0% and 69.4% in N‐WR (n=157). 1‐3 CREG, 0 DR mismatches: 84.5% and 74% in WR (n=1550); 82.7% and 65.7% in N‐WR (n=1083). Based on this analysis, there may be a significant potential advantage of prospective Class I CREG over A, B matching for first cadaver kidney transplantation.
OKT3 induction therapy: influence of duration on rejections and infections
Authors: Zibari G. B. , Boykin K. N. , Thomas J. P. , Aultman D. F. , Aradhye S. A. , McMillan R. W. , McDonald J. C. 
Published: September 2024

AbstractAnti‐lymphocyte induction therapy in renal transplants remains controversial relative to efficacy and cost benefit. It has been suggested that shortening the duration of induction therapy from 14 to 7 d would provide adequate efficacy at less cost. Our objective was to compare the efficacy and complications of short (7 d or less, group A) versus standard (14 d or more, group B) duration of OKT3 induction therapy in renal allograft recipients. We performed a retrospective review of all renal allografts performed between July 1989 and September 1994. Two groups were identified based on the duration of OKT3 induction therapy. There were no significant differences between group A or B in the distribution of age, sex, race, degree of HLA matching, and etiology of renal failure. Patients in group B experienced fewer rejections at 3 and 12 months (p=0.0236 and p=0.0065, respectively) as well as fewer viral infections during the first year of follow‐up (p=0.0435). No difference on the mean number of bacterial or fungal infections existed between the two groups. There were no statistically significant differences in patient or graft survival, although patients in group B had a tendency towards increased 1‐yr graft survival.
Alloimmunization against platelet antigens in renal transplant patients with acute vascular rejection
Authors: Kekomäki S. , Salmela K. , Partanen J. , Koskimies S. , Kekomäki R. 
Published: September 2024

AbstractAcute vascular rejection (AVR) of a kidney graft, in which the graft vascular endothelium is main target for the injury, is considered antibody‐mediated. Integrins of vascular endothelium and platelets have several alloantigenic epitopes in common, e.g. human platelet alloantigen (HPA) 1 on β3, integrin of glycoprotein (GP) IIbIIIa and HPA‐5 on α2of GP lalla. The clinical significance of HPA expression by vascular endothelial cells is unknown. Platelet antibodies in serum samples from 26 renal allograft recipients with AVR and 30 patients without AVR were studied. Also the HPA‐types of the patients and their respective graft donors were determined. Strong platelet alloantibodies were observed in seven of the 26 AVR patients (27%). In five of these cases the antibodies had HPA‐specificity. No reference patient without AVR had strong platelet antibodies. In two AVR patients strong HPA‐5b antibodies coexisted with an HPA‐5b‐positive graft. Despite acute rejection episodes, neither of the grafts was lost. It seems likely that, with current immunosuppressive treatment, anti‐HPA‐5b does not necessarily cause permanent dysfunction of a graft originating from HPA‐5b‐positive donor.
Value of endothelin in cellular rejection after liver transplantation
Authors: Fábrega Emilio , Figols Javier , Dueñas Carmen , Crespo Javier , Casafont Fernando , Sanchez‐Antolín Gloria , de las Heras Gonzalo , Amado Jose Antonio , Pons‐Romero Fernando 
Published: September 2024

AbstractEndothelin‐1 is a vasoconstrictor peptide released by the vascular endothelium by various chemical and mechanical factors. Cellular rejection is one of the most common complications following orthotopic liver transplantation, endotheliitis being its most specific and consistent histological feature. To assess the role of endothelin in cellular hepatic rejection, we studied 21 cirrhotic patients undergoing elective liver transplantation. These patients were divided in two groups: Group I comprised 10 patients without cellular rejection, and Group II comprised 11 patients with cellular rejection. Endothelin was measured on day 7 after transplantation, on the day of liver biopsy, and after treatment for rejection. We found a significant increase in the plasma endothelin levels in the early postoperative period in the patients with moderate or severe cellular rejection compared with the non‐rejection group. It remained significantly elevated until the clinical diagnosis of rejection was made. This value returned to baseline with successful treatment. So, the monitorization of this peptide may be of help in the diagnosis of rejection, its severity, and the evaluation of its resolution.
Isoniazid hepatotoxicity in renal transplant recipients
Authors: Antony Suresh J. , Ynares Christina , Dummer J. Stephen 
Published: September 2024

AbstractTuberculosis occurs at higher rates in renal transplant recipients than in the general population. It would be desirable to use isoniazid prophylaxis in renal transplant recipients at risk for reactivation of tuberculosis; yet many transplant centers do not routinely employ INH prophylaxis because they perceive transplant recipients to be at an enhanced risk of hepatotoxicity from isoniazid. Data on the risk of isoniazid in renal transplant patients receiving cyclosporine‐based immunosuppression are limited. We retrospectively studied 83 renal transplant recipients (mean age 39.1±11.7 yr) who had received INH prophylaxis between 1985 and 1994. Eight patients had laboratory evidence of chronic hepatitis B or chronic hepatitis C infection. The mean duration of INH therapy was 344±163 d. The mean serum glutamate oxalacetic transferase (SGOT) at the start of INH therapy was 24.1±10.9 I.U., and 10% of patients had mildly elevated SGOTS. Mean peak SGOT during therapy was 36.4±15.3 I.U. (p<0.001 compared to start SGOT). In follow up, 31% of patients had an abnormal SGOT (>40 I.U.); however, the elevations were small (the highest SGOT was 88 I.U.) and never necessitated discontinuation of INH. No patient had jaundice or other evidence of clinical hepatotoxicity. The 95% confidence interval for the observed frequency of clinical hepatitis was 0% to 4.3%. At the end of INH therapy the mean SGOT was 22.7±6.2 I.U. (p>0.2, compared with start SGOT) and only one patient had an abnormal SGOT. In conclusion, it appears that the risk of renal transplant recipients developing serious hepatotoxicity with the administration of INH is low and not different from normal individuals.
Ethical and policy issues in altruistic living and cadaveric organ donation
Authors: Spital Aaron 
Published: September 2024

AbstractOrgans for transplantation are usually obtained from living genetic relatives or from heart‐beating cadavers. Unfortunately, these sources have so far been unable to keep up with demand. As a result, there is a large and steadily increasing number of potential recipients awaiting transplantation, some of whom will die before an organ can be found. In an attempt to rectify this tragic situation, several solutions have been proposed. This review will consider proposals designed to increase the availability of human organs without resorting to commercialism. These include expanding the use of living donors by: 1) encouraging donations by genetic relatives; 2) allowing volunteers a greater voice in determining their own suitability; 3) encouraging the use of emotionally related individuals and accepting altruistic strangers; and 4) considering motivated identical twin minors and older adolescents as donors. Suggestions for increasing the pool of cadaveric donors include: 1) overcoming the family consent barrier by presuming consent, mandating completion of binding advanced directives, or by eliminating the need for consent entirely; 2) reconsidering non‐heart‐beating donors; 3) elective ventilation for organ donation; and 4) accepting organs from anencephalic infants before brain death occurs. All of these proposals raise concerns which are discussed. Those approaches considered to be ethically acceptable and to hold promise for success should be vigorously pursued, beginning with carefully designed pilot studies. Hopefully, such an approach will eventually increase the number of organs available for patients sufferung from end‐stage organ disease.
Significance of tubulitis in chronic allograft nephropathy: a clinicopathologic study
Authors: Tsamandas A.C. , Shapiro R. , Jordan M. , Demetris A.J. , Randhawa P.S. 
Published: September 2024

AbstractTubulitis is the principal lesion used for the diagnosis of acute rejection (AR) in the Banff schema for renal allograft pathology. It is considered to be reliable for assessing AR early after transplantation. However, its significance in biopsies with concurrent changes of chronic allograft nephropathy (CAN) is less well understood. To address this issue we studied seventeen allograft biopsies taken 9‐108 (median 39) months post‐transplant from 17 patients. All specimens were scored for AR and CAN using Banff criteria. Medical records were reviewed to determine the clinical course of the patients. Five biopsies showed t1 changes, whereas nine biopsies graded as t2, and three biopsies as t3. The CAN scores varied from cg0, cil, ctl, cvl, to cgl, ci3, ct3, cv3. A response to increased immunosuppression, defined as a fall in the serum creatinine of at least 20% compared to the peak value, was observed in 7/17 (41%) cases. The responsive cases included 2/5, 4/9, and 1/3 cases respectively with t1, t2, and 13 tubulitis. The mean ± SD CAN scores in these three groups were 8.4 ±1.8, 6.5±1.4. and 7.0±1.4, respectively.We conclude that the presence of coexisting tubulitis and CAN in renal allograft biopsies may indicate reversible acute rejection. In this study, clinical response was observed in 7/17 (41%) patients. Patients with therapeutically responsive rejection could not be differentiated from refractory cases by serum creatinine, tubulitis grade, per cent glomerulosclerosis and sum scores for AR or CAN. Hence a trial of anti‐rejection therapy may be warranted pre‐emptively in all such cases.
Prognostic factors and early resumption of cyclosporin A in renal allograft recipients with thrombotic microangiopathy and hemolytic uremic syndrome
Authors: Wiener Yaron , Nakhleh Raouf E. , Lee Min W. , Escobar Francisco S. , Venkat K. K. , Kupin Warren L. , Mozes Martin F. 
Published: September 2024

AbstractBiopsy‐proven thrombotic microangiopathy (TMA) was found in 22 of 436 (5%) renal transplant recipients, with similar incidence in recipients of cadaver or living related allografts. All patients with TMA presented different degrees of severity of the hemolytic uremic syndrome (HUS). Prognosis was poor when HUS occurred shortly after transplant in recipients of cadaveric kidneys (55% graft loss). It was more favorable when HUS occurred later in the post‐transplant course or in recipients with allografts from living related donors, irrespective of time of occurrence. Other factors such as extent of TMA, degree of thrombocytopenia, hemolysis or renal dysfunction were not predictive of graft loss. Cyclosporine was resumed in 14 of 16 recipients shortly after clinical recovery without recurrence of HUS. In conclusion, HUS carries poor prognosis when occurring shortly after transplant in cadaver kidney recipients. Once the graft function. improves, cyclosporine can be safely resumed.
Clostridial infection of a liver transplant treated with retransplantation
Authors: Knechtle Stuart J. , Babalola John A. , D'Alessandro Anthony M. , Pirsch John D. , Kalayoglu Munci 
Published: September 2024

AbstractClostridial infection of a liver transplant is reported and was treated successfully with immediate retransplantation and antibiotics. This strategy may salvage patients who otherwise have a fulminant course and certain death. This case supports the general principle that infection localized to the liver can be successfully treated with retransplantation when appropriate.
Regional vs. national renal sharing organizations: pros and cons
Authors: Bertoni Elisabetta , Carmellini Mario , Bandini Sandro , Tosi Pierluigi , Zanazzi Maria , Rosati Alberto , Pradella Fabio , Fossombroni Vittorio , Rindi Paolo , Rizzo Gaetano , Mattiuz Pierluigi , Mosca Franco , Salvadori Maurizio 
Published: September 2024

AbstractDelayed graft function, defined as the need of dialysis in the first week after transplantation, neither due to immunological nor technical causes, determines a poor outcome of renal grafts. Delayed graft function is related to the cold ischemia time, which is shorter in local allocation programs. These, however, do not assure an optimal HLA‐A,B,DR matching that can be provided by national allocation organizations.We reviewed 160 cadaveric kidney grafts performed in our local transplant network. Owing to the long waiting list caused by organ shortage, we were able to ensure both a high‐grade histocompatibility and short cold ischemia times. The mean HLA‐B,DR mismatch was 1.17. Cold ischemia time was < 24 h in 85% of cases. The incidence of DGF was 23.1%. In our experience a regional sharing program in the case of organ shortage provides good graft outcome (86.9% graft survival at 1 yr) with low incidence of delayed graft function.
Bloodstream infections in liver transplant recipients receiving tacrolimus
Authors: Singh Nina , Gayowski Timothy , Wagener Marilyn M. , Marino Ignazio R. 
Published: September 2024

AbstractThe microbial origin, timing, risk factors, and outcome of bloodstream infections (bacteremia and fungemia) were prospectively analyzed in 130 consecutive liver transplant recipients receiving tacrolimus‐based immunosuppression; median followup was 3 yr. 22% (29/130) of the patients developed 36 episodes of bloodstream infections (0.28 episodes/patient). Bloodstream infections accounted for 36% (36/100) of all major infections. 81% (29/36) of bloodstream infections were due to bacteremia and 19% (7/36) due to fungemia (candidemia 14% and cryptococcemia 5%). Intravascular catheters were the most frequent source and methicillin‐resistantStaphylococcus aureuswas the most frequent pathogen causing bloodstream infections. 70% of the catheter related and all bacteremias due to intra‐abdominal infections occurred ≤ 90 d, whereas 75% of the bacteremias due to biliary source occurred > 90 d after transplantation. Length of initial post‐transplant intensive care unit stay (p = 0.014) and readmission to the intensive care unit (p = 0.003) were independently significant predictors of bloodstream infections. 40% of the candidemias occurred within 30 d of transplantation and were of unknown portal, whereas the portal in all candidemias occurring > 30 d post‐transplant was known (catheter, hepatic abscess, urinary tract). Mortality in patients with bloodstream infections was 52% (15/29) vs. 9% (9/101) in patients without bloodstream infections (p = 0.0001). In conclusion, intravascular catheters (and not intra‐abdominal infections) have emerged as the most common source of bloodstream infections, and gram‐positive cocci (S. aureus) as the predominant pathogens in bloodstream infections after liver transplantation.
Quality of life of hepatitis B and C patients after liver transplantation
Authors: Dickson Rolland C. , Wright Rollin M. , Bacchetta Matthew D. , Bodily Samuel E. , Caldwell Stephen H. , Driscoll Carolyn J. , Pruett Timothy L. , Ishitani Michael B. 
Published: September 2024

AbstractLiver transplantation is an accepted treatment for end‐stage liver disease due to hepatitis C (HCV), but remains controversial for patients with hepatitis B (HBV). Recently, the use of aggressive hepatitis B immunoglobulin (HBIg) to maintain hepatitis B surface antibody (anti‐HBs) titers greater than 500 IU/L has been reported to improve outcome of transplantation for hepatitis B. The aim of this study was to compare the quality of life of patients transplanted for HBV using this regimen of HBIg immunoprophylaxis (group 1) to patients transplanted for HCV (group 2). The State‐Trait Anxiety Inventory (STAI), Sickness Impact Profile (SIP), and a work survey were administered to two groups of patients. The STAI measured anxiety while the SIP evaluated physical and psychosocial function. Lower scores indicated less anxiety and dysfunction. Questions regarding hours worked prior to illness and hours worked after transplantation were administered to both groups. Group 1 included a majority of patients who were hepatitis B e antigen (HBeAg) positive prior to transplantation. Survey response was 13: 16 (81%) for group 1; and 17: 24 (72%) for group 2. Group 1 revealed significantly lower scores than group 2 on the STAI and the overall SIP score. Group 1 reported working similar hours after transplantation as prior to illness while group 2 did not. Thus, patients transplanted for HBV and treated with aggressive HBIg immunoprophylaxis attained a higher quality of life than patients transplanted for HCV.
Predictors of progression of diabetic nephropathy: implication for timing of kidney transplantation
Authors: Cheng Stephen S. , Wilson David M. , Munn Stephen R. 
Published: September 2024

AbstractMultiple risk factors are important predictors in the development of diabetic nephropathy (DN). Once DN has developed, it progresses steadily to renal failure. To determine the rate of renal function decline and the parameters that influence the rate of decline, we retrospectively reviewed the charts of patients with DN who had undergone dialysis or kidney transplantation at the Mayo Clinic from 1983 to 1993. Forty patients were found to have two or more iothalamate clearance (IothmCl) measurements where a slope of renal function decline over time, expressed as mL/ min/month/1.73 m2, can be calculated. The parameters examined included age of onset and duration of diabetes (DM), age at initial presentation, insulin dosage, glycosylated hemoglobin level, proteinuria, blood pressure (BP), number of antihypertensive medications (HTM), use of ACE inhibitors, creatinine, and initial IothmCl. The mean overall decline of clearance was 1.36±1.1 mL/min/month, corrected. Univariate regression analysis showed that only systolic and mean BP (p<0.05), use of HTM (p=0.02), and the number of HTM used (p=0.0001) correlated with the rate of clearance decline. No other parameter was significant. The decline of IothmCl was 0.72±0.41, 1.20±0.9, and 2.34±1.38 mL/min/month, for patients taking no HTM, <3 HTM, and ≥ 3HTM, respectively. Of the eight patients on HTM who presented with initial IothmCl of <30 mL/min/1.73 m2, seven (88%) had clearance of <10 mL/min/1.73 m2 within 1 yr. We conclude that hypertension is an important marker of DN progression, and that the more HTM required for control of BP, the faster the decline of renal function. We recommend that a suitable transplant candidate with DN who presents with hypertension requiring HTM and a clearance of <30 mL/min should be placed on the transplant waiting list.
Renal outcomes in pediatric liver transplantation
Authors: Bartosh Sharon M. , Alonso Estella M. , Whitington Peter F. 
Published: September 2024

AbstractThe outcomes of 294 orthotopic liver transplants performed in 221 children at The University of Chicago Children's Hospital between October 1984 and October 1992 have been retrospectively reviewed. Medical information for 281 transplants in 210 children was sufficient for inclusion in this analysis. The mean age at transplant was 4.1± 5.0 yr. Forty‐four percent of the children were male, and 16% of the transplants were living‐related. Four children received combined liver‐kidney transplants. Seventysix percent of the children are currently alive. The incidence of acute renal failure occuring following transplantation and requiring dialysis was 6.2% with a mortality rate of 85%. Early postoperative hypertension was seen in 65% of the children and persistent hypertension of greater than 12 months duration was seen in 28%. Sixteen percent of children developed metabolic acidosis requiring sustained sodium bicarbonate supplementation. Aggregate and longitudinal analysis of serial calculated glomerular filtration rates revealed abnormal renal function in approximately one third of children at any given time period following transplantation. The renal dysfunction was unrelated to age at transplant, type of transplant, gender, previous transplants, rejection episodes, courses of nephrotoxic drugs, presence of hypertension, or cyclosporin dose. This review supports prior studies which document abnormal renal function following orthotopic liver transplantation in a significant proportion of children.